Buruli Ulcer: Ending the Neglect of a Disease That Impacts the Young
Buruli ulcer disease is a serious skin infection which if untreated can lead to disfiguring and disabling lesions. This neglected tropical disease is mainly endemic in western Africa, although it has been reported elsewhere in Africa, the Americas, Australia and Japan. It affects communities living along slow-flowing bodies of water such as ponds, swamps and lakes. People with HIV and the young appear to be most at-risk, with most patients being under 15 years of age.
Around 5,000 new cases of Buruli ulcer are reported every year worldwide. But the number of people affected by this disease is estimated to be much higher. Many cases are believed to go undiagnosed, as knowledge of the disease is limited and it hits poor, rural communities the hardest.
What needs to happen
Endemic countries should:
1. Invest in educational campaigns to promote early diagnosis along with treatment programmes for Buruli ulcer;
2. Ensure that the drugs and dressings needed to treat Buruli ulcer are available by including them in national essential medicines lists;
3. Support research efforts that aim to test the efficacy and safety of new drug candidates and combinations.
The World Health Organization should:
1. Rapidly evaluate the changing clinical evidence base and create evidence-based guidelines to enable countries and health workers to improve treatment of Buruli ulcer;
2. Ensure that the drugs needed to treat Buruli ulcer, including newer medicines, are available by including them in the WHO Essential Medicines List.
Researchers and pharmaceutical companies should:
1. Intensify research efforts to identify the mode of transmission of the disease;
2. Intensify research efforts aimed at developing simple and accurate tests for early detection of cases;
3. Systematically evaluate potential drugs for efficacy against M ulcerans, including drugs developed for other purposes;
4. Support clinical trials to evaluate the most promising candidate drug combinations, especially those that are all-oral, have minimal side effect profiles, and offer shorter treatment;
5. Ensure that drugs for Buruli ulcer are both available and affordable for those living in resource-poor environments;
6. Identify if Buruli ulcer is an opportunistic infection for HIV patients.