Statistical modeling based on structured surveys of Australian native possum excreta harboring Mycobacterium ulcerans predicts Buruli ulcer occurrence in humans

• DOI: 10.7554/elife.84983
• Publication Date: 2023-04-14T10:15:13Z
• Authors: Koen Vandelannoote; Andrew H Buultjens; Jessica L Porter; Anita Velink; John R Wallace; Kim R Blasdell; Michael Dunn; Victoria Boyd; Janet AM Fyfe; Ee Laine Tay; Paul DR Johnson; Saras M Windecker; Nick Golding; Timothy P Stinear
• Keywords: Mycobacterium ulcerans; Buruli ulcer; Tropical disease

Buruli ulcer (BU) is a neglected tropical disease caused by infection of subcutaneous tissue with Mycobacterium ulcerans. BU commonly reported across rural regions Central and West Africa but has been increasing dramatically in temperate southeast Australia around the major metropolitan city Melbourne, most transmission occurring summer months. Previous research shown that Australian native possums are reservoirs M. ulcerans they shed bacteria their fecal material (excreta). Field surveys show locales where harbor overlap human cases BU, raising possibility using possum excreta to predict risk occurrence humans.We thus established highly structured 12 month surveillance program an area 350 km2 Mornington Peninsula 70 km south Australia. The primary objective our study was assess statistical modeling if provided useful information for predicting future case locations.Over two sampling campaigns winter, we collected 2,282 specimens which 11% were PCR positive ulcerans-specific DNA. Using spatial scanning tool SaTScan, observed non-random, co-correlated clustering both cases. We next trained model survey data likelihood region. By observing subsequently occurred, performance superior null previous year's incidence (AUC 0.66 vs 0.55). then used unseen excreta-informed from new 661 Geelong, geographically separate endemic southwest prospectively location As Peninsula, excreta-based prediction outperformed 0.75 0.50) pinpointed specific locations Geelong interventions could be deployed interrupt spread.This highlights One Health nature confirming quantitative relationship between shedding humans developing BU. survey-informed have described will powerful efficient targeting public health responses stop BU.This supported National Medical Research Council Victorian Government Department (GNT1152807 GNT1196396).