"HAT transmission dynamics in current epidemic North-eastern and traditional gambiense

North-western foci in Uganda"

Loyce Okedi

NARO-LIRI, Uganda

WHO IGGI Meeting, Dec 2006

UgandaAstride the Equator in the “heart” of AfricaWhere the “jungle” of the equatorial forests meets the savanna grasslandThe largest lake in Africa draining

its waters northwards thru the mighty River Nile

Sleeping Sickness foci in Africa Vs Uganda

T. b. gambiense

T. b. rhodesiense

Source WHO/TDRIn Uganda, a merger now fearedIn Uganda, a merger now feared

Sleeping Sickness foci

GULU

KOTIDO

LIRA

MUKONO

KITGUM

APAC

MASINDI

MBARARA

ARUA

PADER

MOROTO

HOIMA

BU

GIR

I

RAKAI

KALANGALA

MPIGI

MUBENDE

KIBALE

KAMULI

MASAKA

KUMI

KATAKWI

NEBBI

SOROTI

KASESE

BUSHENYI

KYENJOJOWAKISO

YUMBE

IGANGA

PALLISA

KABALE

TORORO

JINJA

BUSIAKAMPALA

NAKAPIRIPIRIT

MBALE

SEMBABULE

KAPCHORWASIROKHO

SLEEPING SICKNESS CASES 20001 - 2122 - 5657 - 120121 - 344345 - 641

LAKEDistrict boundary

SLEEPING SICKNESS CASES YEAR 2000

GULU

KOTIDO

LIRA

MUKONO

KITGUM

APAC

MASINDI

MBARARA

ARUA

PADER

MOROTO

HOIMA

BU

GIR

I

RAKAI

KALANGALA

MPIGI

MUBENDE

KIBALE

KAMULI

MASAKA

KUMI

LUWEERO

KATAKWI

KIBOGA

NEBBI

SOROTI

KASESE

BUSHENYI

KYENJOJOWAKISO M

AY

UN

GE

YUMBE

NAKASONGOLA

IGANGA

ADJUM

ANI

PALLISA

KABALE

TORORO

BUN

DIBUG

YO

KAM

WEN

GE

NTUNGAMO

JINJA

BUSIAKAMPALA

NAKAPIRIPIRIT

MOYO

MBALE

SEMBABULE

KA

YU

NG

A

KAB

ARO

LE

KAPCHORWA

RU

KU

NG

IRI

KA

NU

NG

U

SIROKHO

KABERAMAID

O

KIS

OR

O

SLEEPNG SICKNESS CASES 20041 - 89 - 2324 - 3536 - 5960 - 153

LAKEDistrict boundary

SLEEPING SICKNESS CASES YEAR 2004

2000

2004

North West

641

36

344

120

417

68

176

92

145 156

187

74

144

65

206

86

134

32

153

35

0

100

200

300

400

500

600

700

Numbers reported

2000 2001 2002 2003 2004

Year

Sleeping sickness trends in NW 2000-4

Arua

Yumbe

Moyo

Adjumani

Sleeping sickness foci in Uganda, ‘05 (Source: MoH, Kampala, Uganda). Note: Two cases were reported in the north-west district of Masindi in 1998Soroti – 1998Kumi, Kaberamaido and south Lira in 2004-6

Sleeping sickness deaths in Uganda, 1905-1920Source: Uganda Protectorate (1911) Reports of the 1911 Census Returns. The National Archives, Entebbe, Uganda, Open Shelf Library. Assembled by: L. Berrang-Ford, University of Guelph, Canada, 2002.)

Objectives To assess the sleeping sickness status in north of

Lake Kyoga, Uganda

Against the background of no animal reservoir studies confirming any peri-domestic animal to the gambiense reservoir, we now continue to establish the risk of rhodesiense and gambiense HAT overlap in Teso and Lango sub-regions thru/with human sleeping sickness and tsetse fly data

Collect vector and parasite materials for:tsetse population genetics trypanosome transmission dynamics endo-symbiont inter- relationships

Menu For today

Trap of choiceBioconical trap with POCA baitsChallier and Laveissierre (1973

Dry season Wet season

Alongside medical and veterinary Multi-disciplinary teams

Understanding Vector Dynamics Wet – dry senarios in Arua in 2005T/NT ~ 30 % T in Nov

WetUnder 20% T in JanDry

Age 0-3 0-5 upto 6 on lake shores

Tryp infections

Proboscis

Midgut Salivary gland

vivax congolense/brucei

brucei

Age category

2-4early

2-4after ?10 d

3after 18d

FTD Low in refugia High in refugia

Understanding Vector Dynamics in Arua

Jan 2006 June 2006

End of dry End of long rains

FTDs 5.8 5.55

% Teneral

13.3% teneral (n=230)

21.6% teneral (n=111)

Tryp inf 2.6% salivary gland

(3 +ve as T. b. b)

1.14%

Tryp inf 27.7% midgut 13.7%

Tryp inf 7.85% proboscis 5.75

North-west

0

5

10

15

20

25

30

Numbers

FTD % teneral S M P

Parameter

Vector trends in one grid in January and June in Arua district in 2006

January

June

Lira HAT microscopy in 2006 7-d survey

District Sub county

Sample Status

positive

Lira Aloi 348 6 2004 -2; 2005-4;

2006-3

Dokolo Dokolo 1158 1 2004-13; 2005-38, 2006-6

K’maido Otuboi 784 1

Soroti Serere 359 1

Totals 2648 9

Lira Tsetse fly microscopy in 2006 7 d survey

District Sub C’ty Male Fem Prob Midgut Sal

Lira Aloi 99 51 12/21 16/21 6/21

Dokolo Dokolo 5 11 - - -

Kaber’d Otuboi 16 12 - - -

Soroti Serere 0 0 - - -

5

5

5

1

1

Series1, 4

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Number of flies in category

PMS

PM

M

MS

P

NEG

Cat

ego

ryStatus of dissected flies from Aloi in Lira District, Uganda

Aloi is in Lira, north of the 2oN latitude

Distribution of Sleeping sickness vector in Uganda, 1969 Source: Tsetse distributions, 1969, Atlas of Uganda (1971) Department of Lands and

Surveys, Entebbe, Uganda. Digitized and complied by ILRI-Nairobi, 2001.

Reasons for the Progression HAT N-wards

Insurgency of 1990s in districts north of Lake Kyoga

Animal movements - Restocking of cattle Population movements

Insurgency extended in 2003 to Kaberamaido east of Lake Kyoga

-Outbreak in IDP camp in Otuboi.-Dokolo County neighbouring Kaberamaido- Insufficient control and surveillance measures in Soroti districtLira District – Aloi in 2006

Conclusion Because of this progression there’s fear that

the two forms of the disease may merge or have now merged.

There’s therefore urgent need for all partners to further strengthen HAT control and surveillance measures.

Need for new diagnostic and treatment possibilities

Vector-based disease control strategies to knock down the vector and parasites

Characterisation of G.ff vectors from SS foci across Uganda

• For genetic diversity and gene flow within and between G. f. fuscipes sub-populationscompare the genetic variability of G. f. fuscipes sub-populations found in sleeping sickness disease foci.

• Data generated will contribute to decision making in the assessment of areas at risk of trypanosomiasis control

Ongoing WorkOptimization of PCR with dye labeled primers : • ABI fragment analysis of PCR products to estimate:

• genetic variation within sub-populations, between sub-populations and other Gene flow estimates and parameters

– Yale as an associate EANETT member

AcknowledgementsDirector and Staff, Livestock Health Research Institute (LIRI) Tororo, UgandaManager, National SS Programme, MOH, Kampala, UgandaDirector, Coordinating Office for Control of Trypanosomiasis in Uganda, Kampala, Uganda