African Trypanosomiasis: Changing Epidemiology and Consequences.

Human African trypanosomiasis has re-emerged as a serious public health threat after near-elimination because of diminished investment in previously successful control programs. The continued, occasional importation of African trypanosomiasis to the United States can be expected as tourists and immigrants travel from high-risk areas. No vaccine or chemoprophylaxis is available for this disease, and travelers to affected areas should be counseled on tsetse fly avoidance. New diagnostic and staging tests are promising but have not replaced the classical method of examining body fluids for trypanosomes. Prompt diagnosis and staging is essential because if untreated, East African and West African sleeping sickness are fatal. Drug regimens are toxic and cumbersome, and short-term prospects for therapeutic advances are limited.