On 24 May 2022, the World Health Organization (WHO) reported that three African countries, Benin, Uganda and Rwanda have received validation that they have eliminated at least one form of Human African trypanosomiasis (HAT).
HAT, otherwise known as sleeping sickness, is a life-threatening disease that afflicts poor rural populations. Carried by tsetse flies, the disease has for a long-time affected communities in West, Central and East Africa, where two different variants of the disease, gambiense and rhodesiense, were rife.
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.
At the beginning of the twenty-first century, large numbers of HAT cases were being reported, which in 2001 led to the WHO launching an initiative to reinforce surveillance and control of the disease in all endemic countries. A progressive decrease in incidence was noted, with cases going below 1,000 annually for the first time in 2018, prompting 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 extensive dossiers to the WHO for assessment by an independent group of experts, who determine whether the criteria for elimination have been met.
Togo and Côte d’Ivoire were the first two countries to be validated as having eliminated the gambiense form of HAT as a public health problem, in 2020. Since then, 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, tsetse flies. They have also demonstrated that they have detailed plans for ongoing HAT surveillance, monitoring for further outbreaks of disease.
Validation of elimination in Benin, Uganda and Rwanda is an important step towards widespread elimination of both forms of HAT as public health problems, as well as working towards the goal of eliminating the transmission of gambiense HAT by 2030 to meet the 2030 NTD road map target.
Source: WHO, 24 May 2022