%0 Journal Article %T Resolving the apparent transmission paradox of African sleeping sickness %+ College of Medical, Veterinary and Life Sciences [Glasgow] %+ University of Glasgow %+ London School of Hygiene and Tropical Medicine (LSHTM) %+ University of Edinburgh %+ Interactions hôtes-vecteurs-parasites-environnement dans les maladies tropicales négligées dues aux trypanosomatides (UMR INTERTRYP) %+ Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA) %+ University of Kinshasa (UNIKIN) %+ Biologie cellulaire des Trypanosomes - Trypanosome Cell Biology %+ Yale School of Public Health (YSPH) %A Capewell, Paul %A Atkins, Katie %A Weir, William %A Jamonneau, Vincent %A Camara, Mamadou %A Clucas, Caroline %A Swar, Nono-Raymond K %A Ngoyi, Dieudonne %A Rotureau, Brice %A Garside, Paul %A Galvani, Alison %A Bucheton, Bruno, B. %A Macleod, Annette %Z The authors received no specific funding for this work. %< avec comité de lecture %@ 1544-9173 %J PLoS Biology %I Public Library of Science %V 17 %N 1 %P e3000105 %8 2019-01-11 %D 2019 %R 10.1371/journal.pbio.3000105 %M 30633739 %K Parasitic diseases %K Trypanosoma %K African trypanosomiasis %K Skin anatomy %K Skin infections %K Blood %K Tsetse fly %K Infectious disease control %Z Life Sciences [q-bio] %Z Life Sciences [q-bio]/Microbiology and Parasitology %Z Life Sciences [q-bio]/Microbiology and Parasitology/ParasitologyJournal articles %X Human African trypanosomiasis (HAT), or African sleeping sickness, is a fatal disease found throughout sub-Saharan Africa. The disease is close to elimination in many areas, although it was similarly close to elimination once before and subsequently reemerged, despite seemingly low rates of transmission. Determining how these foci persisted and overcame an apparent transmission paradox is key to finally eliminating HAT. By assessing clinical, laboratory, and mathematical data, we propose that asymptomatic infections contribute to transmission through the presence of an overlooked reservoir of skin-dwelling parasites. Our assessment suggests that a combination of asymptomatic and parasitaemic cases is sufficient to maintain transmission at foci without animal reservoirs, and we argue that the current policy not to treat asymptomatic HAT should be reconsidered %G English %2 https://pasteur.hal.science/pasteur-01980391v2/document %2 https://pasteur.hal.science/pasteur-01980391v2/file/journal.pbio.3000105.pdf %L pasteur-01980391 %U https://pasteur.hal.science/pasteur-01980391 %~ IRD %~ CIRAD %~ PASTEUR %~ UNIV-LYON1 %~ AGROPOLIS %~ AGREENIUM %~ UDL %~ UNIV-LYON %~ TRYPANOSOME-CELL-BIOL