Louse-borne relapsing fever in Ethiopia: an urgent call for WHO recognition as a neglected tropical disease

Abstract

Louse-borne relapsing fever (LBRF), caused by <i>Borrelia recurrentis</i> and transmitted by the human body louse, remains a persistent health emergency in Ethiopia, resulting in preventable mortality among young adults. Its continued endemicity reflects systemic failures and amplifies the syndromic effects of poverty, displacement and social stigma-locally termed 'Qmalam'-which deters care-seeking. Clinical management is further complicated by the potentially fatal Jarisch-Herxheimer reaction following antibiotic treatment. Despite these severe consequences, LBRF remains off the official WHO list of neglected tropical diseases (NTDs), hindering the mobilisation of essential resources and political will. LBRF unequivocally meets WHO criteria for NTD designation, a critical step necessary to catalyse the research, funding and coordinated action required for its elimination. In this viewpoint, we present an integrated framework for addressing transmission, treatment and prediction and issue an urgent call for formal WHO recognition.