Sleeping Sickness

MSF lab tech team retests blood samples after the first screening show potential signs of sleeping sickness in a remote village outside of Kajo Keji, South Sudan. Over 500 people arrived this day by foot in order to have their blood tested for sleeping sickness with three cases confirmed positive. For centuries, sleeping sickness, or Human African Trypanosomiasis (HAT), caused havoc in isolated reaches of Africa, preying on people with no access to medical care or those unaware of the biological dangers they faced when wading into a foreign land.Sleeping sickness is endemic in 36 African countries and around 60 million people are at risk of being infected. Spread by the bite of a tsetse fly, the disease was signaled by the onset of fever, headaches, and joint pain, followed by disorientation and profound fatigue that makes it difficult to stay awake—hence the name sleeping sickness.Sustained efforts to fight the disease have been largely successful, but there remain “hot spots” and “blind spots” in Central and West Africa, particularly in areas where conflict reigns but medical coverage and disease surveillance are weak. (Seventeen sub-Saharan Africa countries reported cases in 2009, for instance, and the Democratic Republic of Congo alone recorded three-quarters of all known cases.)Between 1986 and 2010, MSF teams in several countries screened nearly 3 million people and treated more than 51,000 for the disease. At present, MSF has sleeping sickness programs in several other African countries as well. Collectively, this experience has made clear the need not only for ongoing vigilance, but also for new and easier diagnostic tests and shorter, more adaptable treatment regimens for patients.VII Photo’s John Stanmeyer joined one of MSF’s mobile HAT teams, which was designed to augment fixed-site screening and treatment activities in Central Africa, allowing him a firsthand look at the modern-day effort to battle this age-old scourge.

Tsetse flies are found in 36 countries in sub-Saharan Africa, putting 65 million people at risk.

Sleeping sickness is a parasitic infection that kills. Generally known as sleeping sickness, human African trypanosomiasis is transmitted by tsetse flies.

Tsetse flies are found in 36 countries in sub-Saharan Africa, putting 65 million people at risk. The infection attacks the central nervous system, causing severe neurological disorders and death if left untreated.

According to the World Health Organization (WHO), more than 98 per cent of reported cases are caused by the parasite Trypanosoma brucei gambiense, which is found in western and central Africa.

The second form, Trypanosoma brucei rhodesiense, accounts for less than two per cent of cases and is found in eastern and southern Africa.

In the last 10 years, over 70 per cent of reported cases occurred in the Democratic Republic of Congo.

Sustained control efforts have reduced the number of new cases. In 2009, the number of reported cases dropped below 10,000 for the first time in 50 years.

According to the WHO, there were 977 cases of sleeping sickness reported in 2018.

About Sleeping Sickness

What causes sleeping sickness?

The parasite causing sleeping sickness is transmitted to humans through infected tsetse flies, which breed in warm and humid areas.

Inhabiting the vast savannah across sub-Saharan Africa, tsetse flies come into contact with people, cattle and wild animals, all acting as reservoirs for the Trypanosoma parasites.

Symptoms of sleeping sickness

The first stage of sleeping sickness presents with non-specific symptoms such as fever, headache, weakness, itching and joint pain.

At this stage, sleeping sickness is easy to treat but difficult to diagnose.

If no treatment is given, the parasite will invade the infected person’s central nervous system and the second stage sets in.

Named after one of its most striking symptoms, patients with sleeping sickness experience an inability to sleep during the night but are often overcome by sleep during the day.

They may also begin to show other neurological or psychiatric symptoms, such as poor coordination, confusion and convulsions.

Diagnosing sleeping sickness

Diagnosing sleeping sickness before the second stage of the disease is difficult due to the non-specific symptoms of the early stage.

Once the parasite is detected, a painful lumbar puncture must be made to examine the patient’s cerebrospinal fluid.

This will determine the stage of the disease and the appropriate treatment.

Treating sleeping sickness

The type of treatment depends on the stage of the disease. Drugs used in the first stage of the disease are safer and easier to administer than those for the second stage.

However, treatment success in the second stage of the disease depends on drugs that cross the blood-brain barrier to reach the parasite. Such drugs are toxic and complicated to administer.

A new drug, fexinidazole – the first all-oral treatment that works for both stages of the disease – has been developed by Drugs for Neglected Diseases initiative (DNDi) and received approval in late 2018.

While it is being made gradually available, nifurtimox-eflornithine combination therapy, or NECT, is a safe, highly effective but cumbersome treatment developed by MSF, DNDi and Epicentre in 2009.

NECT is currently the WHO's recommended first-line treatment for the gambiense form.

Prevention efforts, such as vector control, are crucial to our efforts to keep sleeping sickness at bay. However, exhaustive screenings require a major investment in human and material resources.

In 2018, MSF treated 80 people for sleeping sickness.