Authors

S Welburn¹;  ¹ Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, UK

Discussion

Despite concerted efforts for control, Human African Trypanosomiasis (HAT) is now endemic across vast swathes of sub-Saharan Africa where tsetse distribution is widespread. In this new era of endemic HAT we look at how peculiarities in the epidemiologies of Gambiense（gHAT) and Rhodesian HAT (rHAT) impact on contemporary strategies for elimination of HAT “as a public health problem”. Epidemics of both forms of sleeping sickness have emerged with remarkable periodicity within spatially stable foci in Sub-Saharan Africa, but are able to migrate if conditions are right. While tsetse flies are the primary vector, gHAT can also be sustained without tsetse. Long-term silent infections, maternal and sexual transmission and the implication of human genetic factors in HAT epidemiology including the role of stress causing breakdown of heritable tolerance in silent disease carriers may all contribute to generation of new gHAT outbreaks. Similarly, long term infection of animal carriers of zoonotic rHAT only serve to complicate control strategies at the human animal interface. Here we look back on the epidemiology and management of gHAT and rHAT epidemics of the past and speculate as to what the future holds for this still neglected disease.