African Sleeping Sickness: A Guide to Prevention and Travel Safety for UK Travellers

African Trypanosomiasis, commonly known as sleeping sickness, is a vector-borne parasitic disease. It is caused by infection with protozoan parasites belonging to the genus Trypanosoma. These parasites are transmitted to humans by tsetse fly bites, which have acquired the infection from human beings or animals harbouring the human pathogenic parasites.

The disease is found only in 36 sub-Saharan African countries where tsetse flies are endemic. According to NHS and World Health Organization (WHO) data, while the number of cases has dropped significantly in recent decades, it remains a serious health concern for those visiting rural areas, particularly those going on safari, trekking, or working in conservation.

The Two Types of Sleeping Sickness

• Trypanosoma brucei gambiense: Found in West and Central Africa. This form accounts for the majority of reported cases and causes a chronic infection that can go unnoticed for months or years.
• Trypanosoma brucei rhodesiense: Found in Eastern and Southern Africa. This is the form most commonly encountered by UK travellers on safari. It causes an acute infection, with symptoms appearing within a few weeks of the bite.

Symptoms of sleeping sickness occur in two distinct stages. The early stage (haemolymphatic phase) involves the parasite multiplying in subcutaneous tissues, blood, and lymph. The second stage (neurological phase) occurs when the parasite crosses the blood-brain barrier to infect the central nervous system.

For UK travellers, the first sign is often a chancre—a large, painful sore at the site of the tsetse fly bite. This typically appears within 5 to 15 days of being bitten. Following this, patients may experience:

• Intermittent high fevers and chills.
• Severe headaches and muscle aches.
• Malaise and extreme exhaustion.
• Swollen lymph nodes (often at the back of the neck).
• Itchy skin rashes.

If the infection progresses to the neurological phase, the hallmark symptom is a disrupted sleep cycle, where the patient is unable to sleep at night but falls into a stupor during the day. Other neurological symptoms include confusion, tremors, and changes in personality.

As there is no vaccine or prophylactic drug for African Trypanosomiasis, prevention is focused entirely on avoiding the tsetse fly. These flies are larger than ordinary houseflies and are known for their aggressive biting behaviour during the day.

The National Travel Health Network and Centre (NaTHNaC) recommends the following protective measures:

• Wear neutral colours: Tsetse flies are attracted to bright colours and very dark colours, particularly blue and black. Opt for khaki, olive, or tan clothing.
• Choose heavy-duty fabrics: Tsetse flies can bite through thin clothing. Wear long-sleeved shirts and trousers made of medium-weight materials.
• Use Insect Repellents: While traditional DEET-based repellents are highly effective against mosquitoes, they are less effective against tsetse flies. However, they should still be used to prevent other diseases like malaria.
• Check vehicles: Tsetse flies are attracted to moving vehicles and the dust they kick up. Always check the interior of your vehicle before entering.
• Avoid bushes: The flies rest in bushes and thickets during the hottest part of the day, so avoid walking through dense vegetation.

If you have recently returned from a high-risk region and develop a fever or a suspicious skin lesion, it is vital to inform a healthcare professional of your travel history. Diagnosis is usually confirmed through blood tests or microscopic examination of fluid from a chancre or lymph node.

In the UK, cases are managed by specialists in tropical medicine, often following NICE guidelines for parasitic infections. Treatment involves specific anti-parasitic medications. The choice of drug depends on the stage of the disease and the specific parasite involved. Early diagnosis significantly improves the chances of a full recovery and reduces the risk of long-term neurological damage.

When planning a trip to sub-Saharan Africa, you can speak to a GP online to discuss your itinerary and receive tailored pre-travel advice. An online doctor can help you understand the specific risks of your destination, including malaria, yellow fever, and sleeping sickness.

If you have returned from travel and feel generally unwell, have a persistent headache, or are concerned about a skin bite that is not healing, an online consultation is an efficient way to get an initial assessment. A GP can review your symptoms, discuss your travel timeline, and provide a referral to a specialist tropical disease unit if sleeping sickness is suspected. They can also provide sick notes if your recovery requires time off work.