CDC planning trial for mysterious nodding syndrome

Abstract

A mysterious illness aff ecting mostly children called nodding syndrome is spreading across wide swaths of northern Uganda and South Sudan, stumping investigators who have failed so far to determine what is causing the disease that gives young people epileptic-like seizures and impairs their cognition. A team of scientists from the US Centers for Disease Control and Prevention will be travelling to the region in mid-February for their fourth such exploration; this time, they hope to lay the groundwork for a clinical trial to test treatments for the disease. “It is a devastating disease from the patient’s point of view and the villagers’ point of view”, said Scott Dowell, director of CDC’s Division of Global Disease Detection and Emergency Response, and the lead investigator on nodding syndrome. “It’s been so diffi cult to fi gure out what is causing it and what should be done about it.” In northern Uganda, the current cases are in the districts of Kitgum, Pader, and Gulu. Ugandan offi cials say that in Pader District alone nodding syndrome is the cause of death for 66 children. They have diagnosed roughly 1000 cases between August and December, 2011. There is no known cure for the disease, and investigators do not know if it is communicable. Researchers have been examining several possible causes for nodding syndrome, a name given because those infected often nod their heads when food is put in front of them. They have found an unexplained association with Ochocerca volvulus, a parasite that can cause river blindness; tests have shown that high numbers of those with nodding syndrome also have antibodies in their system for Ochocerca. Nearly all the children live near rivers or fastmoving streams. The disease also is associated with malnourished children or young adults who have a vitamin B6 defi ciency. Some epidemiologists have suggested that climate change could have played a part, especially if the disease is defi nitively linked to the parasite causing river blindness and the range of the parasite is expanding. But Dowell said many questions remain. One question is if that parasite is connected to the epidemic, why has it in the past attacked people’s corneas, while now it is attacking the brain.