Rapid Responses to:

PAPERS: Jean G Jannin Sleeping sickness—a growing problem? BMJ 2005; 331: 1242 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Sleeping Sickness - access issues

Unni Karunakara, Manica Balasegaram, François Chappuis, Gerardo Priotto   (6 December 2005)

Sleeping Sickness - access issues 6 December 2005
Unni Karunakara, The Access Campaign Médecins sans Frontières, Plantage Middenlaan 14, 1018 DD Amsterdam, The Netherlands, Manica Balasegaram, François Chappuis, Gerardo Priotto Send response to journal: Re: Sleeping Sickness - access issues	Dr. Jannin outlines the difficulties involved in eliminating African Trypanosomiasis from Africa in his commentary on sleeping sickness.[1] The lack of an inexpensive, easy-to-use, point-of-care test makes the diagnosis and treatment of sleeping sickness in remote parts of Africa extremely difficult. Moreover, melarsoprol, the mainstay of second stage treatment, is a toxic arsenical and its efficacy is decreasing with rising levels of treatment failure in several endemic foci.[2] The World Health Organisation has played a commendable role in rectifying the precarious situation with regards to drugs by securing a long-term supply of pentamidine, suramin, melarsoprol, eflornithine, and nifurtimox from Sanofi-Aventis and Bayer. These donations have allowed for the wider use of eflornithine, a safer drug than melarsoprol,[3] in monotherapy as well as in combination with nifurtimox. Early data from a clinical trial in the Republic of Congo indicates the potential for eflornithine-nifurtimox combination to be a shorter, safer and more effective treatment for second stage T.gambiense patients.[4] With no new drugs for second stage treatment in the pipeline for the coming 10 years, the need to increase access to eflornithine and nifurtimox cannot be stressed enough. Currently, much of the eflornithine-based treatments are being provided by agencies such as Médecins sans Frontières and Malteser. Though eflornithine can be accessed free of cost by national programs, the cost of additional materials such as infusions and perfusion sets is a concrete limitation. Nifurtimox, approved for treatment of American Trypanosomiasis is yet to be approved for use in African Trypanosomiasis, and legal requirements surrounding its procurement makes its access problematic. By providing free eflornithine infusion kits and easing access to nifurtimox, WHO and national sleeping sickness control programs can significantly improve quality of treatment for those suffering from sleeping sickness a take a big step towards the elimination of the disease in Africa. [1] Jannin JG. Sleeping Sickness-a growing problem? BMJ 2005;331:1242 [2] Brun R, Schumacher R, Schmid C, Kunz C, Burri C. The phenomenon of treatment failures in Human African Trypanosomiaisis. Trop Med Int Health 2001; 6(11): 906-14. [3] Chappuis F, N Udayraj, K Stietenroth, A Meussen, PA Bovier. Eflornithine is safer than melarsoprol for the treatment of second-stage Trypanosoma brucei gambiense human African trypanosomiasis. Clin Infect Dis 2005;41(5):748-51. [4] Priotto G, S Kasparian, D Ngouama, S Gorashian, U Arnold, U Karunakara. Early report on the nifurtimox-eflornithine clinical trial for late-stage human African trypanosomiasis. Addis Ababa: 28th meeting of the International Scientific Council for Trypanosomiasis research and control, 2005. Competing interests: None declared