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The Hidden Hand of Asymptomatic Infection Hinders Control of Neglected Tropical Diseases: A Modeling Analysis.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 Apr 25; Vol. 78 (Supplement_2), pp. S175-S182. - Publication Year :
- 2024
-
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.<br />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.<br />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.<br />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.<br />Competing Interests: Potential conflicts of interest. E. R. A. reports receiving funding from Wellcome Trust, Medical Research Council, UK, Foundation for Innovative New Diagnostics (FIND), World Health Organization, Global Access Diagnostics. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.<br /> (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
- Subjects :
- Humans
Trypanosomiasis, African prevention & control
Trypanosomiasis, African epidemiology
Trypanosomiasis, African transmission
Trypanosomiasis, African drug therapy
India epidemiology
Animals
Neglected Diseases prevention & control
Neglected Diseases epidemiology
Chagas Disease transmission
Chagas Disease prevention & control
Chagas Disease epidemiology
Chagas Disease drug therapy
Asymptomatic Infections epidemiology
Leishmaniasis, Visceral prevention & control
Leishmaniasis, Visceral epidemiology
Leishmaniasis, Visceral transmission
Leishmaniasis, Visceral drug therapy
Models, Theoretical
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 78
- Issue :
- Supplement_2
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 38662705
- Full Text :
- https://doi.org/10.1093/cid/ciae096