Abstract
Background Cutaneous leishmaniasis (CL) is a major public health concern in Ethiopia. However, knowledge about the complex zoonotic transmission cycle is limited, hampering implementation of control strategies. We explored the feeding behavior and activity of the vector (Phlebotomus pedifer) and established the role of livestock in CL transmission.
Methods Blood meal origins of engorged sand flies were determined by sequencing host DNA. A host choice experiment was performed to assess the feeding preference of P. pedifer when humans and hyraxes are equally accessible. Ear and nose biopsies from goats and bovines were screened for the presence of Leishmania parasites. Sand flies were captured indoor and outdoor with human landing catches (HLC) and CDC light traps to determine at which time and where P. pedifer is mostly active.
Principal findings A total of 180 sand flies were found to bite hosts of 12 genera. Humans were the predominant blood meal source (59.4%, p < 0.001) in all habitats, even in caves, where hyraxes are abundant. Only 10.6% of the sand flies fed on hyraxes based on the blood meal analysis, but the host choice experiment revealed that sand flies have a significant preference for feeding on hyraxes over humans (p = 0.009) when hosts are equally accessible. Only a single goat nose biopsy from 412 animal samples was found with Leishmania RNA. We found that P. pedifer is predominantly endophagic (p = 0.003), but occurs both indoors and outdoors. A substantial amount of sand flies was active in the early evening, which increased over time reaching its maximum around midnight.
Conclusion We indicate that Leishmania transmission in southwestern Ethiopia is, in contrast to earlier suggestions, likely mainly anthroponotic and that livestock does not play a role in transmission. Combined indoor and outdoor vector control measures at night are required for efficient vector control.
Author summary Cutaneous leishmaniasis is a major public health problem in Ethiopia. It is caused by Leishmania aethiopica protozoa that are transmitted when female sand flies take a blood meal. Hyraxes are assigned as the reservoirs of the infection, because many were found infected with Leishmania. There is very limited knowledge about the behavior of sand flies and other potential hosts of the infection. However, this information is a prerequisite for disease control, which is currently hampered. In this study, we found that humans are likely the main source of the infection and that the role of hyraxes in disease transmission needs further investigation to decide whether they should be included in control programs. Livestock appears not play a role in transmission, even though sand flies like to feed on them. We also show that sand flies are active indoors and outdoors, but have a preference for feeding inside human dwellings and that they are mostly active around midnight. Overall, we conclude that disease prevention and control should emphasize on human protection by applying vector control indoors, at night.
Footnotes
↵+ shared contribution
