If the stage is not established, the drugs can be fatal
Jul 26, 2009
MBULAMBERI says treatment depends on the stage of the disease, but whereas lack of treatment could cause death, the drugs can also be fatal.
MBULAMBERI says treatment depends on the stage of the disease, but whereas lack of treatment could cause death, the drugs can also be fatal.
“When treating sleeping sickness, it’s very critical that the stage of infection is established first because merasprol, the drug most commonly used, is so toxic that it kills the patients, especially when they seek treatment late.
It is meant for second stage sleeping sickness and may kill the patient if it is wrongly administered,†he explains. Medical personnel say treatment from this drug is excruciatingly painful.
“Often described by patients as “fire in the veinsâ€, between 5% and 20% of those treated die of complications from the injected drug,†says Doctors Without Borders/Médecins Sans Frontières.
The drugs used in the first stage of the disease are less toxic, easier to administer and more effective.
“The earlier the identification of the disease, the better the prospect of a cure.
Treatment success in the second stage depends on a drug that can cross the blood-brain barrier to reach the parasite. Such drugs are quite toxic and complicated to administer,†he says.
Nonetheless, four drugs are registered for the treatment of sleeping sickness and are free to endemic countries through a WHO private partnership.
First stage treatment includes pentamidine or suramin, while second stage treatment consists of melarsoprol and eflornithine which is less toxic than melarsoprol, but still relatively new.
“The second stage regiments are strict and difficult to apply,†researchers argue. However, recent research suggests a safe, alternative treatment is available through the combination of two drugs, eflornithine and nifurtimox, but while this combination represents an improved therapy for patients, it is not ideal.
The treatment is complicated to administer and requires close patient monitoring — something frequently unavailable in sub-Saharan Africa.
Hence, major efforts are needed to bring truly innovative drugs into the pipeline. Besides toxic, difficult and limited treatment options, many other challenges still exist.
Mbulamberi says borders with increased human trafficking and consequent cross-infections are a problem, especially from Sudan and Congo.
“If one infected fly bites a person, everyone is at risk. There were also some strains which were initially only affecting animals, but they can spread over to humans,†he says.
And like many other ailments, sleeping sickness is also plagued by witch-doctors. “By the time people seek treatment, they are in advanced stages,†he says.
This has been worsened by self-medication. “The symptoms are similar to malaria symptoms. If one is not observant, he may not suspect he has sleeping sickness.â€
Mbulamberi says there is need to conduct massive screening in endemic areas so that treatment interventions are projected in the early stages for better and cheaper recovery.
“The chronic one is particularly a challenge because by the time symptoms present, one is in advanced stages of the disease. It is also dangerous because even without the signs, the infection circle continues,†he adds.
The WHO also notes that the rural populations living in regions where transmission occurs and which depend on agriculture, fishing, animal husbandry or hunting are the most exposed to the bite of the tsetse fly and, therefore, to the disease.
“Sleeping sickness generally occurs in remote rural areas where health systems are weak or non-existent. The disease spreads in poor settings.
Displacement of populations, war and poverty are important factors leading to increased transmission.
Mbulamberi echoes similar concerns noting that it is one of the neglected tropical diseases; Mbulamberi says sleeping sickness affects the rural poor who are underserved and politically voiceless. “Treatment costs between $150 and $200 (sh315,000 to sh420,000) per head.
The manufacturers even decided to stop producing the drugs because they are expensive to manufacture yet affected countries are poor.
“Nonetheless, WHO has entered into a private partnership to procure them and we provide treatment for free, courtesy of funding from DFID and the European Union,†Mbulamberi says.
The health ministry has strategically placed health centres in the endemic areas and is increasing visibility on the ground as an area gets claimed by the flies.
“These are Namungalwe Health Centre in Namutumba, Mayuge Health Centre, Iganga Hospital, Luwuka HC Kiyunga Health Centre and Nhunze Health Centre in Mukono. Others are Bwikwe Health Centre, Yumbe, Moyo and Adjumani hospitals,†he says.
Mbulamberi says children are, especially, at risk because they are defenseless. They hang on their mothers’ backs in the gardens as they dig or collect firewood in the bushes.
“When treating sleeping sickness, it’s very critical that the stage of infection is established first because merasprol, the drug most commonly used, is so toxic that it kills the patients, especially when they seek treatment late.
It is meant for second stage sleeping sickness and may kill the patient if it is wrongly administered,†he explains. Medical personnel say treatment from this drug is excruciatingly painful.
“Often described by patients as “fire in the veinsâ€, between 5% and 20% of those treated die of complications from the injected drug,†says Doctors Without Borders/Médecins Sans Frontières.
The drugs used in the first stage of the disease are less toxic, easier to administer and more effective.
“The earlier the identification of the disease, the better the prospect of a cure.
Treatment success in the second stage depends on a drug that can cross the blood-brain barrier to reach the parasite. Such drugs are quite toxic and complicated to administer,†he says.
Nonetheless, four drugs are registered for the treatment of sleeping sickness and are free to endemic countries through a WHO private partnership.
First stage treatment includes pentamidine or suramin, while second stage treatment consists of melarsoprol and eflornithine which is less toxic than melarsoprol, but still relatively new.
“The second stage regiments are strict and difficult to apply,†researchers argue. However, recent research suggests a safe, alternative treatment is available through the combination of two drugs, eflornithine and nifurtimox, but while this combination represents an improved therapy for patients, it is not ideal.
The treatment is complicated to administer and requires close patient monitoring — something frequently unavailable in sub-Saharan Africa.
Hence, major efforts are needed to bring truly innovative drugs into the pipeline. Besides toxic, difficult and limited treatment options, many other challenges still exist.
Mbulamberi says borders with increased human trafficking and consequent cross-infections are a problem, especially from Sudan and Congo.
“If one infected fly bites a person, everyone is at risk. There were also some strains which were initially only affecting animals, but they can spread over to humans,†he says.
And like many other ailments, sleeping sickness is also plagued by witch-doctors. “By the time people seek treatment, they are in advanced stages,†he says.
This has been worsened by self-medication. “The symptoms are similar to malaria symptoms. If one is not observant, he may not suspect he has sleeping sickness.â€
Mbulamberi says there is need to conduct massive screening in endemic areas so that treatment interventions are projected in the early stages for better and cheaper recovery.
“The chronic one is particularly a challenge because by the time symptoms present, one is in advanced stages of the disease. It is also dangerous because even without the signs, the infection circle continues,†he adds.
The WHO also notes that the rural populations living in regions where transmission occurs and which depend on agriculture, fishing, animal husbandry or hunting are the most exposed to the bite of the tsetse fly and, therefore, to the disease.
“Sleeping sickness generally occurs in remote rural areas where health systems are weak or non-existent. The disease spreads in poor settings.
Displacement of populations, war and poverty are important factors leading to increased transmission.
Mbulamberi echoes similar concerns noting that it is one of the neglected tropical diseases; Mbulamberi says sleeping sickness affects the rural poor who are underserved and politically voiceless. “Treatment costs between $150 and $200 (sh315,000 to sh420,000) per head.
The manufacturers even decided to stop producing the drugs because they are expensive to manufacture yet affected countries are poor.
“Nonetheless, WHO has entered into a private partnership to procure them and we provide treatment for free, courtesy of funding from DFID and the European Union,†Mbulamberi says.
The health ministry has strategically placed health centres in the endemic areas and is increasing visibility on the ground as an area gets claimed by the flies.
“These are Namungalwe Health Centre in Namutumba, Mayuge Health Centre, Iganga Hospital, Luwuka HC Kiyunga Health Centre and Nhunze Health Centre in Mukono. Others are Bwikwe Health Centre, Yumbe, Moyo and Adjumani hospitals,†he says.
Mbulamberi says children are, especially, at risk because they are defenseless. They hang on their mothers’ backs in the gardens as they dig or collect firewood in the bushes.