All in all, the Stop Buruli consortium has made impressive progress over the past two and a half years, advancing substantially the understanding of Buruli ulcer. Some of the highlights are summarized in the following:

Outstanding progress has been made by identifying and using strain difference data from genomic comparisons for developing a molecular tool for high-resolution strain typing. The possibility of genetic fine-typing is a breakthrough for understanding molecular epidemiology. Analysis of the spatial distribution of genetic differences shows a very focal distribution pattern of bacterial strains suggesting chronic, ulcerated lesions as a possible reservoir of M. ulcerans.

Another highlight are immunoassays that detect antibodies to M. ulcerans-specific proteins in human serum - these have been developed for the first time. Antibody responses to six M. ulceransproteins which might be useful as markers of exposure to M. ulceranscould be developed into tools to uncover environmental reservoirs and understand transmission pathways of the bacterium.

It has further been shown that the minimally invasive fine-needle aspiration (FNA) technique offers enough sensitivity to be used for the diagnosis of non-ulcerative Buruli ulcer lesions. In the meantime, FNA has been recommended by the WHO for sampling non-ulcerative lesions in its guidelines for laboratory confirmation of Buruli ulcer disease.

Environmental studies could show that M. ulceranscan survive passage up the food chain from primary to secondary and tertiary consumers, thereby suggesting that mosquito larvae might play a role in dispersal of M. ulceransin an aquatic environment. However, the infections are not carried over into the pupae or adult mosquitoes, thus indicating an unlikely role for mosquitoes as biological vectors of the bacteria.

The eight steering committee members, together with UBS Optimus Foundation representatives, initiated the planning for a potential three-year continuation of the Stop Buruli Initiative. The need for an improved interaction and an enhanced transdisciplinary focus was clearly identified. It was also agreed that the second cycle funding should further emphasize the component of research capacity building. A new proposal will be developed over the next months, and presented to the foundation in 2011 for further funding consideration.