BMJ: Sleeping sickness re-emerges in Africa after years of civil war
British Medical Journal 2001; 322:1382 (9 June 2001)
Roger Dobson, Abergavenny
Researchers have warned that sleeping sickness has returned to alarm-
ing levels in parts of Africa.
Sixty million people are considered to be at risk, but less than 5%
are under active surveillance, according to reports in the journal
Tropical Medicine and International Health (2001; 65: 330-361).
Southern Sudan, the Democratic Republic of Congo, and Angola are re-
ported to be among the worst affected areas, and researchers say that
international help is needed to combat the problem. "A staggering
15,0591 new cases have been detected [in the Democratic Republic of
Congo] during the past decade," said Simon van Nieuwenhove and a team
from the World Health Organization in one of four reports on sleeping
Sleeping sickness, or human African trypanosomiasis, was thought to
have been almost eradicated by the mid-1960s, but population dis-
placement, political instability, and the collapse of health systems
as a result of civil wars has seen a resurgence of the disease. Re-
searchers believe that a key to controlling the disease is surveil-
lance, but in several countries that has not been happening in recent
"In the last decades with little or no surveillance, sleeping sick-
ness has returned to alarming levels," said Pierre Cattand of the As-
sociation Against Trypanosomiasis in Africa and colleagues from the
WHO in a second report. "Sixty million people are considered at risk,
but only three to four million are under surveillance, yielding some
45,000 new cases a year. It is estimated that at least 300,000 to
500,000 are presently affected."
The disease is transmitted by the tsetse fly from game animals, cat-
tle, and pigs. The first line drug of choice is suramin unless there
is involvement of the central nervous system, in which case it would
be melarsoprol, an arsenic based compound.
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