Plos Neglected Tropical Diaseses, vol. 5 (2011) Issue 7 e1233. Open Access. Please download from the website
FIND and Standard Diagnostics (SD) have developed a lateral flow rapid diagnostic test (RDT) to screen for
T.b. gambiense HAT that is cheap and easy to use. The tests are packed individually and are stable at 40°C for
up to 25 months; they are performed on fresh blood obtained from a finger prick..., and no instrument or electricity is required. The RDT detects host antibodies to infection in populations that are at risk, or in suspect individuals. Positive cases are subjected to further confirmatory methods to identify HAT patients.
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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 objectives of the meeting were:
1. To update the current status of the disease transmission, country capacities and plans for tackling the disease.
2. To understand the epidemiology including disease distribution and risk, the models
for estimating under-detection, the geographical variati...ons of in clinical presentation,
the roles of domestic and wild animal reservoirs and the subsequent different
transmission patterns and control approaches, including vector control.
3. To update current research and development efforts for improving diagnostic and
treatment tools.
4. To define the goals for achieving the control of r-HAT, the need for a multisectoral
approach and to discuss the strategy for controlling r-HAT and the coordination
mechanisms.
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The epidemiology of the disease is mediated by the interaction of the parasite (trypanosome) with the vectors (tsetse flies), as well as with the human and animal hosts within a particular environment. Related to these interactions, the disease is confined in spatially limited areas called “foci..., which are located
in Sub-Saharan Africa, mainly in remote rural areas. The risk of contracting HAT is, therefore, determined by the possibility of contact of a human being with an infected tsetse fly. Epidemics of HAT were described at the beginning of the 20th century; intensive activities have been set up to confront the disease, and it was under control in the 1960s, with fewer than 5,000 cases reported in the whole continent.
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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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The development of this target product profile (TPP) was led by the WHO Department of Control of Ne-
glected 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... formed, 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 in-
dependent experts included leading scientists, public health officials and endemic-country end-user rep-
resentatives. 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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In support of the London Declaration goals, PATH aims to catalyze engagement of the diagnostics industry and product development efforts. As part of this work, PATH conducted a diagnostic landscape analysis to identify gaps and evaluated current and nascent HAT diagnostics that may provide solutions....
We conducted literature reviews and interviews with key stakeholders to identify use cases for HAT diagnostics, understand current practices, and analyze progress toward more robust diagnostics across
different biomarkers.
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Treatment of second-stage gambiense human African trypanosomiasis relied on toxicarsenic-based derivatives for over 50 years. The availability and subsequent use of eflornithine,initially in monotherapy and more recently in combination with nifurtimox (NECT), has drasticallyimproved the pro...gnosis of treated patients. However, NECT logistic and nursing requirementsremain obstacles to its deployment and use in peripheral health structures in rural sub-SaharanAfrica. Two oral compounds, fexinidazole and SCYX-7158, are currently in clinical development.The main scope of this article is to discuss the potential impact of new oral therapies to improvediagnosis-treatment algorithms and patients’access to treatment, and to contribute to reach theobjectives of the recently launched gambiense humanAfrican trypanosomiasis elimination program
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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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This report provides a review and analysis of the research landscape for three diseases – Chagas disease, human African trypanosomiasis and leishmaniasis – that disproportionately afflict poor and remote populations with limited access to health services. It represents the work of the disease re...ference group on Chagas Disease, Human African Trypanosomiasis and Leishmaniasis (DRG3) which was established to identify key research priorities through review of research evidence and input from stakeholders' consultations.
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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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A clear understanding of the knowledge, attitudes and practices (KAP) of a particular community is necessary in order to improve control of human African trypanosomiasis (HAT).New screening and diagnostic tools and strategies were introduced into South Sudan, as part of integrated delivery of primar...y healthcare. Knowledge and awareness on HAT, its new/improved screening and diagnostic tools, the places and processes of getting a confirmatory diagnosis and treatment are crucial to the success of this strategy.
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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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This toolkit for integrated vector management (IVM) is designed to help national and regional programme managers coordinate across sectors to design and run large IVM programmes.
The toolkit provides the technical detail required to plan, implement, monitor and evaluate an IVM approach. IVM can... be used when the aim is to control or eliminate vector-borne diseases and can also contribute to insecticide resistance management. This toolkit provides information on where vector-borne diseases are endemic and what interventions should be used, presenting case studies on IVM as well as relevant guidance documents for reference.
The diseases that are the focus of this toolkit are malaria, lymphatic filariasis, dengue, leishmaniasis, onchocerciasis, human African trypanosomiasis and schistosomiasis. It also includes information on other viral diseases (Rift Valley fever, West Nile fever, Chikungunya, yellow fever) and trachoma. If other vector-borne diseases appear in a country or area, vector control with an IVM approach should be adopted, as per national priorities.
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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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DNDi’s long-term goal for sleeping sickness, also known as human African trypanosomiasis (HAT), is to develop and register two new drugs that are effective against both Stage 1 and Stage 2 of the disease and both subspecies of the parasite, T.b. gambiense and T.b. rhodesiense. T.b. rhodesiense is ...an acute form of the disease, occurring primarily in Eastern and Southern Africa. Better treatments for T.b. rhodesiense sleeping sickness are urgently needed.
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Chapter 6 contents
Malaria
Human African trypanosomiasis (sleeping sickness)
American trypanosomiasis (Chagas disease)
Leishmaniases
Intestinal protozoan infections (parasitic diarrhoea)
Flukes
Schistosomiases
Cestodes
Nematode infections
Filariasis
...
Onchocerciasis (river blindness)
Loiasis.
Lymphatic filariasis (LF)
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A wide spectrum of disease severity has been described for Human African Trypanosomiasis (HAT) due to
Trypanosoma brucei rhodesiense (T.b. rhodesiense), ranging from chronic disease patterns in southern countries of East Africa to an increase in virulence towards the north. However, only limited d...ata on the clinical presentation of T.b. rhodesiense HAT is available. From 2006-2009 we conducted the first clinical trial program (I MPAMEL III) in T.b. rhodesiense endemic areas of
Tanzania and Uganda in accordance with international standards (ICH-GCP). The primary and secondary outcome measures were safety and efficacy of an abridged melarsoprol schedule for treatment of second stage disease. Based on diagnostic findings and clinical examinations at baseline we describe the clinical presentation of T.b. rhodesiense HAT in second stage patients from two distinct geographical settings in East Africa.
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