01454nas a2200289   4500000000100000008004100001653003900042653003100081653001200112653002200124653001100146653001300157653002900170653001700199653001400216653001600230653001100246653002200257100001400279700001600293700001400309245010100323300001200424490000700436520070700443022001401150       2016                            d10aNeglected tropical diseases (NTDs)10aAfrica South of the Sahara10aAnimals10aDisease Outbreaks10aHumans10aResearch10aTrypanosomiasis, African10aTsetse Flies10aEpidemics10aepigenetics10afamine10aSleeping sickness1 aWelburn S1 aMolyneux DH1 aMaudlin I00aBeyond tsetse--Implications for research and control of human African trypanosomiasis epidemics.  a230-2410 v323 a<p>Epidemics of both forms of human African trypanosomiasis (HAT) are confined to spatially stable foci in Sub-Saharan Africa while tsetse distribution is widespread. Infection rates of Trypanosoma brucei gambiense in tsetse are extremely low and cannot account for the catastrophic epidemics of Gambian HAT (gHAT) seen over the past century. Here we examine the origins of gHAT epidemics and evidence implicating human genetics in HAT epidemiology. We discuss the role of stress causing breakdown of heritable tolerance in silent disease carriers generating gHAT outbreaks and see how peculiarities in the epidemiologies of gHAT and Rhodesian HAT (rHAT) impact on strategies for disease control.</p>
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