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Rock, Kat S, Chapman, Lloyd A C, Dobson, Andrew P, Adams, Emily 
ORCID: https://orcid.org/0000-0002-0816-2835 and Hollingsworth, T Déirdre
(2024)
'The Hidden Hand of Asymptomatic Infection Hinders Control of Neglected Tropical Diseases: A Modeling Analysis.'. Clinical Infectious Diseases, Vol 78, Issue Supplement_2, S175-S182.
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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.
| Item Type: | Article |
|---|---|
| Subjects: | WC Communicable Diseases > WC 20 Research (General) WC Communicable Diseases > Tropical and Parasitic Diseases > WC 680 Tropical diseases (General) |
| Faculty: Department: | Biological Sciences > Department of Tropical Disease Biology |
| Digital Object Identifer (DOI): | https://doi.org/10.1093/cid/ciae096 |
| SWORD Depositor: | JISC Pubrouter |
| Depositing User: | JISC Pubrouter |
| Date Deposited: | 07 May 2024 10:35 |
| Last Modified: | 07 May 2024 10:35 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/24497 |
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