Combining citizen science and molecular diagnostic methods to investigate the prevalence of Borrelia burgdorferi s.l. and Borrelia miyamotoi in tick pools across Great Britain.

Lyme disease is the most common tick-borne disease and is caused by a group of bacteria known as Borrelia burgdorferi sensu lato (s.l.) complex. Sharing the same genus as B. burgdorferi, Borrelia miyamotoi is a distinct genotype that causes relapsing fever disease. This emerging tick-borne disease is increasingly becoming a concern in public health. To investigate the prevalence of B. burgdorferi s.l. and B. miyamotoi in ticks first, we developed a PCR (Bmer-qPCR) that targets the phage terminase large subunit (terL) gene carried by B. miyamotoi. A similar approach had been used successfully in developing Ter-qPCR for detecting B. burgdorferi s.l. The terL protein functions as an enzyme in packaging phage DNA. Analytical validation of the Bmer-qPCR confirmed its specificity, efficiency and sensitivity. Second, we designed a citizen science-based approach to detect 838 ticks collected from numerous sites across Great Britain. Finally, we applied Bmer-qPCR and Ter-qPCR to 153 tick pools and revealed that the prevalence of B. burgdorferi s.l. and B. miyamotoi was dependent on their geographical locations, i.e. Scotland showed a higher rate of B. burgdorferi s.l. and lower rate of B. miyamotoi carriage as compared to those of the England data. A pattern of diminishing rate of B. miyamotoi carriage from southern England to northern Scotland was visible. Together, the citizen science-based approach provided an estimation of the carriage rate of B. burgdorferi s.l. and B. miyamotoi in tick pools and a potential spreading pattern of B. miyamotoi from the south to the north of Great Britain. Our findings underscore the power of combining citizen science with the molecular diagnostic method to reveal hidden pattern of pathogen-host-environment interplay. Our approach can provide a powerful tool to elucidate the ecology of tick-borne diseases and may offer guidance for pathogen control initiatives. In an era of limited resources, monitoring pathogens requires both field and laboratory support. Citizen science approaches provide a method to empower the public for sample collection. Coupling citizen science approaches with laboratory diagnostic tests can make real-time monitoring of pathogen distribution and prevalence possible.

Targeting Multicopy Prophage Genes for the Increased Detection of Borrelia burgdorferi Sensu Lato (s.l.), the Causative Agents of Lyme Disease, in Blood.

The successful treatment of Lyme disease (LD) is contingent on accurate diagnosis. However, current laboratory detection assays lack sensitivity in the early stages of the disease. Because delayed diagnosis of LD incurs high healthcare costs and great suffering, new highly sensitive tests are in need. To overcome these challenges, we developed an internally controlled quantitative PCR (Ter-qPCR) that targets the multicopy terminase large subunit (terL) gene encoded by prophages that are only found in LD-causing bacteria. The terL protein helps phages pack their DNA. Strikingly, the detection limit of the Ter-qPCR was analytically estimated to be 22 copies and one bacterial cell in bacteria spiked blood. Furthermore, significant quantitative differences was observed in terms of the amount of terL detected in healthy individuals and patients with either early or late disease. Together, the data suggests that the prophage-targeting PCR has significant power to improve success detection for LD. After rigorous clinical validation, this new test could deliver a step-change in the detection of LD. Prophage encoded markers are prevalent in many other pathogenic bacteria rendering this approach highly applicable to bacterial identification in general.

[Measuring drug affordability (Senegal)]. / Mesurer l'accessibilité financière aux médicaments: l'exemple du Sénégal.

This article presents the results of a global survey on drug accessibility conducted in Senegal in 2001. The original tool we developed to measure drug affordability for this study considered 5 marker diseases and their corresponding medical treatments and determined the theoretical amount that each population quintile can devote to the purchase of these treatments at market prices without damaging their economic status (affordability threshold). These results were then compared with those obtained as part of a field survey of 987 patients at 41 health centres and 51 private chemists (pharmacists). The main results show that the population's ability to afford treatment is low (less than 40% at public sector prices and a little over 20% at private sector prices) and that even at the lowest market prices (public sector) 20% to 60% of the population cannot afford treatments for the most common illnesses. The field survey shows, moreover, that these results are exacerbated by four external factors: additional illness-associated expenditures (i.e., transportation costs, doctor visits), lack of compliance with government-set drug prices, prescription habits and dispensing practices. When these added costs are taken into account, less than 20% of the population can actually pay the public-sector treatment costs for the marker diseases, let alone the private sector prices. This tool is also useful for highlighting the insufficiencies of the strategies adopted for the target diseases (inconsistency between pricing policies and health priorities) and for providing a baseline measurement (at t0) of different socioeconomic groups' access to given treatments. Improvement or deterioration can then be assessed with measurements at times t1, t2...tn.

[Why drug prices are high in sub-Saharan Africa. Analysis of price structure: the case of Senegal]. / Pourquoi le prix des médicaments est élevé dans les pays d'Afrique subsaharienne. Analyse de la structure des prix: l'exemple du Sénégal.

This article seeks to shed light on the reasons for the lack of correlation between the price of drugs in this very poor sub-Saharan country and the population's ability to pay for them. The analysis is based on: (i) a comparison between the wholesale (exclusive of VAT and other taxes) and government-fixed retail prices and the corresponding prices of the same drugs in their country of origin (France); (ii) a description of the price-setting mechanisms in Senegal in both the public and private sectors; and (iii) an evaluation of public-sector retail price in Senegal, by end users and prescribing professionals in both sectors. The study found that: (i) patient expenditure would be one-fifth as high if all the drugs in the sample were sold at their government-fixed public-sector retail prices; (ii) the most cost effective drugs are sold at fixed retail prices higher than those of drugs not reimbursed by the national health insurance in France because considered less cost-effective; (iii) the mechanism for setting public retail prices seems to be unrelated to public health objectives, does not consider specific population groups, target diseases, or the drugs' therapeutic value, and therefore cannot be considered an effective tool for implementing national drug policies. Instead, the incentives of this mechanism lead retailers to sell the most expensive drugs first, to generate the highest possible margins. It does not prioritize the essential generic drugs that health authorities have placed at the centre of their pharmaceutical policy.