article · BMC Global and Public Health
Tungiasis is a neglected tropical zoonotic skin disease caused by burrowing sand fleas, predominantly affecting disadvantaged rural communities and unhygienic settlements in Sub-Saharan Africa and Latin America. Despite its inclusion in the World Health Organisation neglected tropical diseases roadmap, its global disease burden had not been formally quantified. To address this, a prevalence-based Disability Adjusted Life Year modelling approach was used, focusing on Years Lived with Disability through a Bayesian hierarchical model and Monte Carlo simulations. The findings show an estimated annual loss of up to 379,645 DALYs globally, rising to 575,298 when comorbidities are incorporated. The vast majority of this burden falls on Sub-Saharan Africa, followed by Brazil, heavily driven by rural populations and urban slum residents within transmission zones. The overall burden is comparable to other major parasitic infections.
Tungiasis causes severe pain, itching, disfigurement, and secondary infections, yet its true impact has remained unquantified. By establishing the first comprehensive estimates of disability adjusted life years for the disease, this research provides essential data for global health bodies, governments, and funders. It highlights the urgent need to prioritise interventions, resource allocation, and targeted public health policies for neglected populations.
The abstract does not indicate a direct commercialisation pathway, as it focuses entirely on epidemiological burden modelling. However, the data provides an evidence base that global health agencies, healthcare funders, and pharmaceutical or medical device developers could use to justify investment into diagnostics, preventative treatments, or targeted interventions. Such intervention development remains at an early concept stage based on these findings.
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BACKGROUND: Tungiasis is a neglected tropical zoonotic skin disease which is endemic to Sub-Saharan Africa and Latin America, caused by sand fleas of the genus Tunga, which burrow into the skin of affected humans and animals, most commonly when the feet come in contact with infested soil. Sand flea infection leads to inflammation, severe itching, and pain, with the potential for secondary bacterial or viral infections, gangrene, and disfigurement. Tungiasis disproportionately affects poor rural communities, and individuals living in unhygienic settlements. To date, the existing burden of tungiasis has never been estimated, despite being included in the World Health Organisation Neglected Tropical Diseases roadmap since 2021. METHODS: We applied a prevalence-based Disability Adjusted Life Year (DALY) approach focusing on Years Lived with Disability (YLD) to model the burden of human tungiasis in endemic countries. Prevalence range estimates were derived using a Bayesian hierarchical Beta-Binomial model, with probability distributions applied to represent uncertainty in estimates based on highly heterogeneous local reports, capture local and regional variation, and reflect fluctuations in symptom severity among affected individuals. A discrete time point model was implemented over a 52-week period to estimate annual DALYs lost per country included in the analysis. Monte Carlo simulation with 1000 iterations was used to generate mean DALY estimates. RESULTS: Globally, we estimate that up to 379,645 (95% UI 361,792-398,309) DALYs are lost annually, with the bulk of the burden in Sub-Saharan Africa. When comorbidities are included, this increases to 575,298 (95% UI 548,948-602,597). When adjusted for population size, we estimate that 24.2 DALYs (36.4 with comorbidities included) are lost annually per 100,000 people. In terms of DALYs lost, the disease burden is disproportionately concentrated in Sub-Saharan Africa, and Brazil. CONCLUSIONS: Our estimates suggest tungiasis exerts a substantial burden of disease in endemic countries, comparable in absolute terms to that of soil-transmitted helminths and echinococcosis, and greater than that of toxocariasis, fascioliasis. Furthermore, we observe marked regional concentration of disease burden within Sub-Saharan Africa, with the disease burden in this region driven by large at-risk rural, and urban slum-dwelling, populations living within the ecological zone of transmission.
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DOI: 10.1186/s44263-026-00318-2
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