Archive for the NTDs and Hannukah 2009 category

End the Neglect Celebrates Hannukah

December 7th, 2010

As we embark on the last few days of Hannukah, End the Neglect would like to take a look back on how we celebrated Hannukah in 2009. For each of the seven nights of the holiday, we spotlighted the seven most common NTDs – ascariasis, trichuriasis, hookworm, schistosomiasis, lymphatic filariasis, onchocerciasis, and trachoma. Click here and take a look back at 2009s Hannukah celebration!

Night 8: The Other NTDs

December 19th, 2009

Tonight well wrap up our Hannukah and NTDs series with a focus on the remaining NTDs as defined by the WHO: buruli ulcer, dengue fever, guinea worm, African sleeping sickness, leishmaniasis, and leprosy.  At the Global Network, we are commonly asked why do you only focus on seven NTDs?  The seven NTDs weve detailed over the last seven nights are the most common NTDs, representing approximately 90% of the total disease burden.  We also focus on them, however, because they are generally referred to as tool-readythat is to say, we have medications that are safe, affordable, and available to treat the seven most common.

Which brings us to the other NTDs that also cause significant suffering among the poorest of the world’s communities. Like the most common ones, these NTDs promote the continuation of poverty in developing communities by impairing physical and intellectual growth and decreasing worker productivity.  But unlike the others, they are either missing treatment/control tools altogether or the tools are difficult to access or afford.

Many groups are working to change this landscape.  Analysis from Drugs for Neglected Diseases initiative (DNDi) clarifies:

For the most neglected diseases, patients are so poor that they have virtually no purchasing power and cannot spark market interest in drug R&D among pharmaceutical companies. Recently, the field of R&D for neglected diseases has seen the emergence of several new organisations, new donors, new financial mechanisms, and a new political environment. However, although the global R&D landscape has improved for neglected diseases since 2003, the dire needs of the most neglected victims who carry on suffering in the developing world are still largely unmet. A recent study by G-Finder revealed that less than 5 percent of worldwide R&D funding for neglected diseases has been directed towards the most neglected diseases.

To read more about these NTDs, visist our website.

Night 7: Schistosomiasis

December 18th, 2009

By Dr. Alan Fenwick, Director, Schistosomiasis Control Initiative at Imperial College London

Schistosomiasis, which is also known as bilharzia or snail fever, is another of the most common NTDs with an estimated 200 million people infected globally, and many more at risk especially in sub-Saharan Africa.

S_mansoni_adult_Lammie1The serious effects of schistosomiasis can be controlled by regular treatment of early infections with the drug praziquantel; this treatment is usually better directed at children who have recently acquired infections before symptoms can develop. Before the year 2000, praziquantel had successfully been used in China and Egypt, but it was expensive at $1 per tablet. The price today from generic manufacturers is a more affordable 8 cents a tablet. Since 2002 the Schistosomiasis Control Initiative has expanded the number of countries with control programmes thanks to support from the Bill & Melinda Gates Foundation, Legatum, and more recently the USAID.  WHO has identified the need for them to take a great interest in schistosomiasis because expansion of coverage has been slower than with the other NTDs mainly due to the absence of a large scale drug donation program. It is estimated that during 2009 less than 10% of those in need of treatment will actually have access to praziquantel, despite investment by USAID and the emergence of other NGOs taking an interest in treating schistosomiasis.

During the next 5 years if the MDGs are to be achieved it will be necessary for the world to donate more money for praziquantel and its distribution so that children can be given a healthy start to their life and perform better at school.

Read more: Night 7: Schistosomiasis

Night 6: Trachoma

December 17th, 2009

Ever had an eyelash in your eye?  Its a commonand really painfulexperience that almost everyone can relate to.  Now think of the pain experienced in the few minutes until you can remove the eyelash, but multiply it by thousands, and youll come close to understanding the pain caused by trachoma long before it even reaches its most well-known manifestation: blindness.

Trachoma - baby with fliesA single exposure to trachoma bacterium does not in itself cause blindness. Repeated exposure to the disease through person-to-person contact or infected flies over time eventually causes the inside of the eyelid to turn inward a condition called trichiasis and the eyelashes to scrape and scar the cornea, leading to the formation of corneal opacities and painful and irreversible blindness. Trachoma is particularly common in children under five and the adults – mainly women – who care for them. In some rural communities, 60 – 90 percent of children are infected.  Adult women are three times more likely to develop the blindness associated with trachoma, attributed in part to their caretaking of very young children.

Trachoma is the world’s leading cause of preventable blindness. More than 84 million people in 56 countries worldwide have active trachoma, and an estimated eight million have lost their sight due to complications from the disease.

Treatment for trachoma focuses on active symptom elimination and future prevention efforts. A major comprehensive public health strategy approved by the World Health Organization, called SAFE, is underway to treat trachoma epidemics in rural Africa and other parts of the developing world. The combination of surgery (S), antibioticstypically azyithromycin/Zithromax (A), facial cleanliness (F) and environmental educational efforts (E) is a multi-pronged approach to the disease and has shown promising results.

Between 1999 and 2006, nearly 41 million antibiotic treatments for blinding trachoma were administered worldwide.  For more information, visit organizations like the International Trachoma Initiative and Helen Keller International.

Night 5: Onchocerciasis

December 16th, 2009

Onchocerciciasis, one of the most common neglected tropical diseases known as “river blindness”, is a major contributor to visual impairment and blindness in sub-Saharan Africa.  Onchocerciasis also causes lesions, skin depigmentation, and debilitating itching, all of which foster stigmatization and social isolation.  Beyond its health impacts, onchocerciasis has also instilled a fear of blindness in affected communities, prompting them to abandon fertile river valleys in Africa, thereby reducing agricultural productivity and increasing poverty.

Approximately 37 million people around the world are infected with onchocerciasis; over 102 million people are at risk for the disease in 19 countries.  500,000 of those infected with onchocerciasis are severely visually impaired, and another 270,000 have been rendered permanently blind from the disease.

Fortunately, there are African-led efforts underway to control and eliminate this disease that can serve as a model for community-led health interventions and health systems strengthening efforts around the developing world.  The African Programme for Onchocerciasis Control (APOC) was established in 1995 to eliminate onchocerciasis as a disease of public health importance in Africa.  At the core of APOC’s strategy to eliminate the disease is community-directed treatment with ivermectin (CDTI), a strategy largely pioneered by APOC’s dynamic director, Dr. Uche Amazigo.

In 1997, APOC formally adopted the CDTI strategy to deliver ivermectin to infected and at-risk communities, and in the years since it has rapidly scaled up and expanded its efforts. Over 600,165 trained CDDs have been trained and engaged in CDTI projects since APOC’s inception, and they have delivered nearly (965,000,000) ivermectin tablets in 11 years (1997-2007).  Millions more have benefitted from other health interventions implemented simultaneously with CDTI, including home-based management of malaria, distribution of insecticide treated bed nets, Vitamin A supplementation, and management of HIV/AIDS as well as awareness campaigns involving the support of CDDs.

APOC

A map of health interventions delivered through the CDTi mechanism across Africa

Read more: Night 5: Onchocerciasis

Night 4: Lymphatic Filariasis

December 15th, 2009

By Fr. Tom Streit, DirectorUniversity of Notre Dame Haiti Program, on behalf of those working on LF in Haiti

The program to eliminate lymphatic filariasis (LF) is the largest public health program you never heard about.  In fact, most people who work in global health are shocked when they hear that more than 500 million people in over 40 countries were treated last year.  That is an impressive number, but it still represents less than one half of the total number that will need to receive annual treatment (for five or more years) if LF is to be eliminated.

These parasites are transmitted by mosquitoes and are best recognized as a cause of elephantiasis.  Adult worms live in the lymphatic vessels in humans and the female worms release motile stages called microfilaria into the blood.  It is this stage that is picked up by mosquitoes when the mosquito takes a blood meal.  After maturation in the mosquito, a process that takes one to two weeks, the larval stage is ready to infect another person during a blood meal.  For most people, the infection has no apparent symptoms, but some are incapacitated.  People with elephantiasis or men with scrotal swelling (also called hydrocele) can be so disabled by LF that they are unable to work or support their families.  They are often ostracized in their communities because of the fear and misunderstanding about the cause of the disease.

clean Antoine

As scientists, we continue to be fascinated by these parasites at the same time we have committed to getting rid of them.  I recognize the paradox here, but if we can reduce the suffering associated with LF and other NTDs, we should, even if it leaves the scientific community with a number of unanswered questions, including a few I’d like to share with you.

In many parts of the world, the microfilaria stage of the parasite is only found in the blood at night – when the mosquitoes are most likely to take a blood meal.  How does this work?  What signals is the parasite using to do this?

Why do only a relatively small percentage of people get elephantiasis?  We know that elephantiasis tends to occur in families, but why?  Is this related to genetic effects, environmental conditions or a combination?  Why does the parasite disappear from most of these people as the swelling develops?

On the opposite side of that question, why are some people more likely to acquire infection and maintain microfilaria in their blood for years or decades?  How does the worm avoid the host immune response?  For LF and many infections, we believe that children are more likely to acquire infection if their mothers were infected during pregnancy.  How does this affect other immune responses?

In truth, we don’t need to know the answers to these questions to eliminate LF.  China and Korea have succeeded; we also know that LF disappears on its own following economic development as it did in the United States.  We are now faced with an historic opportunity – as with small pox and now polio and guinea worm to make a conscious effort to remove the threat of LF permanently.  I, for one, can live with unanswered questions.

Night 3: Hookworm

December 14th, 2009

hookworm

By Peter Hotez, MD, PhD

President, Sabin Vaccine Institute

No, you’re not looking at a screenshot from a Steven Spielberg horror film.  That image of the white blob with teeth is a hookworm, an intestinal parasite that affects nearly one tenth of the world’s population, or almost all of the world’s poorest people (“The Bottom Billion”), and is the leading cause of anemia and protein malnutrition, particularly in pregnant women and children.

Hookworm is widespread in tropical and subtropical regions where the temperature of the soil is suitable for the growth of the hookworm larvae and many people live in abject poverty.

Hookworm larvae are found in human feces and transmitted to humans from contaminated soil through the skin, usually due to contact with contaminated soil or in some cases accidentally ingesting contaminated soil. Once inside the body, larvae are carried through the bloodstream to the lungs and mouth where they are swallowed, digested and passed to the small intestine.  There, the larvae mature into half-inch-long worms which attach themselves to the intestinal wall and feed on human blood.

Currently, there are efforts underway to reduce infection rates including improving sanitation by building or increasing use of outdoor latrines; educating communities on the causes and symptoms of hookworm infection; and distributing annual doses of donated Albendazole or Mebendazole.

It’s devastating to visit the endemic areas of the world’s poorest countries, to see children with profound anemia and malnutrition from hookworm is truly tragic.  I have been conducted research on hookworm infection for the last thirty years beginning when I was an MD/PhD student.  It is my dream and hope to one day see this ancient scourge controlled or eliminated in the low-and middle-income countries of Africa, Asia, and the Americas.

In 2000, I established the Human Hookworm Vaccine Initiative (HHVI) to develop the world’s first-ever safe, affordable, vaccine against human hookworm infection.  A hookworm vaccine would help alleviate the worldwide suffering of more than a half-billion infected people, 44 million of whom are pregnant women; and prevent disease in 3.2 billion people that are at risk, and, most importantly, it would provide immunity against the infection and ensure that fewer and fewer generations are susceptible to infection in the future.

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    • The Global Network for Neglected Tropical Diseases is a major advocacy and resource mobilization initiative of the Sabin Vaccine Institute dedicated to raising the awareness, political will, and funding necessary to control and eliminate the most common neglected tropical diseases (NTDs)--a group of disabling, disfiguring, and deadly diseases affecting more than 1.4 billion people worldwide living on less than $1.25 a day.
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