We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
The Hidden Hand of Asymptomatic Infection Hinders Control of Neglected Tropical Diseases: A Modeling Analysis.
- Authors
Rock, Kat S; Chapman, Lloyd A C; Dobson, Andrew P; Adams, Emily R; Hollingsworth, T Déirdre
- Abstract
Background Neglected tropical diseases are responsible for considerable morbidity and mortality in low-income populations. International efforts have reduced their global burden, but transmission is persistent and case-finding-based interventions rarely target asymptomatic individuals. Methods We develop a generic mathematical modeling framework for analyzing the dynamics of visceral leishmaniasis in the Indian sub-continent (VL), gambiense sleeping sickness (gHAT), and Chagas disease and use it to assess the possible contribution of asymptomatics who later develop disease (pre-symptomatics) and those who do not (non-symptomatics) to the maintenance of infection. Plausible interventions, including active screening, vector control, and reduced time to detection, are simulated for the three diseases. Results We found that the high asymptomatic contribution to transmission for Chagas and gHAT and the apparently high basic reproductive number of VL may undermine long-term control. However, the ability to treat some asymptomatics for Chagas and gHAT should make them more controllable, albeit over relatively long time periods due to the slow dynamics of these diseases. For VL, the toxicity of available therapeutics means the asymptomatic population cannot currently be treated, but combining treatment of symptomatics and vector control could yield a quick reduction in transmission. Conclusions Despite the uncertainty in natural history, it appears there is already a relatively good toolbox of interventions to eliminate gHAT, and it is likely that Chagas will need improvements to diagnostics and their use to better target pre-symptomatics. The situation for VL is less clear, and model predictions could be improved by additional empirical data. However, interventions may have to improve to successfully eliminate this disease.
- Subjects
INDIA; TRYPANOSOMIASIS prevention; TROPICAL medicine; INFECTION control; HUMAN anatomical models; RESEARCH funding; DISEASE vectors; SYMPTOMS; TREATMENT effectiveness; UNCERTAINTY; MICE; NEGLECTED diseases; ANIMAL experimentation; EPIDEMICS; MATHEMATICAL models; MEDICAL screening; THEORY; TRYPANOSOMIASIS; LEISHMANIASIS; DISEASE incidence; EPIDEMIOLOGY
- Publication
Clinical Infectious Diseases, 2024, Vol 78, pS175
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciae096