The epidemiology and control of human African trypanosomiasis

Human African trypanosomiasis is caused by Trypanosoma brucei gambiense in West and Central Africa, and by Trypanosoma brucei rhodesiense in East and southern Africa. In recent years there has been a dramatic resurgence of Gambian trypanosomiasis in Central Africa, especially in the Democratic Republic of Congo, Angola and Sudan. The disease is quiescent in most of West Africa, as is Rhodesian trypanosomiasis the other side of the continent. The epidemiology of Gambian trypanosomiasis is reviewed in detail. The long duration of infection in human hosts with cycles of intermittent parasitaemia, the vectors' feeding habits and the intensity of human-fly contact are the major determinants of the dynamics of transmission of this parasite. The development of immunity may lead to a reduction in the fraction of the population that is susceptible to infection and the burning out of epidemics after 20 to 30 years. So far, the acquired immune deficiency syndrome pandemic has had no impact on the epidemiology of Gambian trypanosomiasis. A brief review of the epidemiology of Rhodesian trypanosomiasis highlights the differences from Gambian trypanosomiasis that, to some extent, explain its lower propensity to cause epidemics: it is a more aggressive disease that rapidly kills its human host, and its transmission involves mostly domestic and game animals, humans being in most circumstances an accidental host. The various methods and strategies for the surveillance and control of both diseases are reviewed.