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African Trypanosomiasis (Sleeping Sickness)
GMJ News knowledge hub · last reviewed August 2026 · Georgian Medical Journal
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Human African trypanosomiasis (HAT, sleeping sickness) — caused by Trypanosoma brucei parasites transmitted by tsetse flies — has been reduced to fewer than 900 reported cases per year (2022), achieving a remarkable WHO elimination target and representing one of global health's great elimination success stories — with two new oral drugs, fexinidazole (2019) and acoziborole (2024), completing the transformation from a fatal disease requiring painful lumbar puncture-guided therapy to one treatable with a simple oral regimen (WHO). Without treatment, HAT is invariably fatal — causing progressive neurological deterioration, somnolence disorders, coma and death.
Key messages
Near elimination — <900 cases in 2022
Human African trypanosomiasis (sleeping sickness) has been reduced to fewer than 900 reported cases in 2022 — down from 300,000 in the 1990s — achieving one of the most remarkable NTD elimination successes in global health history (WHO).
Oral treatment — fexinidazole and acoziborole
Fexinidazole (2019) — the first fully oral treatment for gambiense HAT — has transformed treatment from parenteral melarsoprol (toxic) and NECT (complex hospital-based) to a 10-day oral course. Acoziborole (2024 approval) — a single oral dose — completes the treatment revolution.
Two forms — very different epidemiology
T.b. gambiense HAT (West and Central Africa — approximately 97% of cases): chronic, slow-progressing, human reservoir dominant; potentially eliminable. T.b. rhodesiense HAT (East Africa — approximately 3%): faster-progressing, animal reservoir (cattle, wildlife), harder to eliminate.
Tsetse fly is the vector
Tsetse flies (Glossina species) transmit T. brucei. Active screening of populations in endemic areas and vector control (trapping, insecticides, tiny targets) are essential alongside treatment.
Two stages — stage 2 fatal without treatment
Stage 1 (haemolymphatic): fever, headache, joint pain, lymphadenopathy — manageable. Stage 2 (CNS involvement): personality changes, sleep cycle disruption ("sleeping sickness"), motor/speech disorders, coma → death without treatment. Stage distinction requires lumbar puncture (now simplified with fexinidazole which treats both stages).
2030 WHO elimination target
WHO targets elimination of gambiense HAT as a public health problem (incidence <1/10,000) by 2020 — largely achieved; and interruption of transmission (near zero cases) by 2030.
Key statistics
HAT global case numbers — decline toward elimination (WHO)
Source: WHO. Remarkable 99% decline in HAT cases since the 1990s peak.
Glossary of key terms
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