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

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 new- spectrum and combinations of drugs, including orally available drugs, may affect BU treatment Drug treatment

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. Results from the Genome Project

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

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 Pathogenesis/vaccines

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 Socioeconomic burden

Research Group Priorities for 2006

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 Drug treatment

Diagnosis Increasing access to diagnostic facilities Networking over quality assurances Evaluation of needle aspirates for case confirmation

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. Epidemiological and environmental 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