HUMAN AFRICAN TRYPANOSOMIASIS SLEEPING SICKNESS
A sleeping sickness patient rests in the HAT ward in Katanda, Kasai, DRC.
› Sleeping sickness is usually deadly without treatment.
Patient numbers have fluctuated with time, with disease outbreaks occurring intermittently, particularly when surveillance and control measures were relaxed. In the mid-1960s fewer than 5,000 cases were reported in the whole African continent, but the disease re-emerged, with a major epidemic from 1970, peaking in 1998 with over 38,000 cases detected. Since then, numbers have been falling consistently thanks to the combined efforts of WHO, National Control Programmes, NGOs, and Belgian and French bilateral aid. The most recent figures show that fewer than 3,000 new cases of T.b. gambiense HAT (g-HAT) were reported in 2015, the lowest figure ever recorded by WHO; 117 cases of T.b. rhodesiense (r-HAT) were recorded in 2014. Available treatment options depend on the stage of the disease and the parasite subspecies causing the infection, making the invasive and feared lumbar puncture – to determine if the parasite has entered the brain – mandatory for every patient diagnosed. Nifurtimoxeflornithine combination therapy (NECT), developed by Epicentre, MSF, DNDi, and partners for treating stage 2 g-HAT, replaced melarsoprol, a highly toxic arseniccontaining drug which killed 1 in 20 patients. Eflornithine was initially introduced as a slow-infusion treatment administered 56 times (every 6 hours for 14 days). In NECT, the number of eflornithine infusions is reduced to 14, in combination with orally administered nifurtimox, shortening the time spent in hospital and reducing the burden on resources. For stage 1 disease, pentamidine (discovered in 1940) remains the current treatment for g-HAT and suramin (discovered in 1920) for r-HAT. The arsenic-derivate melarsoprol is still the only treatment available for stage 2 r-HAT. WHO aims to eliminate g-HAT as a public health problem by 2020. A paradigm shift in diagnosis and treatment is therefore needed, with patients screened at home, referred to a nearby centre for diagnostic confirmation