Elimination of sleeping sickness hindered by difficult diagnosis

Overview

Sleeping sickness or human African trypanosomiasis (HAT) is a fatal disease caused by Trypanosoma brucei gambiense and T. b. rhodesiense and transmitted by tsetse flies occurring in sub-Saharan Africa. Almost 80% of cases are detected in the Democratic Republic of the Congo. Control of infection by T. b. gambiense, which causes chronic disease, relies primarily on case detection followed by treatment. The prevalence of this form of HAT has been greatly reduced through intensive campaigns based on active screening by mobile teams that travel to high-incidence settings and test the population. This “vertical” approach is no longer sustainable or cost-effective in light of decreased incidence, and a proposed alternative has been to integrate HAT control activities into the “horizontal” health system. However, organizational, logistical and technical difficulties, especially related to diagnosis, may jeopardize elimination, which is now an established goal.