Neglected tropical diseases

Informal consultation on mycetoma, WHO Headquarters, Geneva, 24 March 2017

On 28 May 2016, the 69th World Health Assembly adopted a resolution (WHA 69.21)1 recognizing mycetoma as a neglected tropical disease.

As a follow-up to this historic event, the WHO Department of Control of Neglected Tropical Diseases convened an informal meeting of experts in Geneva, Switzerland to identify measures for implementing the resolution. Below is a summary report.

PRIORITIES

Coordination at country level

  • Appoint a national focal point responsible for mycetoma

Epidemiology

  • Assess the epidemiological situation on mycetoma at country level by:
    • completing the WHO questionnaire about endemicity status
    • conducting a literature review of the endemicity status
  • Include mycetoma in the surveillance system, if the disease is present
  • Identify priority endemic countries for enhanced surveillance and detailed epidemiological assessment
  • Identify sentinel surveillance sites within priority endemic countries

Case management

  • Produce a package of care for mycetoma (including standard operating procedures on diagnosis and treatment) for dissemination to countries and build capacities in this regard
  • Identify national and international centres that can carry out laboratory diagnostic testing
  • Build national capacities on laboratory diagnosis
  • Convene an expert meeting on diagnostics for mycetoma including manufacturers
  • Identify manufacturers of generic itraconazole to assess quality and cost
  • Address barriers currently limiting access to treatment

Prevention

  • Develop a communication strategy and material on awareness and prevention of mycetoma
  • Ensure that health promotion messages focus on:
    • wearing protective clothing and shoes to prevent injuries (e.g. thorn bushes)
    • encouraging self-reporting in case of suspect lesions

Health system

  • Designate at least one referral centre in each endemic country to manage cases requiring specialist care linked to a network of a referral system
  • Include mycetoma into the integrated skin NTDs initiative/framework

Monitoring and evaluation

  • Indictors on the impact of treatment should include:
    • surgical excision, if needed
    • amputation rates
    • proportion of patients cured
    • loss to follow-up
    • disability averted
    • recurrence rates
    • compliance with treatment
  • Other programme indicators (to be developed)

Operational research

  • Implement surveys aimed at elucidating the epidemiology of the causal agents of the disease, its mode of transmission and risk factors for infection by:
    • identifying the primary reservoir and the route of infection of mycetoma including:
      • role of animal reservoirs
      • environmental sampling
      • observational and case–control studies
    • mapping the etiology of the disease
  • Conduct socioeconomic impact studies
  • Identify potential candidate medicines to treat mycetoma
  • Develop a standardized methodology for clinical trials on drugs
  • Develop point-of-care diagnostic tests for community and clinic-based screening with high sensitivity, non-specific but able to differentiate between fungal and bacterial mycetoma

1Addressing the burden of mycetoma (http://www.who.int/neglected_diseases/mediacentre/WHA_69.21_Eng.pdf)