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KEY INTERVENTIONS: SITUATION REPORT − CHAPTER 3
47
3.1.3 IDM at work
Buruli ulcer
Until 2004, control of Buruli ulcer consisted mainly of surgery to remove infected tissue.
The procedure was done at a late stage in the course of the disease, when severe lesions are
common. Surgery usually involved multiple operations and hospitalization of about 3 months,
if and where an adequately equipped hospital was available. As Buruli ulcer is caused by a
mycobacterium of the same family as the causative agents of tuberculosis and leprosy, in 2004
the possibility was mooted that it might respond to treatment with the existing antibiotics
that had proven effective against the two related mycobacterial infections. This possibility was
confirmed and opened the door to a completely new control strategy, making treatment of
patients feasible at an early stage of the disease before mutilating lesions developed that could
only be managed by surgery.
Early treatment, however, calls for early diagnosis. For want of simple diagnostic tools,
diagnosis was traditionally based on clinical examination. Confirmation of diagnosis required
laboratory resources that are often absent in the resource-poor areas where the disease prevails.
The search is now on for a field-friendly diagnostic test that is based on detection of the toxin
itself and that will enhance the overall effectiveness of the new strategy.
Chagas disease
Chagas disease has traditionally been thought to be endemic only in Latin America, hence its
name, American trypanosomiasis. In 2007, following the deaths of a few transfusion or organ
graft recipients in Europe, WHO surveys found many cases of the disease among Latin American
immigrants to Europe. This finding prompted WHO to launch a Non-Endemic Countries
Initiative aimed at assessing the prevalence and possible transmission of Trypanosoma cruzi
infection in countries where vectorial transmission had never been reported. The findings of
surveys carried out by the Initiative convinced many countries, including Australia, Canada,
Japan, the United States of America and several European countries, to set up surveillance
systems to track the disease.
Today, a worldwide Chagas disease surveillance system is in place. It focuses mainly on
transmission of the infection via blood transfusion and organ transplantation but also on
congenital transmission. A recent development is the finding in many countries, especially
in Asia, of Chagas disease vectors capable of transmitting the infection and thereby raising
the risk of establishing vector transmission in these countries. According to surveillance
findings, about 7 million people are infected worldwide, mostly in the endemic areas of 21
Latin American countries. A study published in 2011 reported an estimated 68 000–123 000
cases in nine European countries: Belgium, France, Germany, Italy, the Netherlands, Portugal,
Spain, Switzerland and the United Kingdom (1).