Buruli ulcer incidence is highest among developing West African nations (WHO 2001), with cases in some countries exceeding those of tuberculosis and leprosy (Amofah et al.1993, 2002). Up to 16% of villages are affected in Côte d’ Ivoire (Marston et al. 1995; WHO 2001), and Benin has recorded 4000 cases since 1989 (Lagarrigue et al. 2000). A 1999 national survey in Ghana identified over 6,000 cases, making BU the second most prevalent mycobacterial disease (after TB) in that country (Amofah et al. 2002). In West Africa, nearly 25% of people infected are left permanently disabled (Johnson et al. 2005). There is also evidence of vast under-reporting of the disease.

The incidence of infection has increased dramatically over the past decade, even after considering improved reporting rates, largely as a consequence of environmental changes. Approximately 31 sub-tropical and tropical regions have reported cases of Buruli ulcer. These countries include: Angola, Australia, Bolivia, Burkina, Faso, Cameroon, China, Congo, Democratic Republic of Congo, Equatorial Guinea, French Guyana, Gabon, Ghana, Guinea, French Guyana, Gabon, India, Indonesia, Japan, Liberia, Malaysia, Mexico, Papua New Guinea, Peru, Sierra Leone, Sri Lanka, Sudan, Suriname, Togo and Uganda. A few isolated cases have been reported in non-endemic areas in North America and Europe, but these cases have been linked to international travel.

BU 01 Prevalencemap

Buruli ulcer prevalence rates among the regions of Ghana, Africa. Figure from Amofah et al. (2002).

BU 02 Worldmap

Worldwide distribution of Buruli ulcer disease. Figure  from WHO (2000).