Sleeping Sickness

Sleeping Sickness, or Trypanosomiasis, is a protozoan borne disease afflicting 36 countries in sub saharan Africa. The disease is transmitted through the bite of the tsetse fly, and has had its transmission rates falling since the turn of the century, with less than 10,000 cases in 2009, and less than 3,000 in 2015. The disease takes two forms, Trypanosoma brucei gambiense, which affects west and central africa while accounting for around 97-98% of all cases reported. This is the more mild of the two, leaving the infected largely asymptomatic until the disease has already reached the nervous system. Trypanosoma brucei rhodesiense affects southern and eastern Africa, attacking the host within a few weeks. The only country to share both forms of the disease is Uganda, however, it afflicts different areas. A similar disease, Chagas, is present in South America, however it is caused by different protozoa. A version that affects both domestic and wild animals exists, however it is also common for the human disease to exist in a reservoir of domestic cattle.

The disease, while ancient, has had few outbreaks since the 20th century. While contained relatively well after an epidemic during 1920, containment lapsed and the disease spread during the 1970’s, leading to an epidemic lasting through the 90’s. Since 2000 however, the disease has dropped by 73%, and the WHO expects it to be eliminated by 2020.

The disease largely affects those in the Congo, it being the only country in recent history to annually have 1,000 new cases. Most of these cases are in rural villages far from a health system. This is a problem in fighting the disease, as infected may have already spread the disease without knowing.  

The disease has been documented to pass from mother to fetus, as well as sexually. This adds further complications as the tsetse fly is not the only vector able to spread the disease. The symptoms of the disease come in two stages, the first, with fever, aches, and itching. After the protozoa pass the blood brain barrier, it becomes neurological, and the disease starts to affect coordination, the sleep cycle, and can become fatal.

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Treatment depends on the stage of symptoms present, if in the first stage, the drugs are relatively harmless, each tooled to the specific strain, Pentamidine and Suramin for Gambiense and Rhodesiense respectively. However, for the second stage of symptoms, treatment is much harder. Nifurtimox and eflornithine are administered through IV’s in a complex process.

To combat the disease on the whole, the WHO has partnered with Aventis and Bayer healthcare to better end the disease. The drugs are provided free of charge to endemic countries in hopes of a quick resolution. As it stands now, the objectives of the WHO are to

  • strengthen and coordinate control measures and ensure field activities are sustained;
  • strengthen surveillance systems;
  • ensure accessibility to the diagnosis and the best treatment available;
  • support the monitoring of treatment and drug resistance;
  • develop an information database for epidemiological analysis, including the atlas of the human African trypanosomiasis, completed in collaboration with the Food and Agriculture Organization (FAO);
  • ensure skilled staff by offering training activities;
  • support operational research to improve diagnostic and treatment tools;
  • promote collaboration with the FAO in charge of animal trypanosomiasis and the International Atomic Energy Agency (IAEA) dealing with vector control through male flies made sterile by radiation. The 3 UN agencies along with the African Union have promoted the Programme Against African Trypanosomiasis (PAAT);
  • synergize vector and disease control activities in collaboration with the Pan African Tsetse and Trypanosomosis Eradication Campaign (PATTEC) of the African Union.

In summary, the disease, while dangerous, has had its infection rates fall sharply in most countries, but the DRC still has high infection rates. The disease is able to exist in multiple forms and vectors all across Africa, meaning a comprehensive solution in necessary to fully combat the disease. That being said, the strategy that the U.N. and WHO has been deploying has been effective, meaning that the 2020 goal may be a success.

http://www.who.int/mediacentre/factsheets/fs259/en/

http://www.dovemed.com/diseases-conditions/sleeping-sickness/

http://www.doctorswithoutborders.org/issue/sleeping-sickness

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