Sleeping Sickness: Is the end in sight?

In June 2010, the World Health Organisation (WHO) announced that the number of new cases of sleeping sickness (proper name: human African trypanosomiasis) reported has dropped below 10,000 for the first time in 50 years. Last year, there were 9,877 reported cases of the disease compared to 17,600 in 2004.

WHO is justifiably proud of this achievement, and says that it has rekindled hopes of eliminating the disease altogether. However, there needs to be a note of caution clipped to this news. The reality is that no one knows exactly how big the problem of sleeping sickness is and in an unknown number of remote and neglected areas of Africa, the disease is still rife.

Sleeping sickness is a parasitic disease transmitted by the bite of the tsetse fly. If left untreated it is 100% fatal. Over the past century, the disease ravaged Africa with severe epidemics in Kenya, Tanzania, Uganda, Nigeria and DRC, with serious socio-economic impact and families and communities decimated. By the 1960s, sleeping sickness was under control and regarded as a public health problem of the past. But complacency led to its re-emergence in the mid-1970s.

Medecins Sans Frontieres’ (MSF) experience shows that the disease is still affecting hundreds of people. Until early 2009, MSF had projects to detect and treat sleeping sickness in Haut-Uélé, Orientale province in the Democratic Republic of Congo (DRC). In that time, medical teams found areas of high infection – approximately 3.4% of the 46,601 people screened (1570 cases) were positive and treated. Disturbingly, however, conflict forced MSF to cease its activities in March 2009; since then, countless infected patients have gone without the treatment they need.

Conflict is also fuelling the spread of sleeping sickness. People on the move – fleeing fighting - risk carrying the parasite with them to infect new areas or reactivating the disease in regions where it has previously been eradicated. An uninfected fly biting an affected person may in turn infect another person – kicking off the cycle of transmission.

The size of the problem is unknown, but the tools to address it are also sorely lacking. Diagnostic measures are outdated: for patients with suspected sleeping sickness, a lumbar puncture is the only way to determine whether they are in the early or late stage of the disease. And until last year, the only treatment for late stage sleeping sickness (stage 2) was melarsoprol – a 20 year old, highly toxic arsenic based treatment that kills between 3 and 10 percent of patients. A new combination treatment (NECT – Nifurtimox Eflornithine Combination Therapy) was accepted by national programmes at the end of 2009, representing an important step forward. However, the treatment still requires 10 days in hospital and is not available everywhere. Sustained research and development for new diagnostics and treatment is still an urgent priority.

In 25 years MSF has treated nearly 50,000 cases and remains one of the leading organisations to respond to outbreaks. It currently has projects in DRC, the Central African Republic, Chad, and is restarting activities in Uganda, which has seen serious epidemics in the past. Further sustained effort is essential before we can claim that we are on the pathway to elimination of sleeping sickness.