Neglected tropical diseases

WHO publishes new guidelines for the treatment of sleeping sickness

8 August 2019 | Geneva – The World Health Organization (WHO) has just published new guidelines to facilitate the treatment of patients affected by the gambiense form of human African trypanosomiasis (also known as sleeping sickness). The guidelines follow the recent approval of an oral medicine (fexinidazole), which has opened new possibilities for the management of the disease.

The guidelines focus on the criteria for deciding which treatment is best for each patient and on the particular conditions that apply to treatment with fexinidazole, which should be done under the strict supervision of trained medical personnel,” said Dr José Ramon Franco Minguell, Medical Officer in charge of WHO’s human African trypanosomiasis control programme. “This includes administration of the medicine only if a patient has had an appropriate intake of food, to enable the medicine to act efficiently and for the completion of a full 10-day treatment schedule.

Sleeping sickness is a serious, life-threatening disease, and recommendations regarding the correct administration of medicines are considered key elements that should be followed.

The updated guidelines are primarily targeted at policy-makers in ministries of health and medical staff looking after affected patients. The guidelines also take into consideration that the disease occurs in remote areas and is managed in health facilities with limited resources.

Sleeping sickness caused devastating epidemics during the 20th century but coordinated efforts by control programmes in affected countries brought the disease under control. A resurgence in the late 1990s prompted a redoubling of efforts, which has yielded a 95% reduction in the number of cases over the past 15 years.

In 2017 there were 1442 cases reported to WHO; within a year, this number had dropped to 977 – a historical low. Progress in the Democratic Republic of the Congo (the most affected country) over just the past 5 years has shown an 88% reduction in the number of cases.

The parasite that causes sleeping sickness is transmitted to humans through the bite of the tsetse fly (Glossina genus) that has acquired the infection from humans or animals harbouring the human pathogenic parasites.

There are two main forms of the disease: Trypanosoma brucei gambiense (accounting for more than 98% of all reported cases) and Trypanosoma brucei rhodesiense (accounting for the remainder of cases).

Ashok Moloo
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