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- Title
Using Molecular Data for Epidemiological Inference: Assessing the Prevalence of Trypanosoma brucei rhodesiense in Tsetse in Serengeti, Tanzania.
- Authors
Auty, Harriet K.; Picozzi, Kim; Malele, Imna; Torr, Steve J.; Cleaveland, Sarah; Welburn, Sue
- Abstract
Background: Measuring the prevalence of transmissible Trypanosoma brucei rhodesiense in tsetse populations is essential for understanding transmission dynamics, assessing human disease risk and monitoring spatio-temporal trends and the impact of control interventions. Although an important epidemiological variable, identifying flies which carry transmissible infections is difficult, with challenges including low prevalence, presence of other trypanosome species in the same fly, and concurrent detection of immature non-transmissible infections. Diagnostic tests to measure the prevalence of T. b. rhodesiense in tsetse are applied and interpreted inconsistently, and discrepancies between studies suggest this value is not consistently estimated even to within an order of magnitude. Methodology/Principal Findings: Three approaches were used to estimate the prevalence of transmissible Trypanosoma brucei s.l. and T. b. rhodesiense in Glossina swynnertoni and G. pallidipes in Serengeti National Park, Tanzania: (i) dissection/microscopy; (ii) PCR on infected tsetse midguts; and (iii) inference from a mathematical model. Using dissection/microscopy the prevalence of transmissible T. brucei s.l. was 0% (95% CI 0–0.085) for G. swynnertoni and 0% (0–0.18) G. pallidipes; using PCR the prevalence of transmissible T. b. rhodesiense was 0.010% (0–0.054) and 0.0089% (0–0.059) respectively, and by model inference 0.0064% and 0.00085% respectively. Conclusions/Significance: The zero prevalence result by dissection/microscopy (likely really greater than zero given the results of other approaches) is not unusual by this technique, often ascribed to poor sensitivity. The application of additional techniques confirmed the very low prevalence of T. brucei suggesting the zero prevalence result was attributable to insufficient sample size (despite examination of 6000 tsetse). Given the prohibitively high sample sizes required to obtain meaningful results by dissection/microscopy, PCR-based approaches offer the current best option for assessing trypanosome prevalence in tsetse but inconsistencies in relating PCR results to transmissibility highlight the need for a consensus approach to generate meaningful and comparable data. Author Summary: Human African trypanosomiasis is a fatal disease that is carried by a tsetse vector. Assessing the proportion of tsetse which carries human-infective trypanosomes is important in assessing human disease risk and understanding disease transmission dynamics. However, identifying flies which carry transmissible infections is difficult, due to potential presence of other trypanosome species in the same fly, and concurrent detection of immature infections which are not transmissible. We used three methods to estimate the proportion of flies carrying human-infective trypanosomes: dissection and microscopic examination of flies to visualise trypanosomes directly in the fly; PCR of fly midguts in which trypanosomes were observed by microscopy; and theoretical analysis using a mathematical model of disease transmission. All three methods found the prevalence to be extremely low. Given the low prevalence, dissection/microscopy requires prohibitively large sample sizes and therefore PCR-based approaches are likely to be of most value. However, interpretation of PCR data is not straightforward; whilst PCR identifies flies carrying pathogen genetic material it does not directly identify flies with transmissible infections. This study highlights the need for a consensus approach on the analysis and interpretation of PCR data to generate reliable and comparable measures of the proportion of flies which carry transmissible human-infective trypanosomes.
- Subjects
TANZANIA; TRYPANOSOMA; TRYPANOSOMA brucei; AFRICAN trypanosomiasis; TSETSE-flies; INFECTIOUS disease transmission; SAMPLE size (Statistics)
- Publication
PLoS Neglected Tropical Diseases, 2012, Vol 6, Issue 1, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0001501