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. 2023 Feb 10;3(1):mtsi.v3i1.2023.317.
doi: 10.48327/mtsi.v3i1.2023.317. eCollection 2023 Mar 31.

[Towards elimination of human African trypanosomiasis]

[Article in French]
Philippe Solano  1 , Fabrice Courtin  2 , Dramane Kaba  3 , Camara  4 , Moïse Kagbadouno  4 , Jean-Baptiste Rayaisse  5 , Vincent Jamonneau  1   3 , Bruno Bucheton  1   4 , Jean-Mathieu Bart  1   4 , Sophie Thevenon  1 , Veerle Lejon  1
Affiliations

[Towards elimination of human African trypanosomiasis]

[Article in French]
Philippe Solano et al. Med Trop Sante Int. .

Abstract
in English, French

Human African Trypanosomiasis (HAT) is caused by Trypanosoma brucei which is transmitted by the tsetse fly insect vector (Glossina spp). It is one of the 20 Neglected Tropical Diseases (NTD) listed by the WHO. These diseases affect the poorest and most vulnerable communities, for which the WHO has established a dedicated 2021-2030 roadmap. At the time of Alphonse Laveran, HAT devastated the African continent. In the 1960s, the disease was nearly under control, but it strongly re-emerged in the 1990s. A coordinated effort of all stakeholders, with national control programs as the main actors, a strong contribution of research and important donations by the private sector, allowed to decrease the HAT burden significantly. Since 2018, less than 1000 cases are detected annually. We here review new diagnostics, treatments and vector control tools that have been implemented jointly and successfully in several endemic countries.The next key challenge will be to sustain the gains. Newly emerging research questions include long-term carriage of trypanosomes and adaptation of tools to low prevalence contexts. Challenges out of the research area comprise the continued need of funding, maintenance of dedicated human resources, and the key question of access. Sustainable elimination as "interruption of transmission", which is the 2030 NTD roadmap target, can be reached, if these challenges are solved. We stress the importance of continuing to combine the efforts in the fight against the disease, because sustainable elimination of HAT is the best long-term prevention strategy against re-emergence. As such, HAT elimination can serve as an example for other infectious diseases.

La maladie du sommeil, ou trypanosomiase humaine africaine (THA), est due à Trypanosoma brucei transmis par Glossina spp ou mouche tsé-tsé. Après avoir ravagé l'Afrique subsaharienne dans la première moitié du XXe siècle, comme en témoigne l'extraordinaire ouvrage d'Alphonse Laveran et Félix Mesnil en 1912 (Trypanosomes et trypanosomiases), la THA, maladie tropicale négligée mortelle, dite « du bout de la piste » et pour laquelle il n'existe pas de vaccin, semble aujourd'hui à portée de main de l’élimination. Nous passons en revue les stratégies, activités et outils qui ont permis cette forte réduction du fardeau sanitaire pour les populations d'Afrique subsaharienne: environ 300 000 cas estimés dans les années 1990 contre moins de 1000 cas rapportés annuellement depuis 2018. La lutte contre la maladie du sommeil consiste principalement à dépister et traiter les cas ainsi qu’à lutter contre la glossine vectrice pour casser le cycle de transmission. En passant en 30 ans d'un contexte épidémique à un contexte d’élimination, la maladie du sommeil a subi une transition épidémiologique sans précédent à laquelle les stratégies et les outils de lutte ont dû s'adapter. Nous montrons comment la recherche a soutenu ces efforts et examinons certains des défis restants pour rendre effective et durable son élimination.

Keywords: Alphonse Laveran; Diagnostic; Elimination; Human African Trypanosomiasis; Treatment; Vector control.

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Figures

Figure 1
Figure 1
Prospection médicale, 2013, province Kwilu, RDC (crédit photo: Veerle Lejon) Medical prospection 2013, Kwilu Province, DRC (photo credit: Veerle Lejon)
Figure 2
Figure 2
Petit écran ou « tiny target » utilisé pour la lutte anti tsé-tsé dans les foyers actifs de THA en combinaison avec les activités médicales de dépistage et traitement 2016, Bonon, Côte d'Ivoire (crédit photo: Dramane Kaba) Tiny target used for tsetse control in active HAT foci in combination with medical screening and treatment 2016, Bonon, Côte d'Ivoire (photo credit: Dramane Kaba)
Figure 3
Figure 3
Évolution du nombre de cas rapportés de THA (chiffres OMS) en comparaison avec les cibles de la feuille de route OMS 2021-2030 (source: OMS, 2022 [6]) Evolution of HAT cases compared with WHO 2021-2030 roadmap targets (source: WHO, 2022 [6])
See this image and copyright information in PMC

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