Abstract
A disproportionate burden of helminthiases in human populations occurs in marginalised, low-income, and resource-constrained regions of the world, with over 1 billion people in developing areas of sub-Saharan Africa, Asia, and the Americas infected with one or more helminth species. The morbidity caused by such infections imposes a substantial burden of disease, contributing to a vicious circle of infection, poverty, decreased productivity, and inadequate socioeconomic development. Furthermore, helminth infection accentuates the morbidity of malaria and HIV/AIDS, and impairs vaccine efficacy. Polyparasitism is the norm in these populations, and infections tend to be persistent. Hence, there is a great need to reduce morbidity caused by helminth infections. However, major deficiencies exist in diagnostics and interventions, including vector control, drugs, and vaccines. Overcoming these deficiencies is hampered by major gaps in knowledge of helminth biology and transmission dynamics, platforms from which to help develop such tools. The Disease Reference Group on Helminths Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps. In this review, we provide an overview of the forces driving the persistence of helminthiases as a public health problem despite the many control initiatives that have been put in place; identify the main obstacles that impede progress towards their control and elimination; and discuss recent advances, opportunities, and challenges for the understanding of the biology, epidemiology, and control of these infections. The helminth infections that will be discussed include: onchocerciasis, lymphatic filariasis, soil-transmitted helminthiases, schistosomiasis, food-borne trematodiases, and taeniasis/cysticercosis.
Highlights
Since the publication by Norman Stoll in 1947 of ‘‘This Wormy World’’ [1], where the intolerable burden of intestinal nematode infections was highlighted, several global efforts have been made to address the health effects of human parasitism by helminths
The morbidity associated with most of the helminthic diseases we focus on in this report and in the other reviews in this issue are closely linked to poverty; they result from poverty and markedly contribute to further poverty by, among others, impairing agricultural and economic productivity, and they exert a detrimental impact on cognitive development and educational outcomes, thereby hampering socioeconomic development
Several new initiatives have been been established, most notably the Schistosomiasis Control Initiative (SCI) in 2002 and the Global Network for Neglected Tropical Disease Control (GNNTDC) in 2006. Despite such World Health Assembly (WHA)/World Health Organization (WHO) resolutions, the initiatives described above, and the many scientific advances in our understanding of the biology and epidemiology of helminth infections, obstacles remain that challenge the global public health community in their efforts to attain the aims of controlling morbidity and eliminating infection
Summary
Despite such WHA/WHO resolutions, the initiatives described above, and the many scientific advances in our understanding of the biology and epidemiology of helminth infections, obstacles remain that challenge the global public health community in their efforts to attain the aims of controlling morbidity and eliminating infection. To control the high-burden NTDs, including helminthiases, in low- and middle-income countries and help achieve the MDGs, a great deal of investment from both international and national funding bodies will be required in order to develop the facilities and the capabilities of scientists who can drive research aimed at developing more effective tools and strategies to fight infectious diseases of poverty [4].
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