In this subsequent part of the issue brief on the NTD Toolbox you will learn about general strategies, roadmaps, key
treatment guidelines, reports, and training material on Dengue & Chikungunya, Human African Trypanosomiasis and
Leprosy.
PLOS Neglected Tropical Diseases 18(4): e0012111. https://doi.org/10.1371/journal.pntd.0012111
PLOS Neglected Tropical Diseases 18(5): e0012091. https://doi.org/10.1371/journal.pntd.0012091
The present guidelines incorporate all these changes, leading to a substantial reconfiguration of therapeutic choices for both disease forms.
HAT is a serious, life-threatening disease and the efficacy of fexinidazole depends on swallowing the medicine after an appropriate intake of food as well as... on completing the full 10-day treatment schedule. Therefore, the recommendations regarding fexinidazole administration are considered key elements that must be carefully followed. When the conditions listed in these guidelines are not met for any individual patient, the alternative available treatments should be prescribed.
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The WHO interim guidelines for the treatment of gambiense HAT, issued in 2019 added as a therapeutic option the new medicine fexinidazole. Thanks to its recent extension of indication, fexinidazole is now also recommended for treatment of rhodesiense HAT.
Human African trypanosomiasis (HAT), or sleeping sickness, is caused by trypanosome parasites that are transmitted by tsetse flies. HAT is found only in sub-Saharan Africa. Two subspecies of Trypanosoma brucei cause disease: T. b. gambiense in West and Central Africa, and T. b. rhodesiense in East A...frica.
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The development of this target product profile (TPP) was led by the WHO Department of Control of Neglected Tropical Diseases (NTD) following standard WHO guidance for TPP development. In order to identify and prioritize diagnostic needs, a WHO NTD Diagnostics Technical Advisory Group (DTAG) was form...ed, and different subgroups were created to advise on specific NTDs, including a subgroup working on the human African trypanosomiasis (HAT) diagnostic innovation needs. This group of independent experts included leading scientists, public health officials and endemic-country end-user representatives. Standard WHO Declaration of Interest procedures were followed. A landscape analysis of the available products and of the development pipeline was conducted, and the salient areas with unmet needs were identified.
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The main purpose of the meeting was to review tsetse control tools, activities and their contribution to the elimination of gHAT and the monitoring thereof. Seven endemic countries provided reports on recent and ongoing vector control interventions at the national level (Angola, Cameroon, Côte d’...Ivoire, Chad, Democratic Republic of the Congo, Guinea and Uganda). Country reports focused on the in situations implementing and supporting vector control activities, the tools and the approaches in use, the coverage of the activities in space and time and their impacts on tsetse populations. Future perspectives for vector control in the respective countries were also discussed, including opportunities and challenges to sustainability.
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WHO convened the fifth stakeholders meeting on the elimination of HAT due to infection with Trypanosoma brucei gambiense (g-HAT) and Trypanosoma brucei rhodesiense (r-HAT) in Geneva, Switzerland, on 7–9 June 2023. The meeting was held again in person after the coronavirus disease (COVID-19) pandem...ic and jointly for both forms of the disease. The previous meetings on g-HAT held in 2014, 2016 and 2018, as well as on r-HAT in 2015, 2017 and 2019, and jointly for g-HAT and r-HAT in 2021 (8) reinforced the partnership and commitment for HAT elimination and structured the mechanisms of collaboration within the WHO network for HAT elimination. The network includes NSSCPs, groups developing new tools, international and nongovernmental organizations involved in disease control, and donors.
Fewer than 1000 cases of HAT annually have been reported over the past 5 years, which is a historic achievement. The area at risk has been substantially reduced. The elimination of HAT as a public health problem at the global level has been achieved.
The new road map for neglected tropical diseases (NTDs) 2021−2030 (“the road map”) with the target to interrupt the transmission of g-HAT requires the strengthened and sustained efforts of all stakeholders, national authorities and partners, under WHO coordination. It will take disproportionally high efforts and innovative strategies to find the last cases of g-HAT and neutralize its transmission. Given the limited resources and other competing public health priorities, this is a challenge that requires our joint commitment.
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Human African trypanosomiasis (HAT), also called sleeping sickness, is a parasitic infection that almost invariably progresses to death, unless treatment is provided. HAT caused devastating epidemics during the 20th century. Thanks to sustained and coordinated efforts during the past 15 years the nu...mber of reported cases has fallen to a historic low. Fewer than 3,000 cases were reported in 2015, and the disease is targeted for elimination by the World Health Organization. Despite recent success, HAT still poses a heavy burden on the rural communities where this highly focal disease occurs, most notably in Central Africa. Since patients are also reported from non-endemic countries outside Africa, HAT should be considered in differential diagnosis for all travellers, tourists, migrants and expatriates who have visited or lived in endemic areas. In the absence of a vaccine, disease control relies on case detection and treatment, and vector control. Available drugs are sub-optimal, but ongoing clinical trials give hope for safer and simpler treatments.
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Human African trypanosomiasis (HAT), or sleeping sickness, is an endemic disease in 36 sub-Saharan African countries, typically occurring in underdeveloped areas, where
health systems face significant difficulties of diverse natures.
The previous report of the WHO Expert Committee on this disease
followed a meeting in 1995. Intensive, coordinated efforts against HAT during
the intervening 18 years have resulted in a decrease in incidence to a point at
which elimination is considered feasible. This report provides informati...on about
new diagnostic approaches, new therapeutic regimens and better understanding
of the distribution of the disease with high-quality mapping. The roles of human
and animal reservoirs and the tsetse fly vectors that transmit the parasites are
emphasized. The new information has formed the basis for an integrated strategy
with which it is hoped that elimination of HAT will be achieved. The report also
contains recommendations on the approaches that will lead to elimination of the
disease.
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Full Perscribing information on Fexinidazole Tablet for oral use
INDICATIONS AND USAGE
Fexinidazole Tablets are indicated for the treatment of both the first-stage (hemolymphatic) and second-stage (meningoencephalitic) human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense in pati...ents 6 years of age and older and weighing at least 20 kg.
Limitations of Use
Due to the decreased efficacy observed in patients with severe second stage HAT (cerebrospinal fluid white blood cell count (CSF-WBC) >100 cells/μL) due to T. brucei gambiense disease, Fexinidazole Tablets should only be used in these patients if there are no other available treatment options [see Warnings and Precautions (5.1)]
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Un comité OMS d’experts sur la trypanosomiase humaine africaine (THA) : lutte et surveillance, s’est réuni à Genève (Suisse), du 22 au 26 avril 2013. Le Dr H. Nakatani, sous-directeur général pour le VIH/SIDA, la tuberculose, le paludisme et les maladies tropicales négligées, a ouvert la... réunion au nom du Dr M. Chan, directeur-général de l’OMS.
La THA est une maladie qui afflige les populations rurales de l’Afrique, là où prolifère la mouche tsé-tsé (ou glossine), vecteur des trypanosomes qui en sont la cause. On distingue deux formes de THA : la forme à T. b. gambiense ou forme gambienne, endémique en Afrique de l’Ouest et en Afrique centrale et qui
représente actuellement 95 % des cas, et la forme à T. b. rhodesiense ou forme rhodésienne, endémique en Afrique de l’Est et en Afrique australe, à laquelle sont dus les 5 % restants.
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Les progrès remarquables réalisés dans la lutte contre la forme à T. b. gambiense reposent sur le dépistage et le traitement curatif, une stratégie qui interrompt la transmission en réduisant le réservoir de parasites chez l’être humain. Parfois, cette
approche a été combinée avec des... activités de lutte antivectorielle. L’objet de ces lignes directrices est donc de la plus haute importance pour la poursuite des progrès en vue de l’élimination de la THA.
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Human African trypanosomiasis (HAT) is a lethal neglected tropical disease (NTD) transmitted by the bite of infected tsetse flies. The disease is also known as “sleeping sickness”. During the 20th century it caused enormous suffering in the endemic areas in sub-Saharan Africa. HAT transmission l...ast soared in the late 1990s, triggering a renewed, coordinated and very successful control effort. In this paper, we present achievements towards HAT elimination, with a focus on the WHO road map targets for 2020. In particular, reported cases continue to decline, from over 30,000 cases per year at the turn of the century to 663 cases in 2020. Despite the impact of the COVID-19 pandemic, HAT surveillance was largely sustained, and the network of health facilities able to diagnose and treat the disease further expanded. Looking to the future, the World Health Organization (WHO) set bold new targets for HAT in its 2021–2030 road map for NTDs, namely: the elimination of transmission of gambiense HAT, which occurs in western and central Africa, and the elimination as a public health problem of rhodesiense HAT, which is found in eastern and southern Africa. The strong commitment of national health authorities and the international community will be essential if these goals are to be achieved.
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This analysis focused on the chronic form of HAT caused by T. b. gambiense, as it contributes to the majority of disease burden. Information from the literature review,
product development landscape, and stakeholder interviews was compiled to:
- Identify use cases and understand current diagnosti...c practices and tools associated with each use case.
- Analyze progress toward robust diagnostics for HAT across different biomarkers.
- Develop recommendations for steps to improve the availability, access, and adoption of HAT diagnostic tools.
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Human African Trypanosomiasis (HAT, sleeping sickness) and Animal African Trypanosomiasis (AAT) are neglected tropical diseases generally caused by the same etiological agent, Trypanosoma brucei. Despite important advances in the reduction or disappearance of HAT cases, AAT represents a risky reserv...oir of the infections. There is a strong need to control AAT, as is claimed by the European Commission in a recent document on the reservation of antimicrobials for human use. Control of AAT is considered part of the One Health approach established by the FAO program against African Trypanosomiasis. Under the umbrella of the One Health concepts, in this work, by analyzing the pharmacological properties of the therapeutic options against Trypanosoma brucei spp., we underline the need for clearer and more defined guidelines in the employment of drugs designed for HAT and AAT. Essential requirements are addressed to meet the challenge of drug use and drug resistance development. This approach shall avoid inter-species cross-resistance phenomena and retain drugs therapeutic activity.
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Since 2000, concerted efforts by national programmes, supported by public–private partnerships, nongovernmental organizations, donors and academia under the auspices and coordination of the World Health Organization (WHO), have produced important achievements in the control of human African trypan...osomiasis (HAT). As a consequence, the disease was targeted for elimination as a public health problem by 2020. The Sixty-sixth World Health Assembly endorsed this goal in resolution WHA66.12 on neglected tropical diseases, adopted in 2013.
National sleeping sickness control programmes (NSSCPs) are core to progressing control of the disease and in adapting to the different epidemiological situations. The involvement of different partners, as well as the support and trust of long-term donors, has been crucial for the achievements.
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The twentieth century ended with human African trypanosomiasis (HAT) epidemics raging across many parts of Africa. Resistance to existing drugs was emerging, and many programs aiming to contain the disease had ground to a halt, given previous success against HAT and the competing priorities associat...ed with other medical crises ravaging the continent. A series of dedicated interventions and the introduction of innovative routes to develop drugs, involving Product Development Partnerships, has led to a dramatic turnaround in the fight against HAT caused by Trypanosoma brucei gambiense. The World Health Organization have been able to optimize the use of existing tools to monitor and intervene in the disease. A promising new oral medication for stage 1 HAT, pafuramidine maleate, ultimately failed due to unforeseen toxicity issues. However, the clinical trials for this compound demonstrated the possibility of conducting such trials in the resource-poor settings of rural Africa.
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