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48 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES
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Cutaneous leishmaniasis
Until 2007, control of cutaneous leishmaniasis was not achieving the desired results.
That year, WHO set up a network aimed at intensifying surveillance and control activities.
This promising initiative, however, faced a major difficulty: the lack of skilled personnel to
implement the intensified control activities. In response, WHO in collaboration with the Open
University of Catalonia, Spain, devised a comprehensive 3-month training course for health
personnel working in cutaneous leishmaniasis control programmes. Participants can access the
course online and receive guidance from trainers through two-way internet communication
technology (e.g. Skype). Participants sit an examination on completion of the course.
Visceral leishmaniasis (kala-azar)
The medicines traditionally used to treat patients with visceral leishmaniasis have proven
too costly, too toxic and of limited efficacy. Ten years ago, clinical trials confirmed the efficacy
of a new medicine – liposomal amphotericin B (AmBisome) – but treatment regimens have
tended to be too prolonged and too costly, and they also require administration by multiple
injections. In 2012, a study supported by WHO showed that a single injection was as effective
as the multiple-injection regimens. WHO has encouraged countries affected by the disease
to incorporate the new regimen in their kala-azar control strategies. Bangladesh was the first
country to comply. Thanks to a WHO-brokered donation of AmBisome by the manufacturer,
more countries, notably Bhutan, Ethiopia, Nepal, Sudan, South Sudan and, most recently,
India, have decided to incorporate it in their control strategies.
Human African trypanosomiasis (sleeping sickness)
By 1964, mass screening and treatment campaigns in West and Central Africa had reduced
the prevalence of human African trypanosomiasis to a record 4500 cases. Over the next four
decades, however, the disease resurged to an estimated prevalence of more than 300 000 cases.
From 2000, WHO intensified control measures by deploying mobile teams to screen entire
populations in vast areas of the continent believed to harbour the disease. This strategy reduced
the prevalence to fewer than 7000 cases.
Several hurdles hampered continued control efforts. The mobile teams had to systematically
screen all populations at risk in order to detect the infection at an early stage, before the
causative parasite reached the brain. Early detection also made it possible to treat patients
with pentamidine, a much safer medicine than melarsoprol and as effective, but only for those
patients with early infection.
Melarsopol, once the only medicine available to treat late-stage disease, is complex to
administer, highly toxic and kills about 5–10% of patients. In 2001, eflornithine, a less toxic
medicine, became available free of charge but proved too difficult to administer by unskilled