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New WHO guideline for the treatment of sleeping sickness

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Cooperation with the Institute of Tropical Medicine

A new oral therapy for sleeping sickness considerably simplifies clinical practice. The new treatment guideline was prepared in collaboration with the Institute of Tropical Medicine and International Health.

Sleeping sickness or African trypanosomiasis is a neglected tropical disease that occurs in rural sub-Saharan Africa. Without treatment, the disease usually leads to death. After devastating epidemics in the 20th century, intensive control measures in the last 20 years led to a historically low number of 977 reported cases in 2018. The goal of eliminating sleeping sickness by 2020 is in sight. A simplification of the diagnosis and therapy are essential elements to achieve an eradication of sleeping sickness. The current standard therapy for stage II of the West African form (NECT: nifurtimox eflornithine combination therapy), however, requires inpatient care with intensive nursing care and complex logistics for transporting the drugs.
An oral therapy, fexinidazole, was developed by DNDi (Drugs for Neglected Diseases Initiative), a non-profit organization, and its partners. The development and approval of Fexinidazole is a milestone achievement of DNDi and partners and a success for the model of non-profit partnerships. Fexinidazole greatly facilitates clinical practice. Fexinidazole is effective in both stages of the disease. A lumbar puncture for staging can consequently be avoided in many cases. By oral administration, the therapy can be close to home, even in remote and unstable regions. However, NECT continues to be first-line therapy for patients in advanced disease.
A new WHO guideline for the treatment of West African sleeping sickness was published in August 2019. Dr. Andreas Lindner from the Institute of Tropical Medicine and International Health was a member of the Guidelines Development Group. Collaboration took place with specialists from the Democratic Republic of the Congo (University of Kinshasa, Ministry of Health) and Uganda (Ministry of Health), the Tropical Institute in Lisbon, the University of Glasgow, the Institut de Recherche pour le Développement at Montpellier, the University Hospital Geneva, the Swiss Tropical and Public Health Institute (Swiss TPH) in Basel and representatives of the WHO Secretariat from Brazzaville, Kinshasa and Geneva.



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