Human African trypanosomiasis (HAT), otherwise known as sleeping sickness, is a life-threatening disease that afflicts poor rural populations. Carried by tsetse flies, the disease has long been a curse for communities in West, Central and East Africa, where two different variants of the disease were rife.
Now, countries and communities are fighting back with vigour and determination – and this is leading to very encouraging results.
Three countries – Benin, Uganda and Rwanda – have now received validation from the World Health Organization (WHO) that at least one form of HAT has been eliminated as a public health problem in their lands.
Uganda is the only country where both forms are endemic but has now achieved elimination as a public health problem of the gambiense form. The country remains committed to eliminating the rhodesiense form as well, which affects central and southern regions.
Turning the tables
This is excellent news and comes as a result of determined efforts to turn the tables on sleeping sickness.
At the beginning of the 21st century, large numbers of HAT cases were being reported so, in 2001, WHO launched an initiative to reinforce surveillance and control of the disease in all endemic countries. This led to a progressive decrease in incidence, with cases going below 1000 annually for the first time in 2018.
This prompted WHO to target the elimination of both variants of HAT as public health problems.
There are strict criteria for validation of elimination whereby countries submit extensive dossiers to WHO for assessment by an independent group of experts to determine whether the criteria for elimination have been met.
Rigorous testing and surveillance
Togo and Côte d’Ivoire were the first two countries to be validated as having eliminated the gambienseform of HAT as a public health problem, in 2020.
Since then, three more countries have received validation: both Benin and Uganda (in November 2021 and April 2022 respectively) were validated as having eliminated the gambiense form of sleeping sickness, while Rwanda received validation regarding the rhodesiense form in April 2022.
All three countries have carried out extensive laboratory tests and reactive interventions in areas where cases were diagnosed, and have also undertaken interventions to target the vectors of disease, in this case, the tsetse flies. They have also demonstrated that they have detailed plans for ongoing HAT surveillance, to monitor for further outbreaks of disease.
Towards elimination of transmission
Validation of elimination in Benin, Uganda and Rwanda is an important step towards widespread elimination of both forms of HAT as public health problems.
It is also an important step on the road towards the ultimate goal, namely to eliminate the transmission of gambiense HAT by 2030 to meet the 2030 NTD road map target.
The further good news is that many others are following in these countries’ footsteps and are currently submitting their own dossiers for validation.
Congratulations to Benin, Uganda and Rwanda – and here’s to even more countries following in their footsteps very soon!