Buruli ulcer elimination (BU)

Buruli ulcer (BU) is a disease of the skin caused by Mycobacterium ulcerans, a bacterium related to those causing tuberculosis and leprosy. BU usually begins with a painless nodule or papule in the skin, which, if left untreated, leads to massive skin ulceration. The extremities and mainly lower limbs are often involved. Since 2004, effectiveness of specific antibiotics was confirmed and WHO recommends a combined antibiotic treatment (rifampicin and streptomycin) for BU case management complemented or not with surgery and care for the prevention of disabilities.

Thirteen Member countries in the African region (Benin, Cameroon, Central Africa Republic, Congo, Cote d'Ivoire, Gabon, Ghana, Guinea, DR Congo, Equatorial Guinea, Nigeria, Togo and Uganda) were confirmed endemic for BU and have set up control programme.

In collaboration with the Global Buruli Ulcer Initiative, WHO AFRO has been coordinating BU control in the region through:

• Developing and disseminating a fieldguide for the control of BU in the African Region
• Developing and distributing guidelines, surveillance forms, IEC materials and training modules
• Promoting research in the epidemiology of the disease;
• Supplying MDT drugs free of charge to countries in need worldwide;
• Providing technical support to endemic countries;
• Support to countries for assessing the disease burden and mapping endemic districts, developing BU strategic plans and annual plans of actions, training health staff, monitoring and assessment National BU control programme

As of 2008, a total of 6 reference laboratories have been set up (Abidjan, Cotonou, Bangui, Kinshasa, Kumasi and Yaoundé) to confirm buruli ulcer disease using PCR techniques. Nigeria and Gabon are preparing to set up labs with PCR capabilities to confirm BU. Currently, all confirmed BU endemic countries are using WHO recommended specific antibiotics (rifampicin and streptomycin) for treatment of BU patients within the existing health service network.

The annual number of reported cases of BU, which had increased in the early and mid nineties to about 10,000 new cases has now stabilised around 5,000 during the latest years (5 867 in 2004; 4 674 in 2005; 5 267 in 2006; 4 906 in 2007 and 5 716 in 2008). Cumulative numbers of BU cases in the African region is estimated at 60 000 at the end of 2008. Out of this number the annual percentage of cases cured with only WHO recommended specific antibiotics has reached 35% and annual percentage of cases healed without limb movement limitation or amputation has been halved from 40% in 2000 to 20% in 2008.

The focal person for the control of Buruli ulcer within the regional program for the control of neglected diseases is Dr Alexandre Tiendrebeogo: This e-mail address is being protected from spambots. You need JavaScript enabled to view it