Sleeping sickness was nearly controlled in the mid-20th century but returned in epidemic proportions because of a relaxing of disease surveillance and control activities (actives screening and systematic treatment) due to war, civil unrest, and economic decline in the central African region.



In 2006, a new epidemiological situation is observed because of greater awareness and commitment on a number of levels: through national control programs in endemic countries; through WHO, with drugs made available from sanofi-aventis and Bayer; and through nongovernmental organizations like Médecins sans Frontières.

During the past 7 years, an increase in surveillance activities and vertical treatment programmes in the most active foci have contributed to a substantial and regular decline in new cases reported.

The top 5 endemic countries, responsible for 95% of 17,616 reported cases in 2004, are Democratic Republic of Congo (DRC), Angola, Sudan, Uganda, and  Central African Republic; with DRC alone accounting for 66% of the cases(1). In Uganda, a worrying trend towards possible geographic overlap of T.b. gambiense and T.b. rhodesiense has recently been spotted and could greatly complicate the disease management due to the disease course and transmission, and treatment sensitivity between the two forms of the disease.

And there remains a big unknown: the difference between the number of cases reported and the actual number of cases. As Victor Kande of DRC noted last month(2), “The national HAT control program of DRC has coverage of only 20% of the total population, and we know that certain historic foci have not been under surveillance for some time.”

1. WHO Weekly Epidemiological Record. 2006; 8: 71-80.
2. Victor Kande presentation at DNDi Africa 2006 Meeting, Nairobi, Africa