Global Epidemiology of Buruli Ulcer, 2010-2017, and Analysis of 2014 WHO Programmatic Targets

Abstract

Buruli ulcer is a neglected tropical disease caused by Myocobacterium ulcerans; it manifests as a skin lesion, nodule, or ulcer that can be extensive and disabling. To assess the global burden and the progress on disease control, we analyzed epidemiologic data reported by countries to the World Health Organization during 2010-2017. During this period, 23,206 cases of Buruli ulcer were reported. Globally, cases declined to 2,217 in 2017, but local epidemics seem to arise, such as in Australia and Liberia. In 2013, the World Health Organization formulated 4 programmatic targets for Buruli ulcer that addressed PCR confirmation, occurrence of category III (extensive) lesions and ulcerative lesions, and movement limitation caused by the disease. In 2014, only the movement limitation goal was met, and in 2019, none are met, on a global average. Our findings support discussion on future Buruli ulcer policy and post-2020 programmatic targets.

Keywords: Australia; Benin; Buruli ulcer; Cameroon; Côte d’Ivoire; DRC; Democratic Republic of the Congo; Gabon; Ghana; Guinea; Japan; Liberia; Mycobacterium ulcerans; Nigeria; Papua New Guinea; Togo; World Health Organization; bacteria; epidemiology; programmatic targets; tuberculosis and other mycobacteria.

Figure 1

Typical Buruli ulcer lesion on the arm of a patient from Ghana. Central necrosis, yellowish-white slough, and undermined edges surround the wound. Photo courtesy of T.S. van der Werf.

Figure 2

Dynamics of Buruli ulcer epidemiology by cases reported to the World Health Organization (WHO) in 2010–2017. A) Globally, reported cases declined over time, but the proportion of cases reported from WPRO increased. B) WPRO data show an increase in cases in Australia. C) In AFRO, cases drastically declined in Côte d’Ivoire but recently increased in other countries such as Ghana, Nigeria, and Liberia. D) Countries in AFRO that reported fewer cases overall showed stagnant or varying numbers. AFRO, WHO African Region; WPRO, WHO Western Pacific Region.

Figure 3

Geographic distribution of Buruli ulcer cases officially reported to World Health Organization during 2010–2017. Concentrations in West Africa and Australia are clearly visible.

Figure 4

Depiction of progress toward World Health Organization programmatic targets for Buruli ulcer–endemic countries that reported continuous data. Black dotted lines indicate 2014 targets. White dots indicate that the country met the target; red dots indicate that it did not. Cat, category; +, positive.