Discussion

Human African Trypanosomiasis or sleeping sickness, transmitted by tsetse flies, is a neglected tropical disease for which elimination as a public health problem has been targeted by WHO in 2020. Whereas the number of annual reported cases has shown a steady decline in the last 10 years, major challenges are still ahead to reach the 2020 goal and later the interruption of transmission. Among those is the existence of overlooked reservoirs of Trypanosoma brucei gambiense, i.e. human asymptomatic carriers or wild or domestic animals. Recent progress concerning their identification and potential role in transmission maintenance in West Africa will be presented as well as the results of immunological and genetic association studies aimed at unraveling the biological mechanisms involved in determining the infection resistance/susceptibility status. Awaiting for new diagnostic tools to improve the detection of latent infections in human or animals, these results argue for a greater integration of vector control in designing tomorrow’s elimination strategies. The example of the Boffa focus in Guinea, where a pilot study combining medical screening and control of tsetse flies with small insecticide impregnated target while be presented.