Passive surveillance of human African trypanosomiasis in Côte d’Ivoire: Understanding prevalence, clinical symptoms and signs, and diagnostic test characteristics

Kone, Minayégninrin; Kaba, Dramane; Kaboré, Jacques; Thomas, Lian F.; Falzon, Laura C.; Koffi, Mathurin; Kouamé, Cyrille Mambo; Ahouty, Bernardin; Compaoré, Charlie Franck Alfred; N’Gouan, Emmanuel Kouassi; Solano, Philippe; Fèvre, Eric M.; Büscher, Philippe; Lejon, Veerle; Jamonneau, Vincent

doi:10.1371/journal.pntd.0009656

Cited by 20 publications

(43 citation statements)

References 49 publications

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“…As expected, the laboratory tests on DBS showed high specificity. The specificity of the ELISA/ T. b. gambiense was similar to the specificity in Côte d’Ivoire [ 29 ], and in several studies carried out in the Democratic Republic of Congo [ 20 , 22 , 33 ]. The 100% specificity for trypanolysis confirms previous observations in the historical Gaoua HAT focus [ 12 ].…”

Section: Discussionsupporting

confidence: 66%

“…As no HAT cases were detected, the diagnostic sensitivity could not be assessed. For all tested RDTs, the specificities were lower than those reported for passive case detection in Côte d’Ivoire [ 29 ]. This lower specificity seems to be the most pronounced with HAT-Sero- K -Set, which was previously reported to be 97.8% specific (95% CI: 97.2–98.2%), while in the present study, specificity was only 89.1% (95% CI: 88.3–89.8%).…”

Section: Discussionmentioning

confidence: 87%

“…Furthermore, trypanolysis performance has been linked to prevalence levels [ 12 ]. It is therefore not surprising that the specificity of trypanolysis in Bonon in Côte d’Ivoire was lower (94.4%), as HAT cases in this focus are still observed [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Monitoring the elimination of gambiense human African trypanosomiasis in the historical focus of Batié, South–West Burkina Faso

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The World Health Organisation has targeted the elimination of human African trypanosomiasis (HAT) as zero transmission by 2030. Continued surveillance needs to be in place for early detection of re-emergent cases. In this context, the performance of diagnostic tests and testing algorithms for detection of the re-emergence of Trypanosoma brucei gambiense HAT remains to be assessed. We carried out a door-to-door active medical survey for HAT in the historical focus of Batié, South–West Burkina Faso. Screening was done using three rapid diagnostic tests (RDTs). Two laboratory tests (ELISA/T. b. gambiense and immune trypanolysis) and parasitological examination were performed on RDT positives only. In total, 5883 participants were screened, among which 842 (14%) tested positive in at least one RDT. Blood from 519 RDT positives was examined microscopically but no trypanosomes were observed. The HAT Sero-K-Set test showed the lowest specificity of 89%, while the specificities of SD Bioline HAT and rHAT Sero-Strip were 92% and 99%, respectively. The specificity of ELISA/T. b. gambiense and trypanolysis was 99% (98–99%) and 100% (99–100%), respectively. Our results suggest that T. b. gambiense is no longer circulating in the study area and that zero transmission has probably been attained. While a least cost analysis is still required, our study showed that RDT preselection followed by trypanolysis may be a useful strategy for post-elimination surveillance in Burkina Faso.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 87%

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Monitoring the elimination of gambiense human African trypanosomiasis in the historical focus of Batié, South–West Burkina Faso

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“…To minimize the number of missed cases, but also to avoid massive overtreatment, near-perfect sensitivity and specificity are essential requirements for these HAT serological tests. The existing serological tests mainly use the native form of variant surface glycoprotein (VSG) antigens LiTat 1.3 and/or LiTat 1.5, although in the last years, new serological tests that use recombinant antigens have been developed [ 10 , 11 ]. The CATT and RDTs using native antigens are the most commonly used serological screening tests at the moment.…”

Section: Introductionmentioning

confidence: 99%

Two-Year Follow-Up of Trypanosoma brucei gambiense Serology after Successful Treatment of Human African Trypanosomiasis: Results of Four Different Sero-Diagnostic Tests

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Gambiense human African trypanosomiasis (gHAT), also known as gambiense sleeping sickness, is a parasitic infection caused by Trypanosoma brucei gambiense. During the last decades, gHAT incidence has been brought to an all-time low. Newly developed serological tools and drugs for its diagnosis and treatment put the WHO goal of interruption of transmission by 2030 within reach. However, further research is needed to efficiently adapt these new advances to new control strategies. We assessed the serological evolution of cured gHAT patients over a two-year period using four different tests: the rapid diagnostic test (RDT) HAT Sero K-SeT, ELISA/T.b. gambiense, Trypanosoma brucei gambiense inhibition ELISA (iELISA), and the immune trypanolysis test. High seropositive rates were observed in all the tests, although sero-reversion rates were different in each test: ELISA/T.b. gambiense was the test most likely to become negative two years after treatment, whereas RDT HAT Sero-K-SeT was the least likely. iELISA and trypanolysis showed intermediate and comparable probabilities to become negative. Stage 1 patients were also noted to be more likely to become negative than Stage 2 patients in all four serological tests. Our results confirm previous findings that trypanosome-specific antibody concentrations in blood may persist for up to two years, implying that HAT control programs should continue to take the history of past HAT episodes into consideration.

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“…New, easier-to-use and more effective tools currently in the pipeline are expected to help the integration process. These new tools include a single-dose oral treatment for both stages of the disease (acoziborole [ 54 , 55 ]), performant and easier-to-produce second generation rapid diagnostic tests [ 56 , 57 ], and high throughput referral tests performed in dry blood spots not requiring sophisticated transport conditions (ELISA [ 58 ] and other molecular tests [ 59 , 60 ]). The adaptation of control strategies to the evolving patterns of disease transmission was one of the keys to success in past years, and it should continue in the future.…”

Section: Discussionmentioning

confidence: 99%

The elimination of human African trypanosomiasis: Achievements in relation to WHO road map targets for 2020

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Background In the 20th century, epidemics of human African trypanosomiasis (HAT) ravaged communities in a number of African countries. The latest surge in disease transmission was recorded in the late 1990s, with more than 35,000 cases reported annually in 1997 and 1998. In 2013, after more than a decade of sustained control efforts and steady progress, the World Health Assembly resolved to target the elimination of HAT as a public health problem by 2020. We report here on recent progress towards this goal. Methodology/principal findings With 992 and 663 cases reported in 2019 and 2020 respectively, the first global target was amply achieved (i.e. fewer than 2,000 HAT cases/year). Areas at moderate or higher risk of HAT, where more than 1 case/10,000 people/year are reported, shrunk to 120,000 km2 for the five-year period 2016–2020. This reduction of 83% from the 2000–2004 baseline (i.e. 709,000 km2) is slightly below the target (i.e. 90% reduction). As a result, the second global target for HAT elimination as a public health problem cannot be considered fully achieved yet. The number of health facilities able to diagnose and treat HAT expanded (+9.6% compared to a 2019 survey), thus reinforcing the capacity for passive detection and improving epidemiological knowledge of the disease. Active surveillance for gambiense HAT was sustained. In particular, 2.8 million people were actively screened in 2019 and 1.6 million in 2020, the decrease in 2020 being mainly caused by COVID-19-related restrictions. Togo and Côte d’Ivoire were the first countries to be validated for achieving elimination of HAT as a public health problem at the national level; applications from three additional countries are under review by the World Health Organization (WHO). Conclusions/significance The steady progress towards the elimination of HAT is a testament to the power of multi-stakeholder commitment and coordination. At the end of 2020, the World Health Assembly endorsed a new road map for 2021–2030 that set new bold targets for neglected tropical diseases. While rhodesiense HAT remains among the diseases targeted for elimination as a public health problem, gambiense HAT is targeted for elimination of transmission. The goal for gambiense HAT is expected to be particularly arduous, as it might be hindered by cryptic reservoirs and a number of other challenges (e.g. further integration of HAT surveillance and control into national health systems, availability of skilled health care workers, development of more effective and adapted tools, and funding for and coordination of elimination efforts).

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Passive surveillance of human African trypanosomiasis in Côte d’Ivoire: Understanding prevalence, clinical symptoms and signs, and diagnostic test characteristics

Cited by 20 publications

References 49 publications

Monitoring the elimination of gambiense human African trypanosomiasis in the historical focus of Batié, South–West Burkina Faso

Monitoring the elimination of gambiense human African trypanosomiasis in the historical focus of Batié, South–West Burkina Faso

Two-Year Follow-Up of Trypanosoma brucei gambiense Serology after Successful Treatment of Human African Trypanosomiasis: Results of Four Different Sero-Diagnostic Tests

The elimination of human African trypanosomiasis: Achievements in relation to WHO road map targets for 2020

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