Annual Meeting on Buruli ulcer Geneva, Switzerland 15 – 17 March 2006 Research Group Report

1. Annual Meeting on Buruli ulcerGeneva, Switzerland15–17 March 2006 Research Group Report Accomplishments in 2005 and work in progress

2. 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

3. Drug treatment • Antibiotic treatment is changing the treatment paradigm • Further experience with use of rifampicin and streptomycin using WHO guidelines, showing the value of antibiotic treatment • Evidence that antibiotic treatment can be used to treat a wide spectrum of disease, including ulcers • Success with antibiotic treatment suggesting that surgery may be delayed or its extent reduced, particularly with oedematous lesions • New data from mouse models suggesting new-spectrum and combinations of drugs, including orally available drugs, may affect BU treatment

4. Results from the Genome Project • Identification of MU-specific antigens that could be useful diagnostics or vaccines. • Development of new tools for identification of MU in environmental samples as a result of the comparison between M. marinum and M. ulcerans genomes • Improved fingerprinting methods for identifying MU transmission pathways.

5. 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.

6. Epidemiological and environmental studies • Progress towards understanding the distribution of MU in the environment and testing the hypothesis that man-made disturbances may be related to BU incidence • Detection of 4 MU-related sequences in mosquitoes from endemic areas in Australia

7. Pathogenesis/vaccines • Evidence for MU and mycolactone in nerve damage • Development of new disease models: • - grass-cutter (nerve damage, osteomyelitis) • - mice for nerve damage • Work in progress for development of subunit or live vaccines for BU

8. Socioeconomic burden • Creation of cost analysis buruli (CAB) – an electronic tool for capturing economic cost • Assessment of BU burden (Ghana) • Economic burden to health facilities (Ghana) • Assessment of BU socioeconomic costs (Cameroon) • Socioeconomic dimensions of health-seeking behaviour • Analysis of stigma, relationship to healing, social exclusion, hospitalization

9. Research Group Priorities for 2006

10. Drug treatment • No change in WHO treatment guidelines • To encourage national programmes to facilitate widespread antibiotic treatment in accordance with WHO guidelines, with continued assessment of the outcomes of antibiotic treatment • Need for further evaluation of new-spectrum and combinations of drugs, including orally available drugs for BU • More astute clinical evaluation of patients in the context of antibiotic treatment

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

12. Epidemiological and environmental studies • 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. • Enhanced village-level prevalence data from all national programmes. • More carefully designed and implemented case–control studies along the lines of recent Australian studies.

13. 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