Model analysis and data validation of structured prevention and control interruptions of emerging infectious diseases.

The design of optimized non-pharmaceutical interventions (NPIs) is critical to the effective control of emergent outbreaks of infectious diseases such as SARS, A/H1N1 and COVID-19 and to ensure that numbers of hospitalized cases do not exceed the carrying capacity of medical resources. To address this issue, we formulated a classic SIR model to include a close contact tracing strategy and structured prevention and control interruptions (SPCIs). The impact of the timing of SPCIs on the maximum number of non-isolated infected individuals and on the duration of an infectious disease outside quarantined areas (i.e. implementing a dynamic zero-case policy) were analyzed numerically and theoretically. These analyses revealed that to minimize the maximum number of non-isolated infected individuals, the optimal time to initiate SPCIs is when they can control the peak value of a second rebound of the epidemic to be equal to the first peak value. More individuals may be infected at the peak of the second wave with a stronger intervention during SPCIs. The longer the duration of the intervention and the stronger the contact tracing intensity during SPCIs, the more effective they are in shortening the duration of an infectious disease outside quarantined areas. The dynamic evolution of the number of isolated and non-isolated individuals, including two peaks and long tail patterns, have been confirmed by various real data sets of multiple-wave COVID-19 epidemics in China. Our results provide important theoretical support for the adjustment of NPI strategies in relation to a given carrying capacity of medical resources.

Hormetic and synergistic effects of cancer treatments revealed by modelling combinations of radio - or chemotherapy with immunotherapy.

BACKGROUND: Radio/chemotherapy and immune systems provide examples of hormesis, as tumours can be stimulated (or reduced) at low radio/chemical or antibody doses but inhibited (or stimulated) by high doses. METHODS: Interactions between effector cells, tumour cells and cytokines with pulsed radio/chemo-immunotherapy were modelled using a pulse differential system. RESULTS: Our results show that radio/chemotherapy (dose) response curves (RCRC) and/or immune response curves (IRC) or a combination of both, undergo homeostatic changes or catastrophic shifts revealing hormesis in many parameter regions. Some mixed response curves had multiple humps, posing challenges for interpretation of clinical trials and experimental design, due to a fuzzy region between an hormetic zone and the toxic threshold. Mixed response curves from two parameter bifurcation analyses demonstrated that low-dose radio/chemotherapy and strong immunotherapy counteract side-effects of radio/chemotherapy on effector cells and cytokines and stimulate effects of immunotherapy on tumour growth. The implications for clinical applications were confirmed by good fits to our model of RCRC and IRC data. CONCLUSIONS: The combination of low-dose radio/chemotherapy and high-dose immunotherapy is very effective for many solid tumours. The net benefit and synergistic effect of combined therapy is conducive to the treatment and inhibition of tumour cells.

Randomness accelerates the dynamic clearing process of the COVID-19 outbreaks in China.

During the implementation of strong non-pharmaceutical interventions (NPIs), more than one hundred COVID-19 outbreaks induced by different strains in China were dynamically cleared in about 40 days, which presented the characteristics of small scale clustered outbreaks with low peak levels. To address how did randomness affect the dynamic clearing process, we derived an iterative stochastic difference equation for the number of newly reported cases based on the classical stochastic SIR model and calculate the stochastic control reproduction number (SCRN). Further, by employing the Bayesian technique, the change points of SCRNs have been estimated, which is an important prerequisite for determining the lengths of the exponential growth and decline phases. To reveal the influence of randomness on the dynamic zeroing process, we calculated the explicit expression of the mean first passage time (MFPT) during the decreasing phase using the relevant theory of first passage time (FPT), and the main results indicate that random noise can accelerate the dynamic zeroing process. This demonstrates that powerful NPI measures can rapidly reduce the number of infected people during the exponential decline phase, and enhanced randomness is conducive to dynamic zeroing, i.e. the greater the random noise, the shorter the average clearing time is. To confirm this, we chose 26 COVID-19 outbreaks in various provinces in China and fitted the data by estimating the parameters and change points. We then calculated the MFPTs, which were consistent with the actual duration of dynamic zeroing interventions.

Prediction of the next major outbreak of COVID-19 in Mainland China and a vaccination strategy for it.

After the widespread prevalence of COVID-19 at the end of 2022 in Mainland China, a major concern is when will the second major outbreak occur and with what prevalence and fatality rates will it be associated with, as peoples' immunity from natural infection subsides. To address this, we established an age-structured model considering vaccine and infection-derived immunity, fitted an immunity-waning curve, and calibrated the model using the epidemic and vaccination data from Hong Kong in 2022. The model and the situation of the first major epidemic in Mainland China were then used to predict the prevalence rate, fatality rate and peak time of the second wave. In addition, the controlling effects of different vaccination strategies on the second major outbreak are discussed. Finally, a characterization indicator for the level of population immunity was provided. We conclude that if the prevalence of the first major epidemic was 80%, the prevalence rate of the second major outbreak would be about 37.64%, and the peak time would have been July 2 2023. Strengthening vaccination can effectively delay the peak of the second wave of the epidemic and reduce the prevalence.

Threshold dynamics of a stochastic mathematical model for Wolbachia infections.

A stochastic mathematical model is proposed to study how environmental heterogeneity and the augmentation of mosquitoes with Wolbachia bacteria affect the outcomes of dengue disease. The existence and uniqueness of the positive solutions of the system are studied. Then the V-geometrically ergodicity and stochastic ultimate boundedness are investigated. Further, threshold conditions for successful population replacement are derived and the existence of a unique ergodic steady-state distribution of the system is explored. The results show that the ratio of infected to uninfected mosquitoes has a great influence on population replacement. Moreover, environmental noise plays a significant role in control of dengue fever.

Threshold conditions for curbing COVID-19 with a dynamic zero-case policy derived from 101 outbreaks in China.

By 31 May 2022, original/Alpha, Delta and Omicron strains induced 101 outbreaks of COVID-19 in mainland China. Most outbreaks were cleared by combining non-pharmaceutical interventions (NPIs) with vaccines, but continuous virus variations challenged the dynamic zero-case policy (DZCP), posing questions of what are the prerequisites and threshold levels for success? And what are the independent effects of vaccination in each outbreak? Using a modified classic infectious disease dynamic model and an iterative relationship for new infections per day, the effectiveness of vaccines and NPIs was deduced, from which the independent effectiveness of vaccines was derived. There was a negative correlation between vaccination coverage rates and virus transmission. For the Delta strain, a 61.8% increase in the vaccination rate (VR) reduced the control reproduction number (CRN) by about 27%. For the Omicron strain, a 20.43% increase in VR, including booster shots, reduced the CRN by 42.16%. The implementation speed of NPIs against the original/Alpha strain was faster than the virus's transmission speed, and vaccines significantly accelerated the DZCP against the Delta strain. The CRN ([Formula: see text]) during the exponential growth phase and the peak time and intensity of NPIs were key factors affecting a comprehensive theoretical threshold condition for DZCP success, illustrated by contour diagrams for the CRN under different conditions. The DZCP maintained the [Formula: see text] of 101 outbreaks below the safe threshold level, but the strength of NPIs was close to saturation especially for Omicron, and there was little room for improvement. Only by curbing the rise in the early stage and shortening the exponential growth period could clearing be achieved quickly. Strengthening China's vaccine immune barrier can improve China's ability to prevent and control epidemics and provide greater scope for the selection and adjustment of NPIs. Otherwise, there will be rapid rises in infection rates and an extremely high peak and huge pressure on the healthcare system, and a potential increase in excess mortality.

Seasonal variations and other changes in the geographical distributions of different cytospecies of the Simulium damnosum complex (Diptera: Simuliidae) in Togo and Benin.

Simulium damnosum s.l., the most important vector of onchocerciasis in Africa, is a complex of sibling species described on the basis of differences in their larval polytene chromosomes. These (cyto) species differ in their geographical distributions, ecologies and epidemiological roles. In Togo and Benin, distributional changes have been recorded as a consequence of vector control and environmental changes (e.g. creation of dams, deforestation), with potential epidemiological consequences. We review the distribution of cytospecies in Togo and Benin and report changes observed from 1975 to 2018. The elimination of the Djodji form of S. sanctipauli in south-western Togo in 1988 seems to have had no long-term effects on the distribution of the other cytospecies, despite an initial surge by S. yahense. Although we report a general tendency for long-term stability in most cytospecies' distributions, we also assess how the cytospecies' geographical distributions have fluctuated and how they vary with the seasons. In addition to seasonal expansions of geographical ranges by all species except S. yahense, there are seasonal variations in the relative abundances of cytospecies within a year. In the lower Mono river, the Beffa form of S. soubrense predominates in the dry season but is replaced as the dominant taxon in the rainy season by S. damnosum s.str. Deforestation was previously implicated in an increase of savanna cytospecies in southern Togo (1975-1997), but our data had little power to support (or refute) suggestions of a continuing increase, partly because of a lack of recent sampling. In contrast, the construction of dams and other environmental changes including climate change seem to be leading to decreases in the populations of S. damnosum s.l. in Togo and Benin. If so, combined with the disappearance of the Djodji form of S. sanctipauli, a potent vector, plus historic vector control actions and community directed treatments with ivermectin, onchocerciasis transmission in Togo and Benin is much reduced compared with the situation in 1975.

Lessons drawn from Shanghai for controlling highly transmissible SARS-CoV-2 variants: insights from a modelling study.

BACKGROUND: The continuous emergence of novel SARS-CoV-2 variants with markedly increased transmissibility presents major challenges to the zero-COVID policy in China. It is critical to adjust aspects of the policy about non-pharmaceutical interventions (NPIs) by searching for and implementing more effective ways. We use a mathematical model to mimic the epidemic pattern of the Omicron variant in Shanghai to quantitatively show the control challenges and investigate the feasibility of different control patterns in avoiding other epidemic waves. METHODS: We initially construct a dynamic model with a core step-by-step release strategy to reveal its role in controlling the spread of COVID-19, including the city-based pattern and the district-based pattern. We used the least squares method and real reported case data to fit the model for Shanghai and its 16 districts, respectively. Optimal control theory was utilized to explore the quantitative and optimal solutions of the time-varying control strength (i.e., contact rate) to suppress the highly transmissible SARS-CoV-2 variants. RESULTS: The necessary period for reaching the zero-COVID goal can be nearly 4 months, and the final epidemic size was 629,625 (95%CI: [608,049, 651,201]). By adopting the city-based pattern, 7 out of 16 strategies released the NPIs more or earlier than the baseline and ensured a zero-resurgence risk at the average cost of 10 to 129 more cases in June. By adopting the district-based pattern, a regional linked release can allow resumption of social activity to ~ 100% in the boundary-region group about 14 days earlier and allow people to flow between different districts without causing infection resurgence. Optimal solutions of the contact rate were obtained with various testing intensities, and higher diagnosis rate correlated with higher optimal contact rate while the number of daily reported cases remained almost unchanged. CONCLUSIONS: Shanghai could have been bolder and more flexible in unleashing social activity than they did. The boundary-region group should be relaxed earlier and more attention should be paid to the centre-region group. With a more intensive testing strategy, people could return to normal life as much as possible but still ensure the epidemic was maintained at a relatively low level.

Inferring a Causal Relationship between Environmental Factors and Respiratory Infections Using Convergent Cross-Mapping.

The incidence of respiratory infections in the population is related to many factors, among which environmental factors such as air quality, temperature, and humidity have attracted much attention. In particular, air pollution has caused widespread discomfort and concern in developing countries. Although the correlation between respiratory infections and air pollution is well known, establishing causality between them remains elusive. In this study, by conducting theoretical analysis, we updated the procedure of performing the extended convergent cross-mapping (CCM, a method of causal inference) to infer the causality between periodic variables. Consistently, we validated this new procedure on the synthetic data generated by a mathematical model. For real data in Shaanxi province of China in the period of 1 January 2010 to 15 November 2016, we first confirmed that the refined method is applicable by investigating the periodicity of influenza-like illness cases, an air quality index, temperature, and humidity through wavelet analysis. We next illustrated that air quality (quantified by AQI), temperature, and humidity affect the daily influenza-like illness cases, and, in particular, the respiratory infection cases increased progressively with increased AQI with a time delay of 11 days.

The relative importance of key meteorological factors affecting numbers of mosquito vectors of dengue fever.

Although single factors such as rainfall are known to affect the population dynamics of Aedes albopictus, the main vector of dengue fever in Eurasia, the synergistic effects of different meteorological factors are not fully understood. To address this topic, we used meteorological data and mosquito-vector association data including Breteau and ovitrap indices in key areas of dengue outbreaks in Guangdong Province, China, to formulate a five-stage mathematical model for Aedes albopictus population dynamics by integrating multiple meteorological factors. Unknown parameters were estimated using a genetic algorithm, and the results were analyzed by k-Shape clustering, random forest and grey correlation analysis. In addition, the population density of mosquitoes in 2022 was predicted and used for evaluating the effectiveness of the model. We found that there is spatiotemporal heterogeneity in the effects of temperature and rainfall and their distribution characteristics on the diapause period, the numbers of peaks in mosquito densities in summer and the annual total numbers of adult mosquitoes. Moreover, we identified the key meteorological indicators of the mosquito quantity at each stage and that rainfall (seasonal rainfall and annual total rainfall) was more important than the temperature distribution (seasonal average temperature and temperature index) and the uniformity of rainfall annual distribution (coefficient of variation) for most of the areas studied. The peak rainfall during the summer is the best indicator of mosquito population development. The results provide important theoretical support for the future design of mosquito vector control strategies and early warnings of mosquito-borne diseases.

A field investigation of short-range dispersal by female Simulium damnosum s.l.

Female Simulium damnosum s.l. were caught at a site in a savannah zone beside the Mono River in Togo and at varying distances westwards perpendicular to it in an experiment to investigate short-range dispersal by the flies. The numbers of flies caught and the percentages that were parous decreased with increasing distance from the river, the latter suggesting that nulliparous flies disperse on average further than parous flies. The decreases were quantified using statistically significant multiple regressions involving distances from the river and the days since the start of the experiment because there was much day-to-day variation, probably attributable to the flies' gonotrophic cycles. For future modelling purposes a relationship between numbers caught and distance alone was also estimated for both numbers caught and parous rates. Of the different members of the S. damnosum species complex identified in larval samples, S. damnosum s.str. predominated (66.7%), with S. squamosum accounting for 25.5% and the Beffa form of S. soubrense for 7.8%, proportions that were not significantly different from those of adults identified at the river and 10 km away. A small sub-sample of dissected parous flies showed that transmission was occurring at the riverside and at 10 km away from the river.

Coupling an individual adaptive-decision model with a SIRV model of influenza vaccination reveals new insights for epidemic control.

Past seasonal influenza epidemics and vaccination experience may affect individuals' decisions on whether to be vaccinated or not, decisions that may be constantly reassessed in relation to recent influenza related experience. To understand the potentially complex interaction between experience and decisions and whether the vaccination rate is likely to reach a critical coverage level or not, we construct an adaptive-decision model. This model is then coupled with an influenza vaccination dynamics (SIRV) model to explore the interaction between individuals' decision-making and an influenza epidemic. Nonlinear least squares estimation is used to obtain the best-fit parameter values in the SIRV model based on data on new influenza-like illness (ILI) cases in Texas. Uncertainty and sensitivity analyses are then carried out to determine the impact of key parameters of the adaptive decision-making model on the ILI epidemic. The results showed that the necessary critical coverage rate of ILI vaccination could not be reached by voluntary vaccination. However, it could be reached in the fourth year if mass media reports improved individuals' memory of past vaccination experience. Individuals' memory of past vaccination experience, the proportion with histories of past vaccinations and the perceived cost of vaccination are important factors determining whether an ILI epidemic can be effectively controlled or not. Therefore, health authorities should guide people to improve their memory of past vaccination experience through media reports, publish timely data on annual vaccination proportions and adjust relevant measures to appropriately reduce vaccination perceived cost, in order to effectively control an ILI epidemic.

Bean Leaf Beetle (Ootheca spp.) (Coleoptera: Chrysomelidae) Management via Planting Timing and Insecticides.

Bean leaf beetles (Ootheca spp.) (Coleoptera: Chrysomelidae) are one of Africa's most important pests of the common bean (Phaseolus vulgaris L.). Roots, leaves, floral parts, and young pods are all attacked, leading to a considerable loss in grain yield. In Uganda, there are no comprehensive prescribed management strategies for bean leaf beetles, but farmers typically try to control the pest by delaying bean crop sowing, and to a lesser extent, using insecticides. Although farmers have consistently implemented the two approaches, there is no information on the effects of the approaches in Uganda. To assess the impact of planting timing and insecticide spray regimes on bean leaf beetle populations, concomitant foliar damage, and grain yield, we set up trials in three agro-ecological zones with known presence of the beetles during the second rainy season of 2016 (2016) and the first rainy season of 2017 (2017). The first planting, coinciding with early planting, was conducted within one week after the onset of rains. The second planting, coinciding with mid planting, followed two weeks later, while the third planting, considered late planting in this study, was conducted one month after the second planting. A foliar application of cypermethrin commencing at 7 days after emergence (DAE), 14 DAE, 21 DAE, 28 DAE, and 35 DAE; a soil drench of imidacloprid at planting combined with a foliar spray starting at 7 DAE; and an untreated control were among the insecticide spray regimes evaluated. Higher bean leaf beetle abundance was recorded from mid-planting, while higher foliar damage was recorded from late planting in two of the three agro-ecological zones. However, higher marketable grain yield was recorded from early planting in all agro-ecological zones, suggesting that delayed planting may not be beneficial. Insecticide application reduced foliar damage and increased marketable grain yield, with a combination of soil drench and foliar spray resulting in much less foliar damage and, as a result, higher grain yield. However, this did not result in economic benefits. Furthermore, marketable grain yield was higher when insecticide spray regimes were combined with early planting in all agro-ecological zones during both seasons. Our findings suggest that the common bean should be planted early and that the control of the bean leaf beetle should target both the adults and the juvenile stages in the soil. Therefore, there is a need for farmers to be able to access less-expensive soil treatments.

Home quarantine or centralized quarantine? A mathematical modelling study on the COVID-19 epidemic in Guangzhou in 2021.

Several outbreaks of COVID-19 caused by imported cases have occurred in China following the successful control of the outbreak in early 2020. In order to avoid recurrences of such local outbreaks, it is important to devise an efficient control and prevention strategy. In this paper, we developed a stochastic discrete model of the COVID-19 epidemic in Guangzhou in 2021 to compare the effectiveness of centralized quarantine and compulsory home quarantine measures. The model was calibrated by using the daily reported cases and newly centralized quarantined cases. The estimated results showed that the home quarantine measure increased the accuracy of contact tracing. The estimated basic reproduction number was lower than that in 2020, even with a much more transmissible variant, demonstrating the effectiveness of the vaccines and normalized control interventions. Sensitivity analysis indicated that a sufficiently implemented contact tracing and centralized quarantine strategy in the initial stage would contain the epidemic faster with less infections even with a weakly implemented compulsory home quarantine measure. However, if the accuracy of the contact tracing was insufficient, then early implementation of the compulsory home quarantine with strict contact tracing, screening and testing interventions on the key individuals would shorten the epidemic duration and reduce the total number of infected cases. Particularly, 94 infections would have been avoided if the home quarantine measure had been implemented 3 days earlier and an extra 190 infections would have arisen if the home quarantine measure was implemented 3 days later. The study suggested that more attention should be paid to the precise control strategy during the initial stage of the epidemic, otherwise the key group-based control measure should be implemented strictly.

Distribution and Relative Abundance of Bean Leaf Beetles (Ootheca spp.) (Insecta: Coleoptera: Chrysomelidae) in Uganda.

Bean leaf beetles (Ootheca spp.) (Insecta: Coleoptera: Chrysomelidae) are one of Africa's most destructive pests of common bean and other leguminous crops. The beetles are widely distributed in Africa where they are estimated to cause annual crop yield losses of 116,400 tons of crop yields in sub-Saharan Africa. Despite their importance, little is known about the distribution, relative abundance and damage caused by bean leaf beetles in Uganda. As a result, the development of effective management methods has been hampered. We conducted surveys in six key Ugandan agro-ecological zones to determine the species distribution and relative abundance of bean leaf beetles. Findings indicate that leaf beetles belonging to 12 genera are present, including members of the genera Afrophthalma Medvedev, 1980, Buphonella Jacoby, 1903, Chrysochrus Chevrolat in Dejean, 1836, Diacantha Dejean, 1845, Exosoma Jacoby, 1903, Lamprocopa Hincks, 1949, Lema Fabricius, 1798, Nisotra Baly, 1864, Neobarombiella Bolz and Wagner, 2012, Ootheca Dejean, 1935, Parasbecesta Laboissière, 1940, and Plagiodera Dejean, 1835. We identified only three species belonging to the genus Ootheca: O. mutabilis, O. proteus, and O. orientalis. Seventy percent of all the beetles collected were O. mutabilis and these were present in all agro-ecological zones studied. The Northern Moist Farmlands (21.9%), West Nile Farmlands (12.9%), Central Wooded Savanna (4.4%) and Southern and Eastern Lake Kyoga Basin (1.4%) were the only agro-ecological zones where O. proteus was found. Only one specimen of O. orientalis was found at a single site in the Central Wooded Savanna. The Northern Moist Farmlands had a significantly (p < 0.05) higher bean leaf beetle density than the West Nile Farmlands and Southwestern Highlands. Similarly, the Northern Moist Farmlands had the highest beetle foliar damage per plant (1.15 ± 0.05), while the Southwestern Highlands had the lowest (0.03 ± 0.02). We provide the first information on Ootheca species distribution, abundance and damage in Uganda. Our findings provide a foundation for assessing the importance of Ootheca spp. as common bean pests in Uganda.

Quantifying competitive advantages of mutant strains in a population involving importation and mass vaccination rollout.

The SARS-CoV-2 Delta variant, known as B.1.617.2 and first identified in India, is becoming a dominant strain in many countries due to its extreme infectiousness. Assessing and quantifying the transmissibility and competitive advantage of the Delta variant is of major significance for countries around the world so that appropriate measures to mitigate and even eliminate the epidemic can be introduced. Aiming at such problems, we proposed a method to model the invasion process of a novel strain and estimate the competitive advantage of the invading strain over the local strain. We applied this method to study the invasion and spread of the Delta variant into England. We have estimated the basic reproduction number of the Delta variant as being 49% higher than that of the Alpha variant (CI: 45-52%), assuming a mean generation interval of 5 days with a standard deviation of 3 days. In the period 11 April to 17 May 2021, the effective reproduction number of the Delta variant was 65% higher than that of the Alpha variant in England (CI: 61-70%). Our results show that the Delta variant has a significantly higher transmission capacity than other strains, which explains the rebound of the epidemic in many countries, even in those with relatively high vaccination coverages.

Micro-CT visualization of a promastigote secretory gel (PSG) and parasite plug in the digestive tract of the sand fly Lutzomyia longipalpis infected with Leishmania mexicana.

Leishmaniasis is a debilitating disease of the tropics, subtropics and southern Europe caused by Leishmania parasites that are transmitted during blood feeding by phlebotomine sand flies (Diptera: Psychodidae). Using non-invasive micro-computed tomography, we were able to visualize the impact of the laboratory model infection of Lutzomyia longipalpis with Leishmania mexicana and its response to a second blood meal. For the first time we were able to show in 3D the plug of promastigote secretory gel (PSG) and parasites in the distended midgut of whole infected sand flies and measure its volume in relation to that of the midgut. We were also able to measure the degree of opening of the stomodeal valve and demonstrate the extension of the PSG and parasites into the pharynx. Although our pilot study could only examine a few flies, it supports the hypothesis that a second, non-infected, blood meal enhances parasite transmission as we showed that the thoracic PSG-parasite plug in infected flies after a second blood meal was, on average, more than twice the volume of the plug in infected flies that did not have a second blood meal.

Capture of high numbers of Simulium vectors can be achieved with Host Decoy Traps to support data acquisition in the onchocerciasis elimination endgame.

Onchocerciasis elimination is within reach in many countries but requires enhanced surveillance of the Simulium vectors of Onchocerca volvulus. Collection of sufficient numbers of adult Simulium to detect infective O. volvulus larvae is hindered by limited sampling tools for these flies. Here, we tested for the first time the Host Decoy Trap (HDT), an exposure free method previously developed for Anopheles vectors of malaria parasites, as a potential sampling tool for adult Simulium. In three replicates of a randomized Latin square experimental design, the HDT was compared to Human Landing Catches (HLC) and the Esperanza Window Trap (EWT). A total of 8,531 adult S. damnosum sensu lato blackflies (S. squamosum group) were found in catches from the three different trapping methods. The HDT (mean catch 533 ± 111) caught significantly more S. squamosum than the EWT (mean catch 9.1 ± 2.2), a nearly 60-fold difference. There was no significant difference between the HLC (mean catch 385.6 ± 80.9) and the HDT. Larvae indistinguishable from those of O. volvulus were dissected from 2.86% of HDT samples (n = 70) and 0.35% of HLC samples (n = 285); a single infective third-stage larvae (L3) was  found during dissection of a sample from the HDT. Owing to its very high capture rate, which was comparable to the HLC and significantly greater than EWT, alongside the presence of infected flies in its catch, the HDT represents a potentially valuable new tool for blackfly collection in elimination settings, where thousands of flies are needed for parasite screening.

Taking the strain out of onchocerciasis? A reanalysis of blindness and transmission data does not support the existence of a savannah blinding strain of onchocerciasis in West Africa.

Onchocerciasis (also known as 'river blindness'), is a neglected tropical disease (NTD) caused by the (Simulium-transmitted) filarial nematode Onchocerca volvulus. The occurrence of 'blinding' (savannah) and non-blinding (forest) parasite strains and the existence of corresponding, locally adapted Onchocerca-Simulium complexes were postulated to explain greater blindness prevalence in savannah than in forest foci. As a result, the World Health Organization (WHO) Onchocerciasis Control Programme in West Africa (OCP) focused anti-vectorial and anti-parasitic interventions in savannah endemic areas. In this paper, village-level data on blindness prevalence, microfilarial prevalence, and transmission intensity (measured by the annual transmission potential, the number of infective, L3, larvae per person per year) were extracted from 16 West-Central Africa-based publications, and analysed according to habitat (forest, forest-savannah mosaic, savannah) to test the dichotomous strain hypothesis in relation to blindness. When adjusting for sample size, there were no statistically significant differences in blindness prevalence between the habitats (one-way ANOVA, P=0.68, mean prevalence for forest=1.76±0.37 (SE); mosaic=1.49±0.38; savannah=1.89±0.26). The well-known relationship between blindness prevalence and annual transmission potential for savannah habitats was confirmed and shown to hold for (but not to be statistically different from) forest foci (excluding data from southern Côte d'Ivoire, in which blindness prevalence was significantly lower than in other West African forest communities, but which had been the focus of studies leading to the strain-blindness hypothesis that was accepted by OCP planners). We conclude that the evidence for a savannah blinding onchocerciasis strain in simple contrast with a non-blinding forest strain is equivocal. A re-appraisal of the strain hypothesis to explain patterns of ocular disease is needed to improve understanding of onchocerciasis epidemiology and disease burden estimates in the light of the WHO 2030 goals for onchocerciasis.