game parks in tanzania have long been considered to be low - risk areas for african trypanosomiasis ( 3 ) . however , in february 2001 , two index patients and seven additional european and south african patients were seen with trypanosomiasis acquired in the tarangire and serengeti national parks , tanzania ( 4 ) . the patients were identified and reported in tropneteurop , a sentinel surveillance network of clinical sites throughout europe for monitoring imported infectious diseases . to our knowledge , all patients had traveled to the tarangire and serengeti national parks , in addition to a number of other destinations . however , the case incidence in tanzanian and foreign nationals has been very low in recent decades . east tsavo np and amboseli np are in kenya ; all other nps mentioned are in tanzania . np , national park ; dic , disseminated intravascular coagulopathy . during their journey or briefly after their return , the patients , all febrile , were seen by general practitioners or emergency departments . most patients were seen during the primary stage of disease ( patients 1 , 3 , 4 , 6 , 7 , 8 ; table ) ; however , several showed signs of the secondary stage , including cerebral manifestations . although three patients had multiorgan failure , and specific medication was difficult to obtain , drug treatment proved successful in all but one patient , who died . drugs for treatment were not chosen for the clinical stage the patients exhibited but rather for availability . thus , patients with complications and a manifest secondary stage of disease received pentamidine only . the temporal clustering of imported cases suggests a change in the local epidemiology of this disease and may herald further cases in tourists during the current travel season . for 1998 , the world tourism organization recorded 450,000 visitors to tanzania ( 5 ) , for a potential annual incidence of trypanosomiasis in tourists to tanzania of at least 9/450,000 . reaction of the tanzanian authorities involved strengthening installation of insecticide - impregnated locations in serengeti to include roads , lodges , staff quarters , and campsites . this initial program resulted in a dramatic decline of tsetse flies in serengeti during the second half of 2001 . this effort will have to be sustained by mandatory killing of flies at some keys areas including serengeti , tarangire , and lake manyara national parks . the national medical research program has been directed to screen more people for the disease around these foci . for many of the patients , drugs for treatment were extremely difficult to obtain . for some european patients , treatment with suramin was possible only after informal help from member sites of the network . drugs for treatment ( suramin , melasoprol , and eflornithin ) have now been obtained . surveillance in cattle to establish their role in the epidemiology of the disease will also be conducted ( tanzania chief veterinary officer , pers . this report highlights the effectiveness and importance of sentinel surveillance methods for monitoring imported infectious diseases in europe . tropneteurop , the network that identified and reported the index cases , is known for its speed of reporting , often within days of diagnosis . the network s use of member sites as regional referral centers is based on an anonymous reporting system at sentinel clinics . discussion of the index patients by member sites triggered increased awareness within the network and led to the rapid recording of additional patients and a pattern that might have otherwise gone undetected .
game parks in tanzania have long been considered to be at low risk for african trypanosomiasis ; however , nine cases of the disease associated with these parks were recently reported . 
 the outbreak was detected through tropneteurop , a sentinel surveillance network of clinical sites throughout europe .