The complex health seeking pathway of a human African trypanosomiasis patient in Côte d’Ivoire underlines the need of setting up passive surveillance systems

Kone, Minayégninrin; N’Gouan, Emmanuel Kouassi; Kaba, Dramane; Koffi, Mathurin; Kouakou, Lingué; N'Dri, L.; Kouamé, Cyrille Mambo; Nanan, Valentin Kouassi; Tapé, Gossé Apollinaire; Coulibaly, Bamoro; Courtin, Fabrice; Ahouty, Bernardin; Denis, Vincent; Bucheton, Bruno; Solano, Philippe; Büscher, Philippe; Lejon, Veerle; Jamonneau, Vincent

doi:10.1371/journal.pntd.0008588

Cited by 6 publications

(12 citation statements)

References 47 publications

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“…The girl presented with terminal HAT and clinical symptoms and signs included weight loss, weakness, psychiatric problems, sleep disturbances, motor disorders, convulsions, and speech disorders. Her physical condition and diagnostic pathway are described in more detail elsewhere [29]. The boy presented with fever and sleep disturbances.…”

Section: Detailed Test Results For 12 Seropositive Laboratory Test Positive Participantsmentioning

confidence: 99%

“…They might have been HAT patients. As previously described, different mAECT examinations might be necessary for confirmation [29]. For the same reason, study participants who were followed up and remained RDT positive until the end of the study might have been real cases, and were therefore referred to the NEPHAT for follow-up.…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

“…Study area and inclusion and exclusion criteria. This study took place in 10 fixed health centers, including two centers for diagnosis and treatment (CDT) and eight serological screening site (SSS) in the Bonon and Sinfra endemic foci in west-central Côte d'Ivoire, as previously described [29]. From August 2017 to December 2019, patients who visited one of the selected fixed health centers were included in the study based on the following inclusion criteria: visitors or residents in a HAT endemic area and clinical suspicion of HAT based on one or more of the following clinical symptoms or signs: 1) long-term fever, resistant to antimalarial treatment, 2) headache for a long period (> 14 days), 3) presence of enlarged lymph nodes in the neck, 4) severe weight loss, 5) weakness 6) severe pruritus, 7) amenorrhea, abortion(s), or sterility, 8) psychiatric problems (aggressiveness, apathy, mental confusion, unusual increasing hilarity), 9) sleep disturbances (nocturnal insomnia and excessive daytime sleep), 10) motor disorders (abnormal movements, tremor, difficulty walking), 11) speech disorders, 12) convulsion, 13) coma.…”

Section: Ethics Statementmentioning

confidence: 99%

“…On the other hand, we cannot guarantee that all individuals presenting at the health centre with one of the 13 clinical symptoms and signs for inclusion were effectively included. Although we tried to sensitize the majority of the health staff working in the study sites, HAT is perceived as a disease from the past in Côte d'Ivoire, and many health professionals are unaware of it, even in endemic foci [29]. Furthermore, we assumed that clinical suspects negative in all 3 RDTs did not suffer from HAT, so they were not examined neither parasitologically nor in the four laboratory tests.…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

“…This passive screening network is now being enlarged through other projects [57]. The intention is to maximally cover known HAT foci, and, taking into account the mobility of the population, also include key health structures in non-endemic districts which might be frequented by HAT cases seeking for care [29]. Furthermore, the study allowed passive screening of 3433 individuals for HAT in the last 2 HAT endemic districts in Côte d'Ivoire and contributed to the elaboration of a WHO dossier for validation of HAT elimination as a public health problem in Côte d'Ivoire.…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

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

Kone

Kaba²,

Kaboré

et al. 2021

PLoS Negl Trop Dis

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Background Little is known about the diagnostic performance of rapid diagnostic tests (RDTs) for passive screening of human African trypanosomiasis (HAT) in Côte d’Ivoire. We determined HAT prevalence among clinical suspects, identified clinical symptoms and signs associated with HAT RDT positivity, and assessed the diagnostic tests’ specificity, positive predictive value and agreement. Methods Clinical suspects were screened with SD Bioline HAT, HAT Sero-K-Set and rHAT Sero-Strip. Seropositives were parasitologically examined, and their dried blood spots tested in trypanolysis, ELISA/Tbg, m18S-qPCR and LAMP. The HAT prevalence in the study population was calculated based on RDT positivity followed by parasitological confirmation. The association between clinical symptoms and signs and RDT positivity was determined using multivariable logistic regression. The tests’ Positive Predictive Value (PPV), specificity and agreement were determined. Results Over 29 months, 3433 clinical suspects were tested. The RDT positivity rate was 2.83%, HAT prevalence 0.06%. Individuals with sleep disturbances (p<0.001), motor disorders (p = 0.002), convulsions (p = 0.02), severe weight loss (p = 0.02) or psychiatric problems (p = 0.04) had an increased odds (odds ratios 1.7–4.6) of being HAT RDT seropositive. Specificities ranged between 97.8%-99.6% for individual RDTs, and 93.3–98.9% for subsequent tests on dried blood spots. The PPV of the individual RDTs was below 14.3% (CI 2–43), increased to 33.3% (CI 4–78) for serial RDT combinations, and reached 67% for LAMP and ELISA/Tbg on RDT positives. Agreement between diagnostic tests was poor to moderate (Kappa ≤ 0.60), except for LAMP and ELISA/Tbg (Kappa = 0.66). Conclusion Identification of five key clinical symptoms and signs may simplify referral for HAT RDT screening. The results confirm the appropriateness of the diagnostic algorithm presently applied, with screening by SD Bioline HAT or HAT Sero-K-Set, supplemented with trypanolysis. ELISA/Tbg could replace trypanolysis and is simpler to perform. Trial registration ClinicalTrials.gov ClinicalTrials.gov, ID NCT03356665

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Section: Detailed Test Results For 12 Seropositive Laboratory Test Positive Participantsmentioning

confidence: 99%

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

Section: Ethics Statementmentioning

confidence: 99%

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

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

Kone

Kaba²,

Kaboré

et al. 2021

PLoS Negl Trop Dis

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

et al. 2022

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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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Towards the sustainable elimination of human African trypanosomiasis in Côte d’Ivoire using an integrated approach

Kaba

Koffi

Kouakou³

et al. 2023

Preprint

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Background: Human African trypanosomiasis is a parasitic disease caused by trypanosomes among whichTrypanosoma brucei gambienseis responsible for a chronic form (gHAT) in West and Central Africa. Its elimination as a public health problem (EPHP) is being achieved. Côte d'Ivoire was one of the first countries to be validated by WHO in 2020 and this was particularly challenging as the country still reported around a hundred cases a year in the early 2000s. This article describes the strategies implemented including a mathematical model to evaluate the reporting results and infer progress towards sustainable elimination. Methods: The control methods used combined both exhaustive and targeted medical surveillance strategies to diagnose and treat cases as well as vector control to reduce the risk of transmission in the most at risk areas. A mechanistic model was used to estimate the number of underlying infections and the probability of elimination of transmission (EoT) between 2000-2021 in two endemic and two hypo-endemic health districts. Results: Between 2015 and 2019, nine gHAT cases were detected in two health districts in which the number of cases/10,000 inhabitants was far below 1, a necessary condition for validating the EPHP. Modelling estimated a slow but steady decline in transmission across the four health districts, bolstered in the two endemic health districts by the introduction of vector control. The decrease in underlying transmission in all health districts corresponds to a high probability that EoT has already occurred in Côte d'Ivoire. Conclusion: This success was achieved through a multi-stakeholder and multidisciplinary one health approach where research has played a major role in adapting tools and strategies to this large epidemiological transition to a very low prevalence. This integrated approach will need to continue to reach the verification of EoT in Côte d'Ivoire targeted by 2025.

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The complex health seeking pathway of a human African trypanosomiasis patient in Côte d’Ivoire underlines the need of setting up passive surveillance systems

Cited by 6 publications

References 47 publications

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

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

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

Towards the sustainable elimination of human African trypanosomiasis in Côte d’Ivoire using an integrated approach

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