Identifying Transmission Cycles at the Human-Animal Interface: The Role of Animal Reservoirs in Maintaining Gambiense Human African Trypanosomiasis
Many infections can be transmitted between animals and humans. The epidemiological roles of different species can vary from important reservoirs to dead-end hosts. Here, we present a method to identify transmission cycles in different combinations of species from field data. We used this method to synthesise epidemiological and ecological data from Bipindi, Cameroon, a historical focus of gambiense Human African Trypanosomiasis (HAT, sleeping sickness), a disease that has often been considered to be maintained mainly by humans. We estimated the basic reproduction number of gambiense HAT in Bipindi and evaluated the potential for transmission in the absence of human cases. We found that under the assumption of random mixing between vectors and hosts, gambiense HAT could not be maintained in this focus without the contribution of animals. This result remains robust under extensive sensitivity analysis. When using the distributions of species among habitats to estimate the amount of mixing between those species, we found indications for an independent transmission cycle in wild animals. Stochastic simulation of the system confirmed that unless vectors moved between species very rarely, reintroduction would usually occur shortly after elimination of the infection from human populations. This suggests that elimination strategies may have to be reconsidered as targeting human cases alone would be insufficient for control, and reintroduction from animal reservoirs would remain a threat. Our approach is broadly applicable and could reveal animal reservoirs critical to the control of other infectious diseases. Gambiense sleeping sickness is a disease transmitted by tsetse flies that mostly affects rural populations in sub-Saharan Africa. Although the parasite that causes the disease can be found in many different wild and domestic animal species, the disease has often been claimed to be maintained mostly by humans. Currently, fewer than 10,000 human cases are reported per year across Africa, and it has been suggested that elimination of gambiense sleeping sickness is feasible. We analysed human and animal case data from a well-known endemic focus of sleeping sickness in Cameroon, to quantify the contribution of the different species to the circulation of the parasite. In a wide range of scenarios, we found that animals are crucial for maintenance in the disease. When informing our model by the distribution of species among habitats as measured in the field, we found indications for independent transmission cycles in animals. This suggests that a risk of reintroduction from animal into human populations would remain even if the disease were eliminated from those human populations.