Human African trypanosomiasis (HAT), otherwise known as sleeping sickness, is a life-threatening disease that afflicts poor rural people. Transmitted 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.
Today, countries and communities are fighting back with vigor and determination, with 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 territory .
Uganda is the only country where both forms are endemic but has now succeeded in eliminating the Gambian form as a public health problem. The country remains committed to eliminating the Rhodesian form as well, which affects central and southern regions.
turn the tables
This is great news and the result of determined efforts to turn the tide on sleeping sickness.
At the beginning of the 21st century, a large number of HAT cases were being reported. In 2001, WHO therefore launched an initiative to strengthen the surveillance and control of the disease in all endemic countries. This has led to a gradual decline in incidence, with cases falling below 1,000 per year for the first time in 2018.
This prompted the 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 detailed dossiers to WHO for evaluation by an independent panel of experts to determine whether the elimination criteria have been met.
Rigorous testing and monitoring
Togo and Ivory Coast were the first two countries to be validated as having eliminated Gambiense form of HAT as a public health problem in 2020.
Since then, three more countries have received validation: Benin and Uganda (November 2021 and April 2022 respectively) have been validated as having eliminated the Gambian form of sleeping sickness, while Rwanda has received validation for the Rhodesian form in April 2022.
All three countries have carried out extensive laboratory testing and reactive interventions in areas where cases have been diagnosed, and have also undertaken interventions to target vectors of the disease, in this case tsetse flies. They have also demonstrated that they have detailed plans for ongoing HAT surveillance to watch for other disease outbreaks.
Towards the elimination of transmission
The validation of elimination in Benin, Uganda and Rwanda is an important step towards the widespread elimination of both forms of HAT as public health problems.
It is also an important step on the way to the ultimate goal, namely the elimination of transmission gambiense HAT by 2030 to achieve the NTD 2030 roadmap target.
The other good news is that many others are following in the footsteps of these countries and are currently submitting their own dossiers for validation.
Congratulations to Benin, Uganda and Rwanda – and many more countries that will soon follow in their footsteps!