Transcript Research

Annual Meeting on Buruli ulcer
Geneva, Switzerland
15–17 March 2006
Research Group Report
Accomplishments in 2005
and work in progress
Priorities for Buruli ulcer research
 Development of simple diagnostic tests
 Drug treatments and new treatment
modalities
 Mode of transmission
 Socioeconomic burden
 Studies to determine the incidence and
prevalence
 Vaccine development
Drug treatment
Antibiotic treatment is changing the treatment paradigm
1. Further experience with use of rifampicin and
streptomycin using WHO guidelines, showing the
value of antibiotic treatment
2. Evidence that antibiotic treatment can be used to
treat a wide spectrum of disease, including ulcers
3. Success with antibiotic treatment suggesting that
surgery may be delayed or its extent reduced,
particularly with oedematous lesions
4. New data from mouse models suggesting newspectrum and combinations of drugs, including orally
available drugs, may affect BU treatment
Results from the Genome Project
1. Identification of MU-specific antigens that
could be useful diagnostics or vaccines.
2. Development of new tools for identification of
MU in environmental samples as a result of
the comparison between M. marinum and M.
ulcerans genomes
3. Improved fingerprinting methods for
identifying MU transmission pathways.
Diagnosis
 Work in progress to develop tools for rapid
diagnosis of M. ulcerans in early lesions
based on antibodies against mycolactone or
other suitable antigens.
Epidemiological and
environmental studies
1. Progress towards understanding the distribution of
MU in the environment and testing the hypothesis
that man-made disturbances may be related to BU
incidence
2. Detection of 4 MU-related sequences in mosquitoes
from endemic areas in Australia
Pathogenesis/vaccines
1. Evidence for MU and mycolactone in nerve
damage
2. Development of new disease models:
- grass-cutter
(nerve damage, osteomyelitis)
- mice for nerve damage
3. Work in progress for development of subunit
or live vaccines for BU
Socioeconomic burden
1. Creation of cost analysis buruli (CAB) – an electronic
tool for capturing economic cost
2. Assessment of BU burden (Ghana)
3. Economic burden to health facilities (Ghana)
4. Assessment of BU socioeconomic costs (Cameroon)
5. Socioeconomic dimensions of health-seeking behaviour
6. Analysis of stigma, relationship to healing, social
exclusion, hospitalization
Research Group
Priorities for 2006
Drug treatment
1. No change in WHO treatment guidelines
2. To encourage national programmes to facilitate widespread
antibiotic treatment in accordance with WHO guidelines,
with continued assessment of the outcomes of antibiotic
treatment
3. Need for further evaluation of new-spectrum and
combinations of drugs, including orally available drugs for
BU
4. More astute clinical evaluation of patients in the context of
antibiotic treatment
Diagnosis
 Increasing access to diagnostic facilities
 Networking over quality assurances
 Evaluation of needle aspirates for case
confirmation
Epidemiological and environmental studies
1. Continued studies of environmental factors associated
with BU distribution, with emphasis on integrating
case prevalence data, laboratory studies and
environmental risk factors in endemic countries.
2. Enhanced village-level prevalence data from all
national programmes.
3. More carefully designed and implemented case–
control studies along the lines of recent Australian
studies.
Socioeconomic burden
 Establishment and validation of a
standardized method for calculating BU costs
at facility, community, household and
individual levels, including validation of CAB
 Research into what determines access to
health facilities, finding the optimal mode of
community treatment delivery and exploring
the socioeconomic implications of BU