Considered a neglected disease, there are two forms of sleeping sickness, caused by two different parasites: Trypanosoma brucei gambiense, which is found in western and central Africa accounts for 98 per cent of cases; Trypanosoma brucei rhodesiense, accounts for less than two percent of cases and is found in eastern and southern Africa. Both parasites are transmitted by the bite of the tsetse fly.
The disease causes severe neurological conditions, including poor coordination, confusion, agitation, aggressiveness or disinhibition. The more commonly-known name of the disease, sleeping sickness, derives from the symptom where patients experience an inability to sleep during the night but are often overcome by sleep during the day.
The parasite causing sleeping sickness is transmitted to humans through infected tsetse flies, which breed in warm and humid areas. Inhabiting the vast savanna across sub-Saharan Africa, tsetse flies come into contact with people, cattle, and wild animals, all acting as reservoirs for the Trypanosoma parasites.
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. The second stage may be characterised by more specific symptoms, such as confusion, violent behaviour, or convulsions. 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.
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 cerebro-spinal fluid. This will determine the stage of the disease and the appropriate treatment.
The type of treatment depends on the stage of the disease.
Drugs used in the first stage of the disease are of lower toxicity and are easier to administer.
However, treatment success in the second stage of the disease depends on a drug that can cross the blood-brain barrier. Nifurtimox-eflornithine combination therapy, or NECT, is now the WHO's recommended course. NECT is much safer than melarsoprol, the drug previously used to treat the disease.
Developed in 1949, melarsoprol is often described by patients as ‘fire in the veins’; between five and 20 percent of those treated die of complications from the toxic drug. New molecules are currently under clinical trial in the hope of developing a safe, effective treatment for both stages of the disease that can be administered orally.
In the past 25 years, sleeping sickness cases have dropped by 97%, leading to its elimination as a public health issue in countries like Equatorial Guinea, Ivory Coast, Benin, Togo, Uganda, Chad in 2024, and now Guinea. This success highlights the impact of political will, funding, and investment from pharmaceutical companies in developing safer, more effective treatments for NTDs. Despite these achievements, 1.5 million people remain at risk.
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“Neglected Tropical Diseases almost exclusively affect people living in extreme poverty.”Dr Christos Christou, MSF’s International President.
When a community faces a disease that is neglected, such as Sleeping Sickness, MSF is able to mobilise and provide critical humanitarian assistance because of our community of supporters. We are dependent on private donors like you to provide medical care wherever people’s needs are greatest – even if it means going beyond the villages to give people the health care they need.
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