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Sleeping sickness

Sleeping sickness, or human African trypanosomiasis (HAT), is a fatal parasitic disease that affects 36 countries in sub-Saharan Africa: 60 million people are at risk. Nearly eliminated in the 1960s, HAT has been making a comeback of epidemic proportions due to war, population movements and the collapse of health systems over the past two decades.

Sleeping sickness is caused by two sub-species of Trypanosoma parasites, which are transmitted to humans by tsetse flies. The disease has two stages. The early stage entails bouts of fever, headaches, pains in the joints and itching. The second, known as the neurological phase, begins when the parasite crosses the blood-brain barrier and infests the central nervous system. Without treatment, the disease is fatal.

Treatment with arsenic kills up to one in ten patients

"It's a terrible drug – you don't feel proud injecting it. It is caustic, it burns them, and you don't know if you are going to save your patient or kill him" – MSF Doctor, Uganda.

Most infected people only seek treatment when the disease has already advanced to the second stage. The most common treatment at this stage in national control programmes is melarsoprol, an archaic drug introduced in 1949. Melarsoprol contains arsenic, is extremely painful when injected, and kills 3-10% of patients treated.

New hope from the 'resurrection' drug: effective but costly

In the 1990s it was found that eflornithine, a drug originally developed against cancer,  was extremely effective against the disease. Its success led to it being dubbed the 'resurrection drug'.   But it came with a heavy price tag. Following a strong advocacy campaign by MSF and other organisations, the pharmaceutical company Aventis (now Sanofi-Aventis) came to an agreement with WHO in 2001 (an agreement renewed in 2006) to make the drug available through a donation programme. Since then the drug has been in wide use in programmes run by non-governmental organisations.

But the uptake has been much slower by national control programmes. This is largely down to the complexity of the procedure to administer the drug: intravenous infusions need to be given at 6 hourly intervals over a 14 day period.  This requires round the clock nursing care and the resources and training to administer infusions.  

In 2007, WHO and MSF organised the production of medical kits containing all the necessary drugs and infusion materials, available at no cost for national control programmes.

Further challenges

Despite the success of eflornithine, there is a concern that continuing to use it as a monotherapy will lead to parasite resistance. This could have catastrophic consequences. It is crucial therefore to use this drug in combination with other drugs. A promising option today is the combination of eflornithine, administered twice a day for 7 days only, with oral nifurtimox. A clinical trial involving these drugs, initiated by MSF and now sponsored by the DNDi and WHO, is presently underway.

MSF and sleeping sickness

MSF teams first encountered an epidemic of human African trypanosomiasis or sleeping sickness in Uganda's West Nile region in 1986 among displaced people from Sudan and Uganda. As of December 2005, MSF programmes had screened at least 2 400 000 people and treated approximately 43 000 patients. The majority of these patients were already at an advanced stage of the disease. MSF remains active with ongoing programmes running in three countries; Democratic Republic of Congo, Sudan and Central African Republic. MSF is also involved in several research studies to push forward treatment and diagnostic options.

 

Read Sleeping Sickness Fact Sheet 

Read report 'Facing the Challenges caused by Neglect' 

This 2006 report presents overall global
trends as well as MSF's perspective on the current
situation regarding diagnostics and treatment for human african trypanosomiasis (HAT) or sleeping sickness