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KEY INTERVENTIONS: SITUATION REPORT − CHAPTER 3
49
health personnel working under field conditions. In 2006, WHO partially solved the problem
by designing a medical kit containing all the materials that a health worker would need. It also
provided training in the use of these kits to all health personnel charged with administering
eflornithine. Deployment of eflornithine, however, was complicated by the possibility of drug
resistance and the difficulty of its administration in remote health centres. In 2009, a combination
of two medicines – eflornithine and nifurtimox – was devised. Combination therapy not only
reduces the risk of drug resistance developing but also halves the duration of treatment compared
with eflornithine alone.
Fexinidazole, a recently developed medicine currently in Phase III clinical trials, is
administered orally over a 10-day period. It could facilitate treatment of both stages of sleeping
sickness. A novel oxaborole compound is also under development for administration as a
single, oral dose. Its availability could be an important element in searches for sustainable
elimination of the disease.
Research is ongoing to devise new diagnostic tools that are easier to use in non-specialized
health services for the disease. This research is facilitated by a human African trypanosomiasis
specimen bank created by WHO and hosted by the Institut Pasteur in Paris, France. To date, the
bank contains nearly 50 000 samples of plasma, sera, cerebrospinal fluid, saliva and urine from
patients infected with trypanosome parasite and controls. About 3000 samples have already
been distributed to 10 international research teams (2).
The new tools for diagnosis and treatment under development could make integrated control
and surveillance in primary health-care services possible and allow sustainable elimination of
human African trypanosomiasis.
WHO provides coordination of the different partners working to eliminate human African
trypanosomiasis through the network for HAT elimination.
Yaws
From 1952 to 1964, WHO and the United Nations Children’s Fund led mass treatment
campaigns that administered injectable benzathine penicillin to some 300 million people in 46
countries. Despite a major shortcoming of this therapy, notably the need for a painful injection
that deterred many young patients, the campaign reduced the prevalence of yaws by 95% –
from 50 million cases at the start of the campaign to 2.5 million at its close.
Yaws has resurged during the past decade, particularly in parts of Africa, South-East Asia and
the Pacific Islands. Clearly, a new strategy was needed, especially as WHO in 2011 had added
yaws to its list of diseases targeted for eradication. In the following year, a study carried out in
a Papua New Guinea island where yaws is endemic showed that a single dose of an antibiotic
(azithromycin) is as effective in curing children of yaws as benzathine penicillin given by
injection. The major asset of azithromycin is that it is administered orally and thus painlessly. It
has therefore become the mainstay of WHO’s Morges Strategy for eradication of yaws by 2020.