Sleeping sickness, also known as Human African trypanosomiasis, has successfully been eliminated as a public health problem in the Togolese Republic, a country in West Africa. Togo has received validation from the World Health Organization as the first African country to reach this milestone.
Human African trypanosomiasis got its nickname "sleeping sickness" because it causes disruption in the sleeping patterns.
Sleeping Sickness in Africa
Sleeping sickness had become a problem in 36 countries in sub-Saharan Africa for more than a century now when the first infected man was identified. Parasites transmitted by infected tsetse flies cause sleeping sickness. If left untreated, it is almost always fatal.
About 300,000 cases have gone undetected in 1995, with over 60 million people estimated at risk. But in 2019, there were only about 1,000 cases of sleeping sickness found.
Experts have identified two forms of sleeping sickness. The first one is the Trypanosoma brucei gambiense found in 24 countries in west and central Africa, accounting for about 98 percent of the sleeping sickness cases. The second form is the Trypanosoma brucei rhodesiense, which represents the rest of the cases and is found in 13 countries in eastern and southern Africa.
The World Health Organization and its partners target to eliminate sleeping sickness as a public health problem in the entire continent by 2030, particularly the gambiense form of the disease.
With support from WHO, Ghana, Cote d'Ivoire, Cameroon, Burkina Faso, and Benin have already started the validation process.
Treatment for Human African Trypanosomiasis
Sleeping sickness is very difficult to treat considering its toxicity, the administration of drugs, and parasite resistance to medication.
Currently, there are only four drugs available to treat trypanosomiasis, which include eflornithine, melarsoprol, suramin, and pentamidine. But there is a fifth drug only administered under special authorizations, called the nifurtimox. According to WHO, pentamidine is administered to patients with an early stage of T.b. gambiense and suramin for those with T. b. rhodesiense.
How did Togo eliminate trypanosomiasis?
In the past ten years, Togo has not reported any case of trypanosomiasis. The country's achievement comes after over two decades of screening, surveillance, and sustained political commitment to eliminate sleeping sickness in Togo. Back in 2000, the country has started implementing control measures for the disease.
By 2011, Togo has already established surveillance sites in their hospitals and Tchamba and Mango cities, covering the main areas at risk of sleeping sickness. The country's public health officials have maintained heightened disease surveillance at high risk regions. Since their neighboring countries are not yet at the same stage, they had to maintain and continue the surveillance to avoid the disease's resurgence.
The country first applied for the certification of elimination of trypanosomiasis in 2018. A team from the WHO studied Togo's data and made some recommendations and requested revisions from the country before giving Togo their certificate.
WHO has supported the country in these efforts by facilitating the donation of medicine and resources from various pharmaceutical companies that helped them strengthen the local capacity and made sure that there are available tools needed for controlling the disease.
But even after WHO's validation, it will still require maintaining the commitment of different countries and donors, and also the control and surveillance activities to wipe out the gambiense form of the sleeping sickness.
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