Press Release WHO/50 7 July 1998 PRESIDENTS JOIN BATTLE TO COMBAT BURULI ULCER A global declaration to combat Buruli ulcer was adopted yesterday by national presidents, health ministers, scientists and representatives of international organizations in Yamoussoukro, Côte d'Ivoire. Buruli ulcer, a mycobacterial disease now emerging in various parts of the world, causes severely deforming ulcers, mainly in women and children, and cannot be treated with antibiotics. At an international meeting being held in Yamoussoukro -- the centre of one of the most endemic areas of Côte d'Ivoire -- over 100 participants from more than 20 countries signed the Yamoussoukro Declaration on Buruli Ulcer. Among the signatories were the Presidents and Ministers of Health from Benin, Côte d'Ivoire and Ghana, the Minister of Health from Togo, the Director-General of the World Health Organization, and participants from Australia, Belgium, France, French Guyana, Guinea, Italy, the Netherlands, Papua New Guinea, Switzerland, Uganda, United Kingdom, United States of America and Zimbabwe. "We have all gathered here because of our interest in Buruli ulcer, our concern for the victims of this devastating disease, and our commitment to work as partners in close collaboration with each other," said Dr Hiroshi Nakajima, Director-General of the World Health Organization (WHO), at the signing of the Declaration. "We have an enormous task ahead as we begin the fight against this disease." Signatories of the Declaration made a commitment to provide the resources necessary to establish effective programmes to control Buruli ulcer in endemic countries. Participants from these countries pledged to intensify action against Buruli ulcer as part of primary health care, provide simple surgical facilities for the treatment of the disease in its early stages, and improve and sustain health education programmes at all levels. The Yamoussoukro Declaration charges WHO with assisting endemic countries to control the disease, organizing a research agenda, and generating the financial resources needed to conduct the Global Buruli Ulcer Initiative (GBUI). GBUI will coordinate control and research activities. Research - including vaccine development - could provide cost-effective ways to prevent the disease. Drug development could provide non-invasive medical treatment of the disease. The only currently available treatment of Buruli Ulcer is surgery, which is unaffordable for patients in the most affected countries. Furthermore, adequate surgical facilities are often not available in endemic areas. The disease – considered the third most common mycobacterial disease after tuberculosis and leprosy - destroys skin and underlying tissues and causes deforming lesions, mainly in the limbs. If left untreated, it can lead to severe complications, loss of organs such as eyes and breasts, amputations and other permanent disabilities. Information on the disease is scarce, little is known about the mode of transmission to human beings, and patients come to health services in the late stages of the disease. Most patients live in rural areas near rivers or wetlands. The meeting (6-8 July) has been organized in collaboration with the Government of Côte d'Ivoire and co-sponsored by WHO, the Nippon Foundation, the Association Française Raoul Follereau, the Damien Foundation, and the Humanitarian Aid Relief Team. "Incidence of Buruli Ulcer is rapidly growing in West Africa. Almost all countries along the Gulf of Guinea are now affected," said Dr Ebrahim Samba, WHO's Regional Director for Africa. "The economic cost of the disease has not yet been quantified but it surely will have severe social and economic consequences for affected countries in West Africa, if it is not addressed with the urgency it deserves." In Côte d'Ivoire, approximately 10,000 cases have been recorded since 1978 and up to 16 percent of the population in some villages are affected. In Benin, 2,300 cases have been recorded since 1989; in Ghana, up to 22 per cent of villagers are affected in some areas. Buruli ulcer was first detected in 1948 among farmers in Australia (where it is known as Bairnsdale ulcer). However, cases were described as early as 1897. Cases have been reported in Angola, Australia, Benin, Bolivia, Cameroon, Congo, Côte d'Ivoire, Democratic Republic of Congo, French Guyana, Gabon, Ghana, Guinea, India, Indonesia, Liberia, Malaysia, Mexico, Papua New Guinea, Peru, Sierra Leone, Sri Lanka, Sudan, Suriname, Togo and Uganda.

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