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116 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES
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Treatment results showed that 87% of people at high risk of the disease lived within 5 hours’
travel time to access the first stage of treatment. However, for the second stage, which requires
complex administration of treatment by skilled staff, access within 5 hours’ travel time is 74%
for people at high risk (6).
In 2014, WHO convened its first meeting of stakeholders on the elimination of
gambiense human African trypanosomiasis (g-HAT) attended by national sleeping sickness
control programmes, groups developing new tools to fight the disease, international and
nongovernmental organizations, and donors. The meeting agreed to establish a WHO-led
network to ensure a coordinated, strengthened and sustained effort to eliminate g-HAT (7).
The first available indicator of progress towards elimination of g-HAT is the global number of
cases reported annually. In 2012, the observed gap of 1106 more reported cases than expected,
a deviation of 18% (7106/6000), was mainly due to cumulative cases from preceding years.
These cases were detected in 2012 in Orientale province (Democratic Republic of the Congo)
and Ouham foci (Central African Republic) when improved security facilitated access to areas
not visited for some years and the detection of cumulated cases for 2–3 years. In 2013, the
indicator was improved and the gap observed was of 728 more reported cases than expected, a
deviation of 13% (6228/5500).
The second indicator, the proportion of foci eliminated, will be calculated as for 2015.
In collaboration with FAO, under the framework of the Programme Against African
Trypanosomiasis, WHO has completed the Atlas of human African trypanosomiasis for the
period 2000–2012. The Atlas maps control activities and cases reported at village level. The
36 endemic countries have completed their mapping, including 196 667 cases and 30 321
geographical sites (8). The Atlas is a powerful tool that can help endemic countries prepare
control strategies, implement interventions, monitor their impact and sustain progress
through surveillance. Using the data in the Atlas and population layers, a methodology has
been developed to calculate secondary indicators to assess the quality and extent of activities
and elimination programmes. These indicators include the proportion of the population at risk
that is covered by control and surveillance activities, the geographical extent of the disease and
the population at different levels of risk (9).
Research priorities
The current rapid test for screening populations at risk of T.b. gambiense is based on native
antigen with limited production. The development of a new-generation test using recombinant
antigens is needed to improve costs and overcome the restrictions of native antigen. Blood or
urine tests for stage determination will still require the feared lumbar puncture.
A specimen bank set up by WHO in 2009 is available to researchers to facilitate the
development of new and affordable diagnostic tools. The bank contains samples of blood,
serum, cerebrospinal fluid, saliva and urine from patients infected with both forms of the disease