Epidemiology and clinical outcomes associated with Theileria parva in a cohort of East African short horn zebu calves.
Jennings, Amy Elizabeth
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This thesis takes data from the Infectious Diseases of East African Livestock (IDEAL) project. The project was a longitudinal calf cohort study based in Western Kenya. Indigenous short horn zebu calves were recruited at birth and then visited every 5 weeks through their first year of life. The aim of this thesis was to improve understanding of the epidemiology of Theileria parva, with a particular focus on variation in host response. 362 of the 548 calves in the study cohort were classified as having seroconverted to T. parva, and 381 to T. mutans before 1 year old. The diagnostic tools used to identify exposure in the calf were compared, and environmental and calf level risk factors associated with the age at seroconversion were sought. Decreased elevation of the homestead and increased size of the herd were found to be significantly associated with an increased hazard of seroconversion to T. parva. There was little variation in hazard of T. mutans captured across the study site. The outcome ‘clinical episode’ was used to classify whether the calf was ill at each routine visit. A large number of calves passed through their first year of life without clinical disease being observed, and a minority of calves experienced the majority of clinical episodes. Multiple clinical episodes were apparently related in time, suggesting that they were due either to the same or connected pathogenic processes. A low birth weight, larger herds, and older farmers were all risk factors for being a sick calf. Both high helminth burden and T. parva were found to be significantly associated with clinical disease at a population level. A lot of variation was seen in the clinical presentation of disease. The clinical signs associated with fatal East Coast Fever (ECF), the clinical disease associated with T. parva infection, were found to be very variable. Although this may have been partly due to the varying times in the disease process that calves were observed prior to death, the complication of the clinical picture was also suggested to be due to co-infections. 71% of the cohort was infected with T. parva in their first year of life, but only a fraction (8.7%) went on to die from that infection. Unmatched and matched nested case control study formats were used to investigate the risk factors associated with death following T. parva infection (ECF death) in these calves. It was found that being infected young was a risk factor for death. Calves owned by older farmers were also at higher risk of death following infection. Going out grazing was found to be protective, and equivocal evidence was found for an association between prior T. mutans exposure and reduced odds of ECF death. If these initial findings from this work are correct, it is likely that T. mutans is influencing the clinical presentation of T. parva in endemic regions.