01800nas a2200337   4500000000100000008004100001653003900042653004000081653002200121653001700143653002500160100001500185700001300200700001100213700001600224700001300240700001300253700001100266700001300277700001500290700001400305700001500319700001500334700001400349245007800363856010200441300001300543490000700556520088500563022001401448       2019                            d10aNeglected tropical diseases (NTDs)10aHuman African Trypanosomiasis (HAT)10aSleeping sickness10aTransmission10aTransmission paradox1 aCapewell P1 aAtkins K1 aWeir W1 aJamonneau V1 aCamara M1 aClucas C1 aSwar N1 aNgoyi DM1 aRotureau B1 aGarside P1 aGalvani AP1 aBucheton B1 aMacLeod A00aResolving the apparent transmission paradox of African sleeping sickness.  uhttps://journals.plos.org/plosbiology/article/file?id=10.1371/journal.pbio.3000105&type=printable  ae30001050 v173 a<p>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.</p>
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