The journey towards elimination of gambiense human African trypanosomiasis: not far, nor easy.

Considering the epidemic situation of gambiense human African trypanosomiasis (HAT) at the end of the twentieth century, the World Health Organization (WHO) and partners strengthened disease control and surveillance. Over the last 15 years, the activities implemented through the National Control Programmes have brought gambiense HAT under control and now its elimination is deemed as an achievable goal. In 2012, WHO targeted gambiense HAT for elimination as a public health problem by 2020. The final goal will be the sustainable disease elimination by 2030, defined as the interruption of the transmission of gambiense HAT. The elimination is considered feasible, because of the epidemiological vulnerability of the disease, the current state of control, the availability of strategies and tools and international commitment and political will. Integration of activities in the health system is needed to ensure the sustainability of the elimination. The development of user-friendly diagnostic and treatment tools will facilitate the integration process. Adequate funding is needed to implement activities, but also to support research that will make the elimination sustainable. A long-term commitment by donors is needed and ownership of the process by endemic countries is critical.

Diversity of human African trypanosomiasis epidemiological settings requires fine-tuning control strategies to facilitate disease elimination.

In 2001, the World Health Organization (WHO) established a public-private partnership to fight human African trypanosomiasis (HAT). As a result of this continuous collaboration, and in addition to the coordination with nongovernmental organizations and bilateral cooperation agencies, the number of new cases of HAT annually reported by the WHO has strikingly decreased. In 2012, HAT was included in WHO's roadmap on neglected tropical diseases with a 2020 target date for elimination. Although the prevalence of HAT is decreasing and its elimination is targeted, control approaches must be adapted to the different epidemiological patterns in order to adopt the most adequate strategies to maintain their cost-effectiveness. These strategies must be flexible and dynamic in order to be adapted to the disease progression, as well as to the changes affecting the existing health facilities in transmission areas, including their accessibility, their capabilities, and their involvement in the elimination process. Considering the different patterns of transmission (Trypanosoma brucei (T.b.) rhodesiense HAT) and transmission intensity (T.b. gambiense HAT), different settings have been defined. In the case of T.b. rhodesiense, this form exists primarily where wild animals are the main parasite reservoir, and where the main parasite reservoir is cattle. In T.b. gambiense, this form exists in areas with high intensity transmission, areas with moderate intensity transmission, and areas with low intensity transmission. Criteria and indicators must be established to monitor and evaluate the actions implemented toward the elimination of HAT.

[Cost of a national program to control human African trypanosomiasis in the high Mbomou region, Central African Republic]. / Cout d'un projet d'appui au programme national de lutte contre la trypanosomiase humaine africaine dans le foyer du Haut Mbomou, Republique Centrafricaine.

An outbreak of human African trypanosiaisis is ongoing in the High Mbomou area of the Central African Republic. This area is located on the Sudanese border approximately 1,100 kilometers from the capital city of Bangui. According to current estimates, the cost of implementing the National Human African Trypanosomiasis Program is 754,000 United States Dollars, i.e., 4.1 dollars per protected inhabitant. However actual conditions in the field suggest that this estimate should be revised. Special field conditions include constant refugee movement across the border, lack of accurate epidemiological data concerning neighboring Haut Zaire, and low participation of village residents in mass screening operations (less than 50%). In response to these problems, the authors recommend the organization of more exploratory missions to allow better targeting of screening and therapy. In the initial plan, exploratory missions were to account for 1% of the total cost. This proportion will probably require upward adjustment.

[Neurocysticercosis in Spain. Apropos 4 cases seen in immigrant patients from endemic countries]. / Neurocisticercosis en España. A propósito de 4 casos observados en pacientes inmigrados de países endémicos.

Neurocysticercosis is a helminthiasis of the central nervous system produced by the encysted larvae of the pork tapeworm Taenia solium. We report 4 cases of neurocysticercosis observed in immigrants from endemic areas (India and Latin America). Three of the patients were diagnosed because of new onset of seizures, all of the no received anthelmintic therapy with favourable outcome. The fourth case was a form known as racemose cysticercosis. She was admitted because of CNS sensorial symptoms with later development of severe intracranial hypertension that required surgical treatment. All the cases had a positive result in the ELISA test for cysticercosis. In only one patient chronic epilepsy persisted thus needing long-term anticonvulsant therapy as a sequelae. Our report helps to familiarize clinicians with the characteristic radiological findings from cysticercosis and em s the fact that epidemiological suspicion and serological data are usually enough to get the diagnosis and avoid unnecessary probes.

Neurocisticercosis en España. A propósito de 4 casos observados en pacientes inmigrados de países endémicos / Neurocystercosis: report of 4 cases observed in inmigrants from endemic areas

La neurocisticercosis es una helmintiasis del sistema nervioso central causada por la larva enquistada de Taenia solium. Presentamos 4 casos de neurocisticercosis observados en inmigrantes procedentes de areas endémicas. Tres de ellos debutaron en forma de epilepsia y presentaron una respuesta favorable al tratamiento antihelmíntico. El cuarto caso fue una forma especial de cisticercosis conocida como racemosa que debutó en forma de focalidad sensitiva con posterior desarrollo de un cuadro de hipertensión endocraneal severa que requirió tratamiento quirúrgico. En todos los casos se obtuvo un test de ELISA positivo para cisticercosis. Solo en un caso persistieron secuelas crónicas en forma de epilepsia. Con la descripción de estos casos pretendemos familiarizar al clínico con las imágenes radiológicas características de esta entidad y recordar que la sospecha epidemiológica y el estudio serológico permiten habitualmente el diagnóstico y evitan exploraciones innecesarias para el paciente (AU)