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72 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES *** tool for field workers, resulting in higher and faster rates of detection. Studies of the cost− effectiveness of PCR should be undertaken to determine whether a new active case-finding strategy is warranted, to detect cases earlier, thereby achieving better treatment outcomes. _____________________ 1 Amoakoh HB, Aikins M. Household cost of out-patient treatment of Buruli ulcer in Ghana: a case study of Obom in Ga South Municipality. BMC Health Serv Res. 2013;13:507. doi:10.1186/1472-6963-13-507. 2 Grietens KP, Boock AU, Peeters H, Hausmann-Muela S, Toomer E, Ribera JM. “It is me who endures but my family that suffers”: social isolation as a consequence of the household cost burden of Buruli ulcer free of charge hospital treatment. PLoS Negl Trop Dis. 2008;2:e321. doi:10.1371/journal.pntd.0000321. 3 Mavinga Phanzu D, Suykerbuyk P, Saunderson P, Ngwala Lukanu P, Masamba Minuku JB, Imposo DB et al. Burden of Mycobacterium ulcerans disease (Buruli ulcer) and the underreporting ratio in the territory of Songololo, Democratic Republic of Congo. PLoS Negl Trop Dis. 2013;7:e2563. doi:10.1371/journal.pntd.0002563. eCollection 2013. 4 Porten K, Sailor K, Comte E, Njikap A, Sobry A, Sihom F et al. Prevalence of Buruli ulcer in Akonolinga Health District, Cameroon: results of a cross sectional survey. PLoS Negl Trop Dis. 2009;3:e466. doi:10.1371/journal.pntd.0000466. Burden and distribution The 33 countries in which Buruli ulcer has been detected have mainly tropical and subtropical climates (Fig. 4.1.1). About 5000 cases annually are reported from 15 of those countries, but this number is considered low. Since 2010, the number of reported cases has declined gradually, Fig. 4.1.1 Distribution of Buruli ulcer, worldwide, 2013 Number of reported cases, 2013 > 1 000 No cases reported 500 999 Previously reported cases 100 499 Not applicable < 100
*** THE DISEASES − CHAPTER 4 73 possibly as a result of less intensive case-finding activities (Fig. 4.1.2). The incidence in endemic regions of Ghana has been estimated at 150 cases per 100 000 population. Japan has reported 46 cases since 1980. Australia reported 695 cases between 2002 and 2013, where an increasing trend is evident. The number of cases has also increased in Gabon. The number of cases has been decreasing in Benin (since 2007) and in Côte d’Ivoire (since 2010). Fig. 4.1.2 Number of Buruli ulcer cases reported to WHO, by region, 2005–2013 6000 5000 Number of new cases detected 4000 3000 2000 1000 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year African Region Region of the Americas Eastern Mediterranean Region South-East Asia Region Western Pacific Region The data available to WHO are limited because (i) control activities within endemic countries have a restricted geographical scope and data may not reflect the national burden; (ii) in some areas there are few or no case-detection activities and the extent of the disease is therefore unknown; (iii) underreporting may result from insufficient knowledge of the disease and its occurrence mainly among poor people in rural communities. Progress towards Roadmap targets The Roadmap’s first target for achieving intensified control of Buruli ulcer requires completion by 2015 of a clinical trial of oral antibiotic therapy (using rifampicin and clarithromycin). The study started in Benin and Ghana in 2013; completion is expected in 2016 instead of 2015 because of the slow recruitment rate. The use of an oral antibiotic regimen would ensure that more people have access to treatment, enabling achievement of the Roadmap’s second target: to cure 70% of cases in endemic countries by 2020.
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INVESTING TO OVERCOME THE GLOBAL IM
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*** FOREWORD ix FOREWORD BY THE DIR
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*** EXECUTIVE SUMMARY xi EXECUTIVE
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*** EXECUTIVE SUMMARY xiii for the
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*** EXECUTIVE SUMMARY xv Neglected
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*** THE RESOLUTION AND THE ROADMAP
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*** ANNEXES 179 ANNEXES
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*** ANNEXES 181 Annex 1a (cont’d)
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*** ANNEXES 183 WHA66.12 Recognizin
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*** ANNEXES 185 WHA66.12 3. REQUEST
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*** ANNEXES 187 Annex 3. Classifica
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*** ANNEXES 189 Annex 5. Medicines
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*** ANNEXES 191 WHO REGIONAL OFFICE
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