Benin, Uganda and Rwanda eliminate human African trypanosomiasis as a public health problem

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!

From WHO

By Manuel Lluberas

I am a public health entomologist with extensive experience in the control of insects of public health and veterinary importance obtained during the past three decades, including twelve years as medical entomologist and medical intelligence officer for the US Navy attached to the US Marines. I have provided technical assistance on the design, implementation, evaluation, and technical capacity building on integrated vector management to ministries of health and agriculture, private and public entities, and UN agencies in four continents. Some of my most significant accomplishments include designing the indoor residual spraying (IRS) campaign against malaria vectors of the US President's Malaria Initiative for Sub Saharan Africa (PMI); helping the University of South Florida and The Bill & Melinda Gates Foundation develop the habitat signatures for mosquito vectors in Cambodia using spectral signatures from sub-meter pixel data obtained from 5 satellites; and conducting Entomological Monitoring and Vector Control Capacity Evaluations against Aedes aegypti (vector of Dengue, Zika and Chikungunya) for portions of Central America under projects with USAID. Other projects include developing and implementing the mosquito population suppression strategies in Banda Aceh and Western Sumatra, Indonesia after the Tsunami of 2005; helping Haiti's Ministry of Health and Population develop mosquito control protocols in the aftermath of the earthquake of 2010; and assisting the Pan Africa Tsetse fly and Trypanosomiasis Eradication Campaign reduce sleeping sickness in parts of West Africa. I have been a member of the Vector Control Working Group of WHO’s Roll Back Malaria Campaign since its inception, have over thirty technical articles on vector management published, wrote a column on Malaria World for two years, contributed to the publication of WHO’s Global Plan for Insecticide Resistance Management in Malaria Vectors, and drafted the first two drafts of WHO’s Operational Manual for Indoor Residual Spraying. I’ve presented numerous keynote addresses and lectures on integrated vector management in Spanish and English in several international congresses on vector control in Africa, Europe, South America, and the United States, and provide simultaneous translation from Spanish to English for the Latin America Symposia for the American Mosquito Control Association. I was twice selected as finalist for the Rear Admiral Charles S. Stevenson Award for excellence in Preventive Medicine, the top award in US Navy Medicine and received the Meritorious Service Medal from the American Mosquito Control Association. I hold an FAA certification as a Remote Pilot of a small, Unmanned Aerial System (sUAS or drone) and a 25-Ton Master Captain Certificate with sailing endorsement from the US Coast Guard.

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