Capewell P. auteur aut IRD Atkins K. auteur aut IRD Weir W. auteur aut IRD Jamonneau Vincent auteur aut IRD Camara M. auteur aut IRD Clucas C. auteur aut IRD Swar N. R. K. auteur aut IRD Ngoyi D. M. auteur aut IRD Rotureau B. auteur aut IRD Garside P. auteur aut IRD Galvani A. P. auteur aut IRD Bucheton Bruno auteur aut IRD MacLeod A. auteur aut IRD text journalArticle eng text/pdf reformatted digital access 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. specialized AFRIQUE SUBSAHARIENNE 052 020 17 1 e3000105 [6 p.] 2019 1545-7885 https://www.documentation.ird.fr/hor/fdi:010075153 10.1371/journal.pbio.3000105 1545-7885 [F B010075153] https://www.documentation.ird.fr/hor/fdi:010075153 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers19-02/010075153.pdf IRD - Base Horizon / Pleins textes 2019-03-06 2025-02-24 fdi:010075153 fre