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Tirados, I.

Publications and source records attributed to Tirados, I..

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Development and pilot application of a point-of-need molecular xenomonitoring protocol for tsetse (Glossina sp.) in a low-resource setting

BackgroundTsetse flies (Glossina sp.) are the primary vectors of trypanosomes causing human African trypanosomiasis (HAT) and animal African trypanosomiasis (AAT). Disease surveillance can be carried out by detecting Trypanosoma DNA in tsetse, also known as molecular xenomonitoring. Whilst molecular methods can increase the efficiency and sensitivity of pathogen detection, trained staff and a well-equipped laboratory are required. In many cases, DNA extraction and screening is outsourced to a central laboratory in a major city either in-country or abroad, far removed from original tsetse collection sites. This increases results turnaround time, incurs transportation costs, and can lead to sample loss or damage. Methodology/Principle FindingsWe set out to develop, optimise and trial methods for tsetse xenomonitoring in a low-resource point-of-need setting. A low-cost protocol was developed consisting of rapid alkali-based DNA extraction and Trypanosoma detection qPCR assays using air-dryable reagent mixes. A minimally-equipped laboratory was established in a field station in Arua, Uganda. Following a training workshop, three entomology technicians carried out screening on 286 tsetse collected over a nine-week study period. The technicians consistently extracted high quality DNA (98% success rate) and were able to successfully detect T. brucei sensu lato, T. congolense and T. vivax DNA in 3.6% - 4.3% (95% confidence interval [1.73, 7.73]) of total tsetse. Conclusions/SignificanceThis study demonstrated that sensitive molecular xenomonitoring of HAT and AAT pathogens can be carried out without the need for cold-chain storage or high-powered equipment. Further improvements to the system might be achieved by modifying the DNA extraction protocol to enable high-throughput or pooled samples, increasing the sensitivity of the T. b. gambiense DNA detection assay and exploring more sustainable power sources. Author SummaryTsetse flies spread the parasitic diseases human African trypanosomiasis (sleeping sickness) and animal African trypanosomiasis (nagana) that impact populations across sub-Saharan Africa. Disease surveillance can be carried out using tests to detect parasite DNA in tsetse, termed molecular xenomonitoring. Currently, these methods are too complex, costly and logistically-challenging to be carried out in remote areas where sleeping sickness is a problem. However, advances in molecular testing technology are now making this a possibility. We set out to develop a tsetse molecular xenomonitoring system using a basic laboratory set-up in Arua, Uganda. The protocol comprised a low-cost method to extract DNA from tsetse, a portable qPCR machine to test samples and air-dried reagents that did not require cold storage. Following a two-week training workshop, three technicians went on to carry out testing on 286 tsetse over a nine-week period. The technicians were able to consistently extract high-quality DNA (98% success rate) and successfully detected trypanosome parasite DNA in 30 (10.7%) tsetse samples. Whilst there are still challenges to overcome, this study has demonstrated that molecular xenomonitoring of tsetse can be carried out without the need for trainees with previous molecular experience, refrigerated reagents or high-powered equipment.

molecular biology↗

Modelling framework to demonstrate elimination of a vector population: tsetse elimination in Chad

Every year, over 700 000 people, particularly children under five, die from vector-borne diseases worldwide. Effectively controlling current endemics and preventing new outbreaks requires an integrated approach that can lead to the elimination of both vectors and diseases. In the last two decades, integrating medical interventions and vector control has significantly reduced the incidence of Gambian Human African Trypanosomiasis (gHAT), with the World Health Organization validating eight countries as having eliminated the disease as a public health problem. However, elimination of the tsetse vector has not been confirmed, leaving the possibility of re-emergence. We developed a five-step modelling framework to assess vector elimination by calculating: (i) the probability of vector capture; (ii) the probability of observing a series of zero catches, even without actual elimination; (iii) the probability of natural elimination; (iv) the probability of failing to detect a rebound; and (v) the reinvasion risk. Our case study is g-HAT in Mandoul, Chad and the elimination of G. fuscipes fuscipes. We used vector control from 2014 to 2025 with no tsetse detected since 2018. We cannot yet conclude, with more than 90% confidence, that tsetse has been eliminated from Mandoul, nor that any remnant population will be naturally eliminated. However, since vector control was stopped in April 2025, we estimate that with continued sampling over the next two years, and no tsetse detected, elimination could be demonstrated with 99% confidence. Our multi-step modelling framework can be applied to other vectors, providing policymakers with clear guidelines for ongoing and future efforts. Significance StatementThe World Health Organisation has set the elimination of transmission of several neglected tropical vector-borne diseases, including human African trypanosomiasis (sleeping sickness), as a target for 2030. We show that deliberate elimination of tsetse, the vector, is feasible and can be demonstrated. We draw on our large-scale intervention in Mandoul, Chad where 3000 insecticide-treated Tiny Targets were deployed between 2014 and 2025, with no tsetse detected since 2018. While small undetected remnant populations cannot be entirely excluded, they would rapidly rebound in the absence of control, rendering them detectable. If no tsetse are caught over the next two years, it will confirm elimination. This illustrates a pathway for assessing and achieving vector elimination as a cornerstone of disease eradication.

ecology↗

Impact of a national tsetse control programme to eliminate Gambian sleeping sickness in Uganda: a spatio-temporal modelling study.

IntroductionTsetse flies (Glossina) transmit Trypanosoma brucei gambiense which causes gambiense human African trypanosomiasis (gHAT). As part of national efforts to eliminate gHAT as a public health problem, Uganda implemented a large-scale programme of deploying Tiny Targets, which comprise panels of insecticide-treated material which attract and kill tsetse. At its peak, the programme was the largest tsetse control operation in Africa. Here, we quantify the impact of Tiny Targets and environmental changes on the spatial and temporal patterns of tsetse abundance across north-western Uganda. MethodsWe leverage a 100-month longitudinal dataset detailing Glossina fuscipes fuscipes catches from monitoring traps between October 2010 and December 2019 within seven districts in north-western Uganda. We fitted a boosted regression tree model assessing environmental suitability which was used alongside Tiny Target data to fit a spatio-temporal geostatistical model predicting tsetse abundance across our study area ([~]16,000 km2). We used the spatio-temporal model to quantify the impact of Tiny Targets and environmental changes on the distribution of tsetse, alongside metrics of uncertainty. ResultsEnvironmental suitability across the study area remained relatively constant over time, with suitability being driven largely by elevation and distance to rivers. By performing a counterfactual analysis using the fitted spatio-temporal geostatistical model we show that deployment of Tiny Targets across an area of 4000 km2 reduced the overall abundance of tsetse to low levels (median daily catch = 1.1 tsetse/trap, IQR = 0.85-1.28) with no spatial-temporal locations having high (>10 tsetse/trap/day) numbers of tsetse compared to 18% of locations for the counterfactual. ConclusionsIn Uganda, Tiny Targets reduced the abundance of G. f. fuscipes and maintained tsetse populations at low levels. Our model represents the first spatio-temporal model investigating the effects of a national tsetse control programme. The outputs provide important data for informing next steps for vector-control and surveillance. Key questionsO_ST_ABSWhat is already known on this topic?C_ST_ABSSmall panels of insecticide-treated fabric, called Tiny Targets, are used to attract, and kill riverine tsetse, the vectors of T. b. gambiense which causes gambiense human African trypanosomiasis (gHAT). In large-scale (250-2000 km2) trials conducted in five countries, deployment of Tiny Targets reduced the densities of tsetse by between 60 and >90%. What this study addsWe report an analysis of, and data from, a large-scale ([~]4,000km2) national tsetse control programme, implemented in Uganda to eliminate gHAT as a public health problem. We found that Tiny Targets reduced tsetse abundance across the study period (2011-2019) and maintained densities at low (<1 tsetse/trap/day) levels. We produce maps which detail spatial variances in tsetse abundance in response to vector control. How this study might affect research, practice, or policyIn 2022, Uganda received validation from the World Health Organisation (WHO) that it had eliminated gHAT as a public health problem. The large-scale deployment of Tiny Targets contributed to this achievement. Our findings provide evidence that Tiny Targets are an important intervention for other countries aiming to eliminate gHAT.

ecology↗

Impact of vector control on effective population sizes; empirical evidence for a control- based genetic bottleneck in the tsetse fly Glossina fuscipes

We investigated genetic variation at 37 newly-developed microsatellite loci in populations of the tsetse fly Glossina fuscipes fuscipes captured from the upper and lower reaches of a single hydrographical network within an endemic Human African Trypanosomiasis focus. Our primary aim was to assess the impact of vector control using insecticide-treated baits (Tiny Targets) on genetic structure. We initially used STRUCTURE to delineate geographical boundaries of two stable ancestral reference populations without any history of vector control but marked for either vector control ( intervention) or no control ( non-intervention). We then used the ADMIXTURE model to assess genetic divergence in temporal populations collected after vector control implementation. We applied the Linkage Disequilibrium method to explicitly measure spatial and temporal changes in effective population size (Ne). We observed a significant reduction in Ne coincident with vector control, whereas Ne remained stable in the non-intervention area. Our empirical findings show how classical population genetics approaches detected within a short period of time, a significant genetic bottleneck associated with vector control, and opens up the possibility of using routine genomic surveillance. We have also generated a resource of new genetic markers for studies on the population genetics of tsetse at finer-scale resolution. FundingThis work was funded through a Wellcome Trust Masters Fellowship in Public Health and Tropical Medicine awarded to Allan Muhwezi (103268/Z/13/Z).

evolutionary biology↗

Impact of Tiny Targets on Glossina fuscipes quanzensis, the primary vector of Human African Trypanosomiasis in the Democratic Republic of Congo.

BackgroundOver the past 20 years there has been a >95% reduction in the number of Gambian Human African trypanosomiasis (g-HAT) cases reported globally, largely as a result of large-scale active screening and treatment programmes. There are however still foci where the disease persists, particularly in parts of the Democratic Republic of the Congo (DRC). Additional control efforts such as tsetse control using Tiny Targets may therefore be required to achieve g-HAT elimination goals. The purpose of this study was to evaluate the impact of Tiny Targets within DRC. Methodology/Principal findingsIn 2015-2017, pre- and post-intervention tsetse abundance data were collected from 1,234 unique locations across three neighbouring Health Zones (Yasa Bonga, Mosango, Masi Manimba). Remotely sensed dry season data were combined with pre-intervention tsetse presence/absence data from 332 locations within a species distribution modelling framework to produce a habitat suitability map. The impact of Tiny Targets on the tsetse population was then evaluated by fitting a generalised linear mixed model to the relative fly abundance data collected from 889 post-intervention monitoring sites within Yasa Bonga, with habitat suitability, proximity to the intervention and intervention duration as covariates. Immediately following the introduction of the intervention, we observe a dramatic reduction in fly catches by > 85% (pre-intervention: 0.78 flies/trap/day, 95% CI 0.676-0.900; 3 month post-intervention: 0.11 flies/trap/day, 95% CI 0.070-0.153) which is sustained throughout the study period. Declines in catches were negatively associated with proximity to Tiny Targets, and while habitat suitability is positively associated with abundance its influence is reduced in the presence of the intervention. Conclusions/SignificanceThis study adds to the body of evidence demonstrating the impact of Tiny Targets on tsetse across a range of ecological settings, and further characterises the factors which modify its impact. The habitat suitability maps have the potential to guide the expansion of tsetse control activities in this area. Authors SummaryThere have been large declines in the number of cases of sleeping sickness as a result of programmes that actively screen and treat the at-risk population. Additional control is needed in areas where the disease persists such as parts of the Democratic Republic of Congo (DRC). The disease is transmitted by tsetse flies, and reducing the tsetse population using Tiny Targets has been shown to control the disease in other countries. Extensive tsetse monitoring has been undertaken in one Health Zone in DRC where Tiny Targets have been deployed. We used these data to gain a better understanding of tsetse habitat, to produce habitat suitability maps, and to subsequently measure the impact of Tiny Targets on the tsetse population. We show that tsetse flies are largely found along rivers and surrounding densely vegetated habitat, with there being a positive relationship between habitat suitability and the number of flies caught. Once Tiny Targets were introduced, the number of flies caught in monitoring traps decreased by >85%, with habitat suitability at the trap location, and the proximity of the trap to the nearest Tiny Target influencing the size of the effect of the intervention. This study adds to the body of evidence demonstrating the impact of Tiny Targets on tsetse distribution in addition to providing information that can be used to guide the expansion of tsetse control activities in this area.

ecology↗

Evidence of the absence of Human African Trypanosomiasis in northern Uganda: analyses of cattle, pigs and tsetse flies for the presence of Trypanosoma brucei gambiense

BackgroundLarge-scale control of sleeping sickness has led to a decline in the number of cases of Gambian human African trypanosomiasis (g-HAT) to <2000/year. However, achieving complete and lasting interruption of transmission may be difficult because animals may act as reservoir hosts for T. b. gambiense. Our study aims to update our understanding of T. b. gambiense in local vectors and domestic animals of N.W. Uganda.\n\nMethodsWe collected blood from 2896 cattle and 400 pigs and In addition, 6664 tsetse underwent microscopical examination for the presence of trypanosomes. Trypanosoma species were identified in tsetse from a subsample of 2184 using PCR. Primers specific for T. brucei s.l. and for T. brucei sub-species were used to screen cattle, pig and tsetse samples.\n\nResultsIn total, 39/2,088 (1.9%; 95% CI=1.9-2.5) cattle, 25/400 (6.3%; 95% CI=4.1-9.1) pigs and 40/2,184 (1.8%; 95% CI=1.3-2.5) tsetse, were positive for T. brucei s.l.. Of these samples 24 cattle (61.5%), 15 pig (60%) and 25 tsetse (62.5%) samples had sufficient DNA to be screened using the T. brucei sub-species PCR. Further analysis found no cattle or pigs positive for T. b. gambiense, however, 17/40 of the tsetse samples produced a band suggestive of T. b. gambiense. When three of these 17 PCR products were sequenced the sequences were markedly different to T. b. gambiense, indicating that these flies were not infected with T. b. gambiense.\n\nConclusionThe absence of T. b. gambiense in cattle, pigs and tsetse accords with the low prevalence of g-HAT in the human population. We found no evidence that livestock are acting as reservoir hosts. However, this study highlights the limitations of current methods of detecting and identifying T. b. gambiense which relies on a single copy-gene to discriminate between the different sub-species of T. brucei s.l.\n\nAuthor SummaryThe decline of annual cases of West-African sleeping sickness in Uganda raises the prospect that elimination of the disease is achievable for the country. However, with the decrease in incidence and the likely subsequent change in priorities there is a need to confirm that the disease is truly eliminated. One unanswered question is the role that domestic animals play in maintaining transmission of the disease. The potential of cryptic-animal reservoirs is a serious threat to successful and sustained elimination of the disease. It is with the intent of resolving this question that we have carried out this study whereby we examined 2088 cattle, 400 pigs and 2184 tsetse for Trypanosoma brucei gambiense, the parasite responsible for the disease. Our study found T. brucei s.l. in local cattle, pigs and tsetse flies, with their respective prevalences as follows, 1.9%, 6.3% and 1.8%. Further analysis to establish identity of these positives to the sub-species level found that no cattle, pigs or tsetse were carrying the pathogen responsible for Gambian sleeping sickness. Our work highlights the difficulty of establishing the absence of a disease, especially in an extremely low endemic setting, and the limitations of some of the most commonly used methods.

microbiology↗