Journal Article > ResearchFull Text
Trop Med Int Health. 2004 August 1; Volume 9 (Issue 8); DOI:10.1111/j.1365-3156.2004.01266.x
Robays J, Ebeja Kadima A, Lutumba P, Miaka mia Bilenge C, Kande Betu Ku Mesu V, et al.
Trop Med Int Health. 2004 August 1; Volume 9 (Issue 8); DOI:10.1111/j.1365-3156.2004.01266.x
BACKGROUND: Increasing numbers of human African trypanosomiasis (HAT) cases have been reported in urban residents of Kinshasa, Democratic Republic Congo since 1996. We set up a case-control study to identify risk factors for the disease. METHODS: All residents of the urban part of Kinshasa with parasitologically confirmed HAT and presenting for treatment to the city's specialized HAT clinics between 1 August, 2002 and 28 February, 2003 were included as cases. We defined the urban part as the area with contiguous habitation and a population density >5000 inhabitants per square kilometre. A digital map of the area was drawn based on a satellite image. For each case, two serologically negative controls were selected, matched on age, sex and neighbourhood. Logistic regression models were fitted to control for confounding. RESULTS: The following risk factors were independently associated with HAT: travel, commerce and cultivating fields in Bandundu, and commerce and cultivating fields in the rural part of Kinshasa. No association with activities in the city itself was found. DISCUSSION: In 2002, the emergence of HAT in urban residents of Kinshasa appears mainly linked to disease transmission in Bandundu and rural Kinshasa. We recommend to intensify control of these foci, to target HAT screening in urban residents to people with contact with these foci, to increase awareness of HAT amongst health workers in the urban health structures and to strengthen disease surveillance.
Conference Material > Slide Presentation
Beko P, Woudenberg T
MSF Scientific Days International 2020: Research. 2020 May 13
Journal Article > EditorialFull Text
Pathogens. 2023 October 19; Volume 12 (Issue 10); 1263.; DOI:10.3390/pathogens12101263
Santos ALS, Rodrigues IA, d’Avila-Levy CM, Sodré CL, Ritmeijer KKD, et al.
Pathogens. 2023 October 19; Volume 12 (Issue 10); 1263.; DOI:10.3390/pathogens12101263
Human African trypanosomiasis (also known as sleeping sickness, with Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense as etiological agents), American trypanosomiasis (also known as Chagas disease, with Trypanosoma cruzi as the etiological agent), and leishmaniasis (including cutaneous, mucocutaneous, and visceral forms, with multiple species belonging to the Leishmania genus as etiological agents) are recognized as neglected tropical diseases (NTDs). These diseases affect marginalized populations and pose a high-impact health problem, primarily in low- or low-to-middle-income countries in Africa, Asia, Latin America, and the Caribbean. Leishmania and Trypanosoma not only infect humans, but they also infect wild and domesticated animals, which serve as reservoirs for these diseases. Relevantly, the movement of people and animals across borders and within countries has become increasingly common in our interconnected world, and this mobility can both facilitate the transmission of diseases and challenge efforts to control outbreaks. Furthermore, climate changes can contribute to the spread of NTDs to areas that were previously unaffected.
Conference Material > Abstract
Baudin E, Mordt OV, Alves D, Seixas J, Lemerani M, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/6ss9-0934
INTRODUCTION
Trypanosoma brucei rhodesiense human African trypanosomiasis (r-HAT), the zoonotic, acute form of sleeping sickness in eastern Africa, is lethal if untreated. Today, only one arsenic- based, neurotoxic drug, melarsoprol, is available for treatment of the advanced meningo-encephalitic stage. A new oral treatment would simplify HAT elimination as proposed by WHO. Fexinidazole was recommended by the European Medicines Agency (EMA) in 2018 as the first oral treatment for Trypanosoma brucei gambiense HAT, but it was not yet evaluated for r-HAT.
METHODS
This single-arm clinical trial, sponsored by DNDi, began in October 2019 and tested fexinidazole treatment in patients with r-HAT as an alternative to existing treatment in Malawi and Uganda. Patients (aged ≥6 years) with both stages of the disease were recruited up to the target of 34 patients with stage 2 disease evaluable at the end of hospitalization. Patients were hospitalised during the 10 days of treatment and followed up to 12 months after hospital discharge. The primary outcome was r-HAT-related or treatment-related fatality at the end of hospitalisation in patients with stage 2 disease and was compared with an unacceptable fatality rate of 8.5%, a threshold defined according to results from a previous clinical trial with melarsoprol. This trial is registered with ClinicalTrials.gov, NCT03974178.
RESULTS
45 patients received treatment between 1 October 2019 and 28 November 2021 (35 [78%] had stage 2 disease and ten [22%] stage 1, 31 [69%] were male and 14 [31%] female, with median age of 24 years). The primary efficacy result of the clinical trial, analysed among the 34 evaluable patients, was achieved, with no r-HAT-related or treatment-related deaths during hospitalisation (0.0%, 95% CI 0.0–8.4), compared with a benchmark of 8.5% lethality attributable to melarsoprol. Safety was acceptable, with no severe adverse events related to fexinidazole; and one patient relapsed.
CONCLUSION
Fexinidazole, an oral treatment, was shown to be a good alternative to existing injectable and toxic drugs. Results were submitted for EMA regulatory review in preparation for use in endemic countries, and a positive scientific opinion was received in December 2023 to extend the indication of fexinidazole for the treatment of r-HAT. Fexinidazole is expected to be deployed in 2024 as a new r-HAT therapeutic.
Trypanosoma brucei rhodesiense human African trypanosomiasis (r-HAT), the zoonotic, acute form of sleeping sickness in eastern Africa, is lethal if untreated. Today, only one arsenic- based, neurotoxic drug, melarsoprol, is available for treatment of the advanced meningo-encephalitic stage. A new oral treatment would simplify HAT elimination as proposed by WHO. Fexinidazole was recommended by the European Medicines Agency (EMA) in 2018 as the first oral treatment for Trypanosoma brucei gambiense HAT, but it was not yet evaluated for r-HAT.
METHODS
This single-arm clinical trial, sponsored by DNDi, began in October 2019 and tested fexinidazole treatment in patients with r-HAT as an alternative to existing treatment in Malawi and Uganda. Patients (aged ≥6 years) with both stages of the disease were recruited up to the target of 34 patients with stage 2 disease evaluable at the end of hospitalization. Patients were hospitalised during the 10 days of treatment and followed up to 12 months after hospital discharge. The primary outcome was r-HAT-related or treatment-related fatality at the end of hospitalisation in patients with stage 2 disease and was compared with an unacceptable fatality rate of 8.5%, a threshold defined according to results from a previous clinical trial with melarsoprol. This trial is registered with ClinicalTrials.gov, NCT03974178.
RESULTS
45 patients received treatment between 1 October 2019 and 28 November 2021 (35 [78%] had stage 2 disease and ten [22%] stage 1, 31 [69%] were male and 14 [31%] female, with median age of 24 years). The primary efficacy result of the clinical trial, analysed among the 34 evaluable patients, was achieved, with no r-HAT-related or treatment-related deaths during hospitalisation (0.0%, 95% CI 0.0–8.4), compared with a benchmark of 8.5% lethality attributable to melarsoprol. Safety was acceptable, with no severe adverse events related to fexinidazole; and one patient relapsed.
CONCLUSION
Fexinidazole, an oral treatment, was shown to be a good alternative to existing injectable and toxic drugs. Results were submitted for EMA regulatory review in preparation for use in endemic countries, and a positive scientific opinion was received in December 2023 to extend the indication of fexinidazole for the treatment of r-HAT. Fexinidazole is expected to be deployed in 2024 as a new r-HAT therapeutic.
Journal Article > ResearchFull Text
Trop Med Infect Dis. 2020 November 17; Volume 5 (Issue 4); 172.; DOI:10.3390/tropicalmed5040172
Kwedi Nolna S, Ntone R, Fouda Mbarga N, Mbainda S, Mutangala W, et al.
Trop Med Infect Dis. 2020 November 17; Volume 5 (Issue 4); 172.; DOI:10.3390/tropicalmed5040172
BACKGROUND
Based on the premise that Africans in rural areas seek health care from traditional healers, this study investigated a collaborative model between traditional healers and the national Human African Trypanosomiasis (HAT) programs across seven endemic foci in seven central African countries by measuring the model's contribution to HAT case finding.
METHOD
Traditional healers were recruited and trained by health professionals to identify HAT suspects based on its basics signs and symptoms and to refer them to the National Sleeping Sickness Control Program (NSSCP) for testing and confirmatory diagnosis.
RESULTS
35 traditional healers were recruited and trained, 28 finally participated in this study (80%) and referred 278 HAT suspects, of which 20 (7.19%) were CATT positive for the disease. Most cases originated from Bandundu (45%) in the Democratic Republic of Congo and from Ngabe (35%) in Congo. Twelve (4.32%) patients had confirmatory diagnosis. Although a statistically significant difference was not shown in terms of case finding (p = 0.56), traditional healers were able to refer confirmed HAT cases that were ultimately cared for by NCSSPs.
CONCLUSION
Integrating traditional healers in the control program of HAT will likely enhance the detection of cases, thereby, eventually contributing to the elimination of HAT in the most affected communities.
Based on the premise that Africans in rural areas seek health care from traditional healers, this study investigated a collaborative model between traditional healers and the national Human African Trypanosomiasis (HAT) programs across seven endemic foci in seven central African countries by measuring the model's contribution to HAT case finding.
METHOD
Traditional healers were recruited and trained by health professionals to identify HAT suspects based on its basics signs and symptoms and to refer them to the National Sleeping Sickness Control Program (NSSCP) for testing and confirmatory diagnosis.
RESULTS
35 traditional healers were recruited and trained, 28 finally participated in this study (80%) and referred 278 HAT suspects, of which 20 (7.19%) were CATT positive for the disease. Most cases originated from Bandundu (45%) in the Democratic Republic of Congo and from Ngabe (35%) in Congo. Twelve (4.32%) patients had confirmatory diagnosis. Although a statistically significant difference was not shown in terms of case finding (p = 0.56), traditional healers were able to refer confirmed HAT cases that were ultimately cared for by NCSSPs.
CONCLUSION
Integrating traditional healers in the control program of HAT will likely enhance the detection of cases, thereby, eventually contributing to the elimination of HAT in the most affected communities.
Conference Material > Abstract
Genovese GOM, Woudenberg T, Kamau C, Beko P, Miaka EM, et al.
MSF Scientific Days International 2020: Research. 2020 May 26; DOI:10.7490/f1000research.1117908.1
INTRODUCTION
Human African trypanosomiasis (HAT) is a parasitic disease that can be fatal if left untreated. MSF conducted an active screening campaign for HAT, deploying mobile teams in remote areas of the Democratic Republic of Congo (DRC) between February 2018 and June 2019. We aimed to identify village-level risk factors associated with the presence of HAT cases, to better inform future targeted screening activities.
METHODS
Between Jan 2018 and June 2019, 170 villages were included in an exploratory phase of the study, with activities involving information, education and communication, population counts, collection of global positioning system coordinates, and assessment of risk factors. Risk factors were identified based on literature review and interviews with HAT experts, and included distances between village and water, presence of specific land types, tsetse flies, and hunting and fishing activities. 152 villages were included in the later active screening phase. Screening involved lymph node palpation, card agglutination test for trypanosomes (CATT) done on whole blood for all villagers, CATT dilutions, as well as parasitological testing and confirmation should patients test 1:16 CATT positive. Serological suspect cases were defined as those CATT 1:16 positive. Treatment with pentamidine was given to all suspect cases. Univariable and multivariable Poisson regression models were used to examine the association between at least one positive case in a village and risk factors.
ETHICS
This work fulfilled the exemption criteria set by the MSF Ethics Review Board (ERB) for a posteriori analyses of routinely collected clinical data, and thus did not require MSF ERB review. It was conducted with permission from Sidney Wong, Medical Director, Operational Centre Amsterdam, MSF.
RESULTS
Of 33,147 screened individuals, from a population of 41,764 (79%) in 152 villages, 46 suspect cases were diagnosed (1.4 cases per 1000). Suspect cases came from 33 villages (22%), of which nine villages (6%) had more than one suspect case. The highest incidence was in Otanga, with 5.6 suspect cases per 1000 screened population. Limited sample size prevented us from conducting a multivariable Poisson regression, and reduced power to find statistically significant effects. Incidence rate ratios (IRR) for relevant risk factors were: presence of hunters in a village (IRR 1.7; 95%CI 0.9-3.8), village screened more than 5 years ago (IRR 2.0; 95%CI 1.0–4.7), tsetse fly observed on visit (IRR 1.3; 95%CI 0.4 –3.3), and absence of forests within 1000m of village (IRR 0.2; 95%CI 0.0–1.0).
CONCLUSION
We detected small numbers of HAT suspect cases, preventing predictive algorithm development. However our data suggest that where HAT prevalence is low, active screening campaigns might not be effective; risk factors are not likely predictive enough to enable development of targeted screening programmes. Integrating passive screening into health posts and reactionary responses, when parasitological confirmed cases are detected, may be a better alternative. This will require training of medical staff, and reformed strategies within MSF.
CONFLICTS OF INTEREST
None declared.
Human African trypanosomiasis (HAT) is a parasitic disease that can be fatal if left untreated. MSF conducted an active screening campaign for HAT, deploying mobile teams in remote areas of the Democratic Republic of Congo (DRC) between February 2018 and June 2019. We aimed to identify village-level risk factors associated with the presence of HAT cases, to better inform future targeted screening activities.
METHODS
Between Jan 2018 and June 2019, 170 villages were included in an exploratory phase of the study, with activities involving information, education and communication, population counts, collection of global positioning system coordinates, and assessment of risk factors. Risk factors were identified based on literature review and interviews with HAT experts, and included distances between village and water, presence of specific land types, tsetse flies, and hunting and fishing activities. 152 villages were included in the later active screening phase. Screening involved lymph node palpation, card agglutination test for trypanosomes (CATT) done on whole blood for all villagers, CATT dilutions, as well as parasitological testing and confirmation should patients test 1:16 CATT positive. Serological suspect cases were defined as those CATT 1:16 positive. Treatment with pentamidine was given to all suspect cases. Univariable and multivariable Poisson regression models were used to examine the association between at least one positive case in a village and risk factors.
ETHICS
This work fulfilled the exemption criteria set by the MSF Ethics Review Board (ERB) for a posteriori analyses of routinely collected clinical data, and thus did not require MSF ERB review. It was conducted with permission from Sidney Wong, Medical Director, Operational Centre Amsterdam, MSF.
RESULTS
Of 33,147 screened individuals, from a population of 41,764 (79%) in 152 villages, 46 suspect cases were diagnosed (1.4 cases per 1000). Suspect cases came from 33 villages (22%), of which nine villages (6%) had more than one suspect case. The highest incidence was in Otanga, with 5.6 suspect cases per 1000 screened population. Limited sample size prevented us from conducting a multivariable Poisson regression, and reduced power to find statistically significant effects. Incidence rate ratios (IRR) for relevant risk factors were: presence of hunters in a village (IRR 1.7; 95%CI 0.9-3.8), village screened more than 5 years ago (IRR 2.0; 95%CI 1.0–4.7), tsetse fly observed on visit (IRR 1.3; 95%CI 0.4 –3.3), and absence of forests within 1000m of village (IRR 0.2; 95%CI 0.0–1.0).
CONCLUSION
We detected small numbers of HAT suspect cases, preventing predictive algorithm development. However our data suggest that where HAT prevalence is low, active screening campaigns might not be effective; risk factors are not likely predictive enough to enable development of targeted screening programmes. Integrating passive screening into health posts and reactionary responses, when parasitological confirmed cases are detected, may be a better alternative. This will require training of medical staff, and reformed strategies within MSF.
CONFLICTS OF INTEREST
None declared.
Conference Material > Slide Presentation
Baudin E, Mordt OV, Alves D, Seixas J, Lemerani M, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/eoc91a