Transmission of human African trypanosomiasis in the Komo-Mondah focus, Gabon

BACKGROUND: Knowledge about transmission of sleeping sickness in a given focus is of a great importance since it governs the efficacy and the cost-effectiveness of control strategy. The Komo-Mondah focus is the most endemic sleeping sickness focus of Gabon. This focus has hardly been investigated and available publications are more than thirty years old. In order to update transmission features of sleeping sickness in that focus, we have conducted epidemiological and entomological surveys in March-April 2008. METHODS: Epidemiological investigation relied on a case-control study using a quantitative and qualitative methodology (a structured questionnaire). Cases were affected people (parasitological positive) diagnosed by the national control program from 2004 to 2007, controls were those found disease-free after clinical examination and biological tests in the same period. They were asked to respond to a standard questionnaire concerning their activities after having signed a written consent. An unvaried analysis was first performed and then a multivariate analysis using the conditional logistic regression for matching method. Traps were then set out for four days in areas where people were working. Tsetse flies captured were identified and dissected; their density and human-fly contact points were determined. RESULTS: A risk of infection was associated with fishing activities (Odds-ratio: 5.69; CI95%: 3.38-9.57). Three species of Glossina were captured: Glossina palpalis palpalis, Glossina fuscipes fuscipes and G. Caliginea. Human-fly contact points were mainly landing stages. CONCLUSION: A combined strategy of case-detection and vector control targeted at landing stages should be efficient against the disease.