World Health Organization · 1st edition, 2025 · 28 pages
Normative guidance on collecting, analysing and using Buruli ulcer surveillance and clinical data at health facility level for programme monitoring.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Health workers diagnosing/treating BU, data clerks, health information system managers, ministry of health decision-makers, epidemiologists, national BU programme staff, partner organizations, researchers
- Evidence
- Expert consensus based on WHO technical programme guidance and field experience
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO guidance establishes standardized data collection, quality assessment and core indicators for Buruli ulcer (BU) programmes, targeting health workers, data managers and public health decision-makers. BU is the third most common mycobacterial disease globally after tuberculosis and leprosy, caused by Mycobacterium ulcerans, and is endemic in 33 countries, primarily in West and Central Africa and Australia.
The document defines core indicators aligned with the NTD road map 2021–2030, including case definitions (suspected and PCR-confirmed), lesion categorization (I: ≤5 cm; II: 5–15 cm; III: >15 cm or multiple/critical sites), and treatment outcomes. Key targets for 2030 include: <10% of cases presenting as category III (late stage), ≥95% laboratory PCR confirmation, and ≥98% antibiotic treatment completion. Standard treatment is an 8-week course of rifampicin plus clarithromycin (56 doses within 70 days).
The guidance emphasizes data quality assessment through timeliness, completeness and internal consistency checks, alongside core analyses by geographical location, time trends, age, sex and clinical outcomes. Early detection is critical because late presentation leads to joint limitation, disability and need for surgery. The document provides detailed instructions for health facility data recording (BU 01 and BU 02 forms), aggregation and interpretation to monitor programme effectiveness and guide control strategies.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Suspected case: painless nodule, papule, plaque or oedema evolving to painless ulcer with undermined edges; confirmed by PCR, histopathology, culture or mycolactone test
- Lesion classification: Category I (≤5 cm), Category II (5–15 cm), Category III (>15 cm or multiple lesions or critical sites or osteomyelitis)
- Standard antibiotic treatment: 8-week course of rifampicin plus clarithromycin (56 doses within 70 days); up to 7 missed doses considered treatment completed
- 2030 targets: <10% category III at diagnosis, ≥95% PCR confirmation of suspected cases, ≥98% antibiotic treatment completion
- Joint limitation at presentation indicates late detection and increased disability risk; WHO recommends <15% of cases present with joint limitation
- Refer to level 2/3 facilities: all ulcers >2 cm, all oedematous/plaque forms, bone involvement, lesions on head/neck/genitalia/breast/fingers
- Most lesions occur on limbs: 35% upper limbs, 55% lower limbs, 10% other sites; lower leg lesions require careful differential diagnosis from diabetes, vascular ulcers
- Data quality requires monitoring timeliness and completeness of laboratory specimen transport and PCR result turnaround (3–7 days standard)
Buruli ulcer core indicators for monitoring and surveillance
Table extracted from the guideline
| Core indicator | Definition | Disaggregation | Comments |
|---|---|---|---|
| Number of suspected BU cases | Number of suspected BU cases | By type (new/recurrent); Age group (<5, 5–14, ≥15 years); Sex; Administrative unit | Part of core morbidity data; SDG indicator for NTDs |
| Number of confirmed BU cases | Number of laboratory PCR confirmed BU cases | By type (new/recurrent); Age group (<5, 5–14, ≥15 years); Sex; Administrative unit | Part of core morbidity data |
| Confirmed BU incidence per 10 000 | Number of new PCR confirmed BU cases / population × 10 000 | At lowest administrative level available | Requires population data at finest administrative level |
| Proportion of PCR confirmed Category III BU cases | % = number of PCR confirmed BU category III cases / total PCR confirmed cases × 100 | From lowest administrative to district level | Indicative of late detection; WHO target <25% by current standards, <10% by 2030 |
| Proportion of antibiotic treatment completed | % of new PCR confirmed cases completing 56 doses within 70 days | From lowest administrative to district level | Flexible approach: ≤7 missed doses considered completed |
| Proportion of healed PCR confirmed BU cases | % = Number healed / Total PCR confirmed cases × 100 | From lowest administrative to district level | Final treatment outcome indicator |
Source: World Health Organization, Routine health information system and health facility data for neglected tropical diseases: Buruli ulcer. Reproduced in summary form.
From the guideline
Verbatim
“Early detection and antibiotic treatment are the cornerstones of the control strategy.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia and WHO consultant, I find this guidance particularly valuable for strengthening our national surveillance architecture for skin-related neglected tropical diseases, even though Buruli ulcer is not endemic here. The standardized data quality assessment framework—evaluating timeliness, completeness and internal consistency—can be directly applied to Georgia's existing tuberculosis and leprosy programmes, which share mycobacterial diagnostic infrastructure. The emphasis on early detection through systematic indicator monitoring (category III <10%, PCR confirmation ≥95%) aligns with our national approach to other elimination programmes such as hepatitis C. However, Georgian clinicians should recognize that implementing such comprehensive facility-level data collection requires sustained investment in health information systems and laboratory capacity that may compete with other public health priorities in resource-limited settings.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
While Buruli ulcer is not currently endemic in Georgia or the South Caucasus, this guidance is relevant for Georgian epidemiologists and dermatologists managing imported cases from travellers or migrants from endemic regions, particularly West and Central Africa. National surveillance systems should incorporate BU case definitions and reporting mechanisms to enable early detection of potential imported cases. The standardized data quality assessment framework and indicator monitoring approach presented here are directly applicable to Georgia’s other NTD surveillance programmes and can strengthen routine health information systems for multiple skin-related conditions. Georgian laboratory reference centres would benefit from establishing PCR capacity for M. ulcerans as part of comprehensive mycobacterial diagnostics, given existing tuberculosis and leprosy infrastructure.
Questions this guideline answers
Quick answers
What is the standard antibiotic treatment for Buruli ulcer?
An 8-week course of rifampicin plus clarithromycin: 56 doses completed within 70 days. If a patient misses 7 days or fewer (continuously or intermittently), this is considered treatment completed, though continuous 56-day treatment is encouraged.
How are Buruli ulcer lesions classified by severity?
Category I: single lesion ≤5 cm diameter; Category II: single lesion 5–15 cm diameter; Category III: single lesion >15 cm diameter, or multiple lesions, or lesions at critical sites (head/neck/genitalia/breast/fingers), or osteomyelitis. Category III indicates late detection.
When should a BU case be referred to a higher-level facility?
All ulcers >2 cm, all oedematous and plaque forms, lesions involving deeper structures including bone, lesions on head/neck/genitalia/breast/fingers, difficult diagnoses (clinically and by laboratory), and systemically unwell patients.
What are the 2030 targets for Buruli ulcer control?
Less than 10% of cases presenting as category III (late stage) at diagnosis; at least 95% of suspected cases confirmed by PCR; and at least 98% of confirmed cases completing a full course of antibiotic treatment.
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- Issuer
- World Health Organization
- Type
- Guidance (normative)
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-08-05
- Languages
- English
- Scope
- Routine health information systems and health facility data collection, aggregation and analysis for Buruli ulcer surveillance and programme monitoring
- Audience
- Health workers diagnosing/treating BU, data clerks, health information system managers, ministry of health decision-makers, epidemiologists, national BU programme staff, partner organizations, researchers
- Pages
- 28
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-010705-2
- Evidence
- Expert consensus based on WHO technical programme guidance and field experience
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
World Health Organization. Routine health information system and health facility data for neglected tropical diseases: Buruli ulcer. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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