Neglected Tropical Diseases Elimination Research Articles

Neglected Tropical Diseases, Cross-Cutting Issues Workshop, 4-6 February 2015, Utrecht, the Netherlands: meeting report.

In the last decade, work on neglected tropical diseases (NTDs) has gained momentum. This was accelerated by the London Declaration on NTDs in January 2012. Work on NTDs has expanded worldwide and many countries have set up NTD control and elimination programs. However, the work has focussed disproportionately on preventive treatment. There is an urgent need for more attention and resources to work with people with NTD-related morbidity and disability. A lot can be gained in the fight against NTDs by combining knowledge and experience from cross-cutting fields. For this reason a workshop was organized bringing together scientists, experts and practitioners from different NTD backgrounds to explore options for cross-cutting strategies, interventions and research in the field of NTDs, particularly focusing on issues related to morbidity management and disability, in the broadest sense. The workshop produced an inventory of cross-cutting issues, an overview of knowledge gaps and research questions, proposals for pilot (research) projects and a list of recommendations. One of the main recommendations is based on the need for baseline data: to review existing indicators used for monitoring and surveillance of NTD-related morbidity and disability in order to identify common indicators that can be shared across NTDs.

The Neglected Tropical Disease Non-governmental Development Organization Network (NNN): the value and future of a global network aiming to control and eliminate NTDs.

The Neglected Tropical Disease Non-governmental Development Organization Network (NNN) (www.ntdngdonetwork.org) is a global forum for non-governmental development organizations (NGDOs) working to control or eliminate neglected tropical diseases (NTDs): currently including, leprosy, lymphatic filariasis (LF), onchocerciasis, schistosomiasis (SCH), soil-transmitted helminthiasis (STH) and trachoma. Each of these diseases has elimination as a target where feasible and each receives generous donations of medicines from the pharmaceutical industry. The NNN was formed at a meeting in Accra, Ghana, in September 2009 when several existing NTD-specific coordination groups combined forces following a general trend towards integrated NTD control and elimination. Today, the NNN is composed of five NTD-specific NGDO coordination groups: the LF NGDO Network; the International Coalition for Trachoma Control (ICTC) (http://www.trachomacoalition.org/node/873); the NGDO Coordination Group for Onchocerciasis Elimination; the SCH/STH NGDO Coordination Group; and the International Federation of Anti-Leprosy Associations (ILEP) (http://www.ilepfederation.org/ about-us/history-of-ilep/). In addition to these five diseasecoordination groups, the NNN has two thematic working groups: 1. Water, Sanitation, and Hygiene (WASH), and 2. Disease Management, Disability and Inclusion (DMDI). These working groups allow NNN members to address key cross-cutting issues that are common to the targeted NTDs. Together, these coordinating and working groups (Figure 1 and Table 1) comprise nearly 80 NGDO members of the NNN, working directly to support the world’s most underserved populations suffering from the NTDs by:

Compliance with anthelmintic treatment in the neglected tropical diseases control programmes: a systematic review.

Preventive chemotherapy (PCT) programmes are used to control five of the highest burden neglected tropical diseases (NTDs): soil-transmitted helminth infections (hookworm, ascariasis, and trichuriasis), lymphatic filariasis, schistosomiasis, onchocerciasis, and trachoma. Over the past decade, new resource commitments for the NTDs have enabled such programmes to intensify their control efforts, and for some diseases, to shift from goals of morbidity control to the interruption of transmission and elimination. To successfully eliminate the parasite reservoir, these programmes will undoubtedly require prolonged, high treatment coverage. However, it is important to consider that even when coverage levels reach an acceptable proportion of the target population, there may be a considerable gap between coverage (those who receive the drug) and compliance (those who actually consume the drug)—a topic of fundamental and perhaps underestimated importance. We conducted a systematic review of published literature that investigated compliance to PCT programmes for NTD control and elimination. Databases searched included PubMed/Medline, Web of Knowledge (including Web of Science), OVID, and Scopus. Data were collected on compliance rates, reasons for non-compliance, as well as the heterogeneity of compliance definitions and calculations across programmes and studies. A total of 112 studies were selected for inclusion. The findings of the review revealed substantial heterogeneity across compliance terms and definitions; an imbalance of available studies for particular disease areas and countries; and finally, a lack of longitudinal compliance studies to properly investigate the role of systematic non-compliance. The lack of consistency among reporting of compliance data can result in under- or over-estimating compliance in a population, and therefore has serious implications for setting and reaching elimination targets. Reframing of the guidelines on compliance definitions coupled with an urgent call for longitudinal research in systematic non-compliance should be essential elements in the programmatic shift from control to elimination.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-016-1311-1) contains supplementary material, which is available to authorized users.

From River Blindness to Neglected Tropical Diseases--Lessons Learned in Africa for Programme Implementation and Expansion by the Non-governmental Partners.

After more than 20 years of action against some of the most debilitating neglected tropical diseases (NTDs), lessons have been learned by the non-governmental development organisations (NGDOs) in the light of changes in programme strategies and partnerships. This article aims to summarise the development of the non-governmental networks supporting the NTD programmes, starting with the original 1992 model to combat onchocerciasis (river blindness), and will review the lessons learned that have equipped the NGDOs to step up their support to NTD control and elimination. At the beginning of the 1990s, a small group of seven NGDOs began to work together to support onchocerciasis control [1]. Today, more than 50 international and national NGDOs (of which 30 collaborate at the international level) work together to control or eliminate five priority NTDs affecting more than one billion of the poorest people [2]. This is a significant contribution to the objectives of World Health Assembly resolutions and the London Declaration on NTDs [3], as well as addressing Millennium Development Goal (MDG) 1, “Eradicate extreme poverty and hunger;” MDG 6 “Combat HIV/AIDS, malaria, and other diseases;” and MDG 8, “Develop a global partnership for development.” In 2013, the first annual report of the London Declaration on Neglected Tropical Diseases recorded increased treatments and funding and significant progress towards the World Health Organization (WHO)’s roadmap for implementation for control, elimination, or eradication by 2020. This achievement has been made possible by developing networks of NGDOs and partnerships with governments of the endemic countries, with international and bilateral agencies, with drug donation programmes for specific diseases, and with the communities affected by those diseases [4]. By 2011, NGDOs reported support in 125 countries to more than 330 million treatments for five priority diseases: onchocerciasis, trachoma, lymphatic filariasis (LF), schistosomiasis, and soil-transmitted helminthiasis (STH) [5]. These diseases have effective mass drug administration (MDA) strategies supported by donated or very-low-cost drugs available to control or eliminate them [6,7].

Neglected tropical diseases among the Association of Southeast Asian Nations (ASEAN): overview and update.

The ten member states of the Association of Southeast Asian Nations (ASEAN) constitute an economic powerhouse, yet these countries also harbor a mostly hidden burden of poverty and neglected tropical diseases (NTDs). Almost 200 million people live in extreme poverty in ASEAN countries, mostly in the low or lower middle-income countries of Indonesia, the Philippines, Myanmar, Viet Nam, and Cambodia, and many of them are affected by at least one NTD. However, NTDs are prevalent even among upper middle-income ASEAN countries such as Malaysia and Thailand, especially among the indigenous populations. The three major intestinal helminth infections are the most common NTDs; each helminthiasis is associated with approximately 100 million infections in the region. In addition, more than 10 million people suffer from either liver or intestinal fluke infections, as well as schistosomiasis and lymphatic filariasis (LF). Intestinal protozoan infections are widespread, while leishmaniasis has emerged in Thailand, and zoonotic malaria (Plasmodium knowlesi infection) causes severe morbidity in Malaysia. Melioidosis has emerged as an important bacterial NTD, as have selected rickettsial infections, and leptospirosis. Leprosy, yaws, and trachoma are still endemic in focal areas. Almost 70 million cases of dengue fever occur annually in ASEAN countries, such that this arboviral infection is now one of the most common and economically important NTDs in the region. A number of other arboviral and zoonotic viral infections have also emerged, including Japanese encephalitis; tick-borne viral infections; Nipah virus, a zoonosis present in fruit bats; and enterovirus 71 infection. There are urgent needs to expand surveillance activities in ASEAN countries, as well as to ensure mass drug administration is provided to populations at risk for intestinal helminth and fluke infections, LF, trachoma, and yaws. An ASEAN Network for Drugs, Diagnostics, Vaccines, and Traditional Medicines Innovation provides a policy framework for the development of new control and elimination tools. Together with prominent research institutions and universities, the World Health Organization (WHO), and its regional offices, these organizations could implement important public health improvements through NTD control and elimination in the coming decade.

The global burden of disease study 2010: interpretation and implications for the neglected tropical diseases.

The publication of the Global Burden of Disease Study 2010 (GBD 2010) and the accompanying collection of Lancet articles in December 2012 provided the most comprehensive attempt to quantify the burden of almost 300 diseases, injuries, and risk factors, including neglected tropical diseases (NTDs) [1]–[3]. The disability-adjusted life year (DALY), the metric used in the GBD 2010, is a tool which may be used to assess and compare the relative impact of a number of diseases locally and globally [4]–[6]. Table 1 lists the major NTDs as defined by the World Health Organization (WHO) [7] and their estimated DALYs [1]. With a few exceptions, most of the NTDs currently listed by the WHO [7] or those on the expanded list from PLOS Neglected Tropical Diseases [8] are disablers rather than killers, so the DALY estimates represent one of the few metrics available that could fully embrace the chronic effects of these infections. Table 1 Estimated DALYs (in millions) of the NTDs from the Global Burden of Disease Study 2010. Disease DALYs from GBD 2010 (numbers in parentheses indicate 95% confidence intervals) [1] NTDs 26.06 (20.30–35.12) Intestinal nematode infections 5.19 (2.98–8.81) Hookworm disease 3.23 (1.70–5.73) Ascariasis 1.32 (0.71–2.35) Trichuriasis 0.64 (0.35–1.06) Leishmaniasis 3.32 (2.18–4.90) Schistosomiasis 3.31 (1.70–6.26) Lymphatic filariasis 2.78 (1.8–4.00) Food-borne trematodiases 1.88 (0.70–4.84) Rabies 1.46 ((0.85–2.66) Dengue 0.83 (0.34–1.41) African trypanosomiasis 0.56 (0.08–1.77) Chagas disease 0.55 (0.27–1.05) Cysticercosis 0.50 (0.38–0.66) Onchocerciasis 0.49 (0.36–0.66) Trachoma 0.33 (0.24–0.44) Echinococcosis 0.14 (0.07–0.29) Yellow fever <0.001 Other NTDs * 4.72 (3.53–6.35) Open in a separate window * Relapsing fevers, typhus fever, spotted fever, Q fever, other rickettsioses, other mosquito-borne viral fevers, unspecified arthropod-borne viral fever, arenaviral haemorrhagic fever, toxoplasmosis, unspecified protozoal disease, taeniasis, diphyllobothriasis and sparganosis, other cestode infections, dracunculiasis, trichinellosis, strongyloidiasis, enterobiasis, and other helminthiases. Even DALYs, however, do not tell the complete story of the harmful effects from NTDs. Some of the specific and potential shortcomings of GBD 2010 have been highlighted elsewhere [9]. Furthermore, DALYs measure only direct health loss and, for example, do not consider the economic impact of the NTDs that results from detrimental effects on school attendance and child development, agriculture (especially from zoonotic NTDs), and overall economic productivity [10], [11]. Nor do DALYs account for direct costs of treatment, surveillance, and prevention measures. Yet, economic impact has emerged as an essential feature of the NTDs, which may trap people in a cycle of poverty and disease [10]–[12]. Additional aspects not considered by the DALY metrics are the important elements of social stigma for many of the NTDs and the spillover effects to family and community members [13], [14], loss of tourism [15], and health system overload (e.g., during dengue outbreaks). Ultimately NTD control and elimination efforts could produce social and economic benefits not necessarily reflected in the DALY metrics, especially among the most affected poor communities [11].

Could Nitazoxanide Be Added to Other Essential Medicines for Integrated Neglected Tropical Disease Control and Elimination?

In 2011, the World Health Organization (WHO) determined that more than 700 million people were treated with at least one essential medicine for neglected tropical diseases (NTDs) under the auspices of a global preventive chemotherapy initiative [1,2]. However, a total of at least 1.9 billion people require annual preventive chemotherapy [1,2], so these efforts will need to be greatly expanded in order to meet NTD control and elimination targets as outlined in the 2012 London Declaration and the 2013 World Health Assembly resolution for these diseases [3]. The original ‘‘rapid-impact’’ package of NTD interventions targeted up to seven NTDs highly endemic to sub-Saharan Africa, including the three soil-transmitted helminthiases, schistosomiasis, lymphatic filariasis, onchocerciasis, and trachoma, and was comprised of up to four essential NTD medicines that could include a benzimidazole anthelminthic drug (i.e., mebendazole or albendazole), ivermectin, praziquantel, and/or azithromycin [4,5]. However, it was quickly noted that either the entire rapid-impact package or some component thereof had applicability outside of Africa (with modifications depending on the specific NTDs being targeted) [6]. By controlling or eliminating the seven major NTDs, this approach could potentially effect a global disease burden reduction almost as important as HIV/ AIDS, tuberculosis, or malaria control [7,8]. As global preventive chemotherapy efforts expanded, it also became apparent that they could produce important collateral public health benefits that were not originally anticipated, including overall reductions in child mortality from the azithromycin component [9] and coverage for additional NTDs such as food-borne trematodiases, scabies, and yaws [3,10,11]. There are equally important efforts underway to broaden the interventions to include water, sanitation, and hygiene (WASH) initiatives [12]. Thus, in the decade since rapid impact was originally proposed, there are new uses and approaches for preventive chemotherapy. In the last year, two important studies were published that could alter how we think about current preventive chemotherapy approaches. The first, known as the Global Enteric Multicenter Study (GEMS) for diarrheal diseases, made the surprising finding that cryptosporidiosis is one of the most important causes of infectious diarrhea in children in developing countries [13]. The second is the Global Burden of Disease Study 2010 (GBD 2010), which found that, together, cryptosporidiosis and amoebiasis exceed the disease burden–as measured in disability-adjusted life years (DALYs) or in deaths—of any helminth infection now currently being targeted for preventive chemotherapy (Table 1) [14,15]. Although there are important disagreements in the NTD community about whether the DALYs for helminth infections (and other NTDs) were underestimated [16], both GEMS and GBD 2010 provide important information to our community that we need to consider in deciding whether it is possible to add coverage for cryptosporidiosis and amoebiasis as part of global preventive chemotherapy efforts. A potential candidate drug for use in mass drug administration programs to target intestinal protozoa is the nitrothiazole benzamide drug, nitazoxanide (Figure 1) [17]. The development program for nitazoxanide was led by Jean Francois Rossignol in the 1970s, initially as a veterinary anthelminthic agent, but the drug was subsequently shown to be active against intestinal protozoa and some human helminths, as well as anaerobic bacteria [17]. It was approved in 2002 by the United States Food and Drug Administration, initially as an oral suspension for pediatric use (100 mg/5 ml) against cryptosporidiosis and giardiasis, and subsequently as 500 mg tablets for adults [17]. According to The Medical Letter, the recommended therapeutic dosage is administered over three days [18]. Although the initial indication for nitazoxanide was for cryptosporidiosis and giardiasis, subsequent investigative research has revealed that the drug is effective for amoebiasis caused by Entamoeba histolytica and could be used to treat both invasive intestinal amoebiasis and colonization with E. histolytica [19]. Moreover, nitazoxanide is active against a number of nonprotozoan parasites, including the

Resource Planning for Neglected Tropical Disease (NTD) Control Programs: Feasibility Study of the Tool for Integrated Planning and Costing (TIPAC)

Neglected tropical diseases (NTDs) cause significant morbidity and mortality worldwide and impose a large economic burden on endemic countries [1]. In 2006, the United States Agency for International Development (USAID) founded the NTD Control Program to target five NTDs in African, Asian, and Latin American countries, namely, lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminthiases (STH), and trachoma; the three targeted STH infections are ascariasis, hookworm, and trichuriasis. The NTD Control Program supported national NTD control and elimination programs' efforts to integrate and scale up delivery of preventive chemotherapy (PC) [2]. PC is the administration of safe, single-dose drugs, either alone or in combination, as a public health intervention against targeted NTDs. Administration is characterized by population-based diagnosis,population-based treatment,and implementation at regular intervals. PC can be delivered as universal chemotherapy (i.e., mass drug administration [MDA]), where the entire population of an area is targeted; targeted chemotherapy, where only high-risk groups (e.g., school age children) are targeted; or selective chemotherapy, where only screened individuals found or suspected to be infected are targeted [3]. Between October 2006 and March 2012, the program provided 589 million NTD treatments through the collaborative efforts of ministries of health, implementing partners, funders, and pharmaceutical donation programs. The implementation of integrated NTD programs at the full national scale remains an important objective in many endemic countries [4]–[8]. Several theoretical frameworks for integration have been proposed; most protocols stress the importance of long-term commitments and concerted efforts of partnerships to realize NTD control and elimination objectives [9]–[14]. However, there is currently a paucity of economic evidence on the costs of integrated PC delivery for NTDs, primarily due to the significant variation in program structures and operations [14]. Given the scarce resources and substantial costs associated with NTD control and elimination, there is therefore a need to accurately determine the cost of program implementation. It is also important to delineate funding commitments to ensure that additional assistance is used to complement available resources, rather than duplicate or replace previous efforts. To allow governments to more easily enumerate costs and funding commitments for NTD control and elimination, the NTD Control Program developed the Tool for Integrated Planning and Costing (TIPAC). The TIPAC, a versatile planning and costing instrument, is designed to be used by members of a NTD program at the national level. For countries with decentralized political structures, the TIPAC can also be implemented at a subnational administrative level. NTD program and financial managers are the primary users of the tool; the involvement of other personnel, including representatives from partner organizations and ministries of education, improves the accuracy and completeness of the TIPAC data. The TIPAC implementation process includes four main phases: Background data collection: country coordinators compile, review, and verify demographic, epidemiologic, and cost classification data. In countries where individual disease control programs are not integrated, this phase may generate fruitful discussions among stakeholders and stimulate collaboration on program planning, outreach, implementation, and monitoring. Data entry: a focal person appointed by the national program enters the planned activity costs. The national strategic plans for NTD control and elimination, also referred to as master plans, serve as the guiding documents for data entry. As the tool is populated, integration opportunities and areas of overlap and duplication are identified. After the costs are entered, stakeholder meetings are convened to identify drug and funding commitments. Finalization and approval: the entered data is reviewed by all stakeholders and approved for use by ministry of health representatives from the national NTD control and elimination program. Results application: the results can be used to inform and guide annual work plans, drug applications, donor coordination efforts, and advocacy and fundraising strategies. The TIPAC is able to convert the information in the tool for use during another funding year, thereby facilitating data entry in subsequent years. The aim of this feasibility study is to assess whether the TIPAC effectively informs and facilitates country program decision-making and the integration of program activities. This study presents excerpts from data collected in two African countries (Sierra Leone, fiscal year [FY] Oct. 2010–Sept. 2011, and Tanzania, FY Oct. 2010–Sept. 2011), one Asian country (Nepal, FY Jul. 2010–Jul. 2011), and one Latin American country (Haiti, FY Oct. 2011–Sept. 2012). The lessons learned from implementing the TIPAC in these four countries can guide the planning and costing of annual NTD control and elimination activities in other NTD-endemic countries.

Aboriginal Populations and Their Neglected Tropical Diseases

Although Aboriginal people make up a small percentage of the worlds population, they are disproportionately affected by poverty and neglected tropical diseases (NTDs). Unless prioritized, Aboriginal populations may be the last to receive access to essential medicines as part of global NTD elimination efforts. An estimated 370 million people are today classified as belonging to Indigenous or Aboriginal groups [1], [2]. According to Gracey and King, included among the major criteria defining these populations are self-identification as belonging to an Indigenous group historical ties to specified geographic areas and natural resources, frequently followed by external invasion or colonization a distinct culture with beliefs and ceremonies and resolve to maintain ancestral environments and manage their own affairs [1]. However, there is not universal agreement on what constitutes an Aboriginal group, leading in some cases to exclusion or further marginalization [1]. As a whole, Aboriginal populations are disproportionately impoverished, accounting for 15 of global poverty even though they comprise only 5 of the global population [3]. Poverty, especially rural poverty, and its associated poor housing and sanitation, environmental degradation, inadequate or improper nutrition, forced migrations, and lack of access to health care, combine and synergize to create a number of adverse health consequences for Aboriginal populations [1], [2]. These include a spectrum of non-communicable diseases such as diabetes, obesity, hypertension, and cardiovascular disease (frequently related to tobacco consumption), as well as interpersonal violence and suicide often linked to alcohol and drugs [1], [2]. Aboriginal populations are also disproportionately affected by infectious diseases, especially infections of the skin (e.g., impetigo and tungiasis), eye (e.g., trachoma), and ear (e.g., acute and chronic otitis), dental caries, respiratory and urinary tract infections, and diarrheal diseases [1]. Neglected tropical diseases (NTDs) are especially common among Aboriginal populations. Shown in Table 1 are five representative groups of Aboriginal peoples and their major NTDs. The most common NTDs are intestinal helminth and protozoan infections zoonotic parasitic infections neglected bacterial infections such as trachoma, leprosy, and yaws and a number of important vector-borne illnesses, including malaria and dengue. Many, but not all, are included in the list of 17 NTDs as defined by the World Health Organization [4]; others are on the expanded list of diseases as defined by PLOS Neglected Tropical Diseases [5]. Table 1 Major Aboriginal populations and their neglected tropical diseases (NTDs).

NTDs V.2.0: “Blue Marble Health”—Neglected Tropical Disease Control and Elimination in a Shifting Health Policy Landscape

The concept of the neglected tropical diseases (NTDs) was established in the aftermath of the Millennium Development Goals. Here, we summarize the emergence of several new post-2010 global health documents and policies, and how they may alter the way we frame the world's major NTDs since they were first highlighted. These documents include a new Global Burden of Disease 2010 Study that identifies visceral leishmaniasis and food-borne trematode infections as priority diseases beyond the seven NTDs originally targeted by preventive chemotherapy, a London Declaration for access to essential medicines, and a 2013 World Health Assembly resolution on NTDs. Additional information highlights an emerging dengue fever pandemic. New United Nations resolutions on women and the non-communicable diseases (NCDs) have not yet embraced NTDs, which may actually be the most common afflictions of girls and women and represent a stealth cause of NCDs. NTDs also have important direct and collateral effects on HIV/AIDS and malaria, and there is now a robust evidence base and rationale for incorporating NTDs into the Global Fund to Fight AIDS, Tuberculosis, and Malaria. “Blue marble health” is an added concept that recognizes a paradoxical NTD disease burden among the poor living in G20 (Group of Twenty) and other wealthy countries, requiring these nations to take greater ownership for both disease control and research and development. As we advance past the year 2015, it will be essential to incorporate global NTD elimination into newly proposed Sustainable Development Goals.

Developing eradication investment cases for onchocerciasis, lymphatic filariasis, and human African trypanosomiasis: rationale and main challenges.

The global health community pays renewed attention to evaluating the feasibility of elimination and eradication of certain communicable diseases [1,2] besides continuing to reduce the burden of ill-health. Eradication depends on both the availability of tools to interrupt transmission, the capacity of health systems to implement these solutions effectively across all populations concerned, the required resources, and sustained political will. While the health and economic benefits of disease elimination and subsequent eradication may be substantial, elimination initiatives represent resourceintensive efforts with associated opportunity costs [3,4]. Given the increasingly intense competition for global health resources, the decision to commit to national/regional elimination or eventual global eradication initiatives needs to be based upon robust analysis of benefits, risks, and costs. Following an initial proposal of the Ernst Strungmann Forum, convened in 2010 to explore the prospects, feasibility, and challenges of disease eradication [2], a working group developed a Guide to Preparing an Eradication Investment Case (EIC) [5]. The Guide proposes a generic approach applicable to any potentially eradicable disease. Among the diseases tentatively identified as amenable to eradication are several neglected tropical diseases (NTDs) [6]. The vision of eliminating and eradicating selected NTDs has gathered momentum over recent years. In 2011, the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases and its partners adopted a roadmap for the control, elimination, and eradication of many NTDs. The global financial support for NTDs control and elimination is still comparatively low but has recently started to substantially increase. Following major pledges by the US Agency for International Development (USAID) (350 million USD for the period 2009–2013) and the UK’s Department for International Development (DfID) for 2011–2015 (245 million GBP), the Bill and Melinda Gates Foundation (BMFG) donated 363 million USD for NTDs control and elimination in January 2012 (London Declaration, http://endtheneglect. org/2012/01/ntds-take-spotlight-at-londondeclaration-meeting/).

Global trends in neglected tropical disease control and elimination: impact on child health

The neglected tropical diseases (NTDs) are a group of 17 lesser known chronic infections which predominantly affect poor and disenfranchised communities. There are a number of NTDs that cause significant...

Contributions of the Guinea Worm Disease Eradication Campaign toward Achievement of the Millennium Development Goals

Infectious diseases have influenced the biological, historical, and political development of the human species more than any other factor: from the outcome of wars to the success of empires, from the pace of technological advance to the structure of society [1]. Dracunculiasis (Guinea worm disease) was considered a mild affliction not warranting a widespread public health campaign. However, examination of the benefits of eradicating Guinea worm disease (GWD) reveals the effort is contributing to development, including contributions to certain Millennium Development Goals (MDGs) [2]. Given the use of the MDGs in the development of global health agendas, it is timely to consider the contributions of neglected tropical disease (NTD) programs, such as the Guinea Worm Eradication Program (GWEP), toward the achievement of the MDGs. The prevention of NTDs, and their cost-effective interventions, fuels long-term economic growth and development, and human advancement [3]. The effort to eradicate GWD is considered one of the most cost-effective health interventions available [2,4,5]. The authors provide evidence that concentrated efforts on eradication, elimination, and control of some NTDs can yield far-reaching results, and given these results, stimulate increased efforts toward NTD eradication, elimination, and control among public health advocates, global health entities, and donors. GWD is a disease of the poor, debilitating many in the most remote and disadvantaged communities in parts of sub-Saharan Africa, where potable water is limited and health care and education are lacking [6]. Endemic GWD transmission is an indicator of extreme poverty [6,7]. GWD is a preventable, painful, and incapacitating waterborne helminthic disease, which harms health, agriculture, school attendance, and overall quality of life for individuals and communities [7–9]. GWD is transmitted when humans drink water, usually from stagnant water sources, containing tiny copepods that have ingested larvae of the parasite. Once consumed, the digestive juices in the human stomach kill the copepods, allowing the larvae to be released and move to the intestinal wall where they migrate to connective tissues of the thorax. Male and female larvae mature and mate 60–90 days after infection. Symptoms appear 10–14 months later when the gravid adult female(s), measuring up to 70–100 cm long, emerges from the skin, causing a painful lesion [10]. When the emerging worm is exposed to water, she ejects hundreds of thousands of larvae into the water to continue the cycle. During emergence, an infected person can be incapacitated for an average of 8.5 weeks [10,11]. Although rarely fatal, GWD inflicts devastating pain and infection resulting in immobility [8,12]. The pain is so long-lasting that infected individuals may be incapacitated for up to three months during and after the Guinea worm (GW) emerges [11,13–15]. Other symptoms include nausea, vomiting, diarrhea, and dizziness; secondary bacterial infections can also occur and can lead to arthritis, tetanus, and permanent crippling [8]. There is no cure, vaccine, or immunity after infection [11]. Since there is no evidence that animals are reservoir hosts, the disease is deemed a good candidate for eradication [8]. The global eradication campaign began at the United States Centers for Disease Control and Prevention (CDC) in 1980 and was then adopted as a subgoal of the United Nations International Drinking-Water Supply and Sanitation Decade (1981–1990). In that same year, the decision-making body of the World Health Organization (WHO) adopted a resolution (WHA 34.25) recognizing the decade could be an opportunity to eliminate GWD. Since 1986, The Carter Center (TCC) has led the effort, with the help of the CDC, WHO, United Nations Children’s Fund (UNICEF), and many other donors and nongovernmental organizations, to assist national eradication efforts by governments of the countries where GWD is endemic [11]. The GWEP assists ministries of health (MOH) in each endemic country to provide GWD interventions. The GWEP is an eradication effort that relies heavily on behavioral change via health education and interventions. The GWEP has demonstrated that when people are given the proper tools and health education, cases decrease dramatically [16]. The most effective and cost-efficient way to prevent GWD is the promotion of its health campaign coupled with proper and consistent use of filters to remove the copepods from drinking water, case containment, and the application of ABATE, a safe chemical larvicide, to control the copepods [4,17–19]. GWD is an infectious disease categorized as a neglected tropical disease (NTD) [20]. NTDs are among the most common infectious diseases of the world’s poorest people [21,22]. An estimated 1.2 billion people are infected with one or more NTDs [23]. These individuals are among the billion people living on less than $1 per day, a population identified as the ‘‘bottom billion’’ [23]. NTDs are a group of parasitic, bacterial, and viral diseases that cause

Elimination of tropical disease through surveillance and response.

Surveillance and response represent the final crucial steps in achieving effective control and particularly elimination of communicable diseases as recognized in the area of neglected tropical diseases (NTDs), applied in increasing numbers in endemic countries with ongoing control and elimination programmers. More and more national NTD elimination initiatives are scheduled based on the innovative and effective One world-One health perspective to detect pockets of transmission and disease reintroduction. Resource-constrained countries, which carry the heaviest NTD burdens, face various challenges how to strengthen the health system as well as developing effective and novel tools for surveillance and response tailored to local settings. Surveillance-response approaches take place in two different stages corralling the basic components of the surveillance-response system for NTD elimination. Six different research priorities have been identified:1)dynamic mapping of transmission, 2) near real-time capture of population dynamics, 3) modelling based on a minimum essential database/dataset, 4) implementation of mobile health (m-health) and sensitive diagnostics, 5) design of effective response packages tailored to different transmission settings and levels, and 6) validation of approaches and responses packages.

Now We Are Six

Now We Are Six

Drug Coverage Surveys for Neglected Tropical Diseases: 10 Years of Field Experience

Mass drug administration is one of the public health strategies recommended by the World Health Organization for the control and elimination of seven neglected tropical diseases (NTDs). Because adequate coverage is vital to achieve program goals, periodically conducting surveys to validate reported coverage to guide NTD programs is recommended. Over the past decade, the Centers for Disease Control and Prevention (CDC) and collaborators conducted more than 30 two-stage cluster household surveys across three continents. The questionnaires gathered coverage data and information relevant to improving NTD programs including NTD-related attitudes and practices. From the 37 coverage survey estimates obtained in those surveys, 73.3% indicated an over reporting of coverage, including all three that assessed school-based distributions. It took an average of 1 week to conduct a survey. Our experiences led us to conclude that coverage surveys are useful and feasible tools to ensure NTD elimination and control goals are reached.

The 'Neglected Tropical Diseases': now a brand identity; responsibilities, context and promise

Editorial On 30 January, Bill Gates, Margaret Chan, the DirectorGeneral of the World Health Organization, CEOs of major pharmaceutical companies, senior government officials from donor and endemic countries gathered in London together with NGOs and academic institutions, at a meeting entitled “Uniting to Combat NTDs: Ending the Neglect and Reaching the 2020 Goals” http:// www.unitingtocombatntds.org to announce a massive expansion of the support to control and potentially eliminate or eradicate a group of seventeen Neglected Tropical Diseases. The meeting was convened by the Bill and Melinda Gates Foundation. Since 2004 there has been a gradual but increasing recognition of the importance of neglected tropical diseases (NTDs) as an impediment to development. If the Millennium Development Goals (MDGs), which relate to health, are to be achieved then controlling only HIV, tuberculosis and malaria will not alone address the needs of the poorest. It is essential the so called “other diseases” of the MDGs are given a high priority on the global Health agenda. The London meeting is the culmination of the efforts by many interested partners from diverse constituencies. These groups working together, since the publication in 2010 of the first WHO Report” Working to overcome neglected Tropical Diseases” have recognised the importance of NTDs as impediments to development. It is also important to note that these conditions touch the “bottom billion” but can be addressed either with available tools or through targeted research to develop new products and tools within an acceptable time frame to address well defined needs. Endemic countries, international agencies, bilateral and philanthropic donors, academia and nongovernmental organisations as well as existing global partnership organisations are coming togetherall committed to achieving unprecedented cooperation to solve a major health problem. The London meeting was a landmark in public health cooperation setting the agenda for the next decade. The commitments made will bring hope providing the final nail in the coffin of diseases which have plagued humanity for millennia. All parties present endorsed the “London” Declaration inspired by WHO’s Road Map on NTDs published on the 26 January. The road map sets targets for the period 2012-2020. WHO believes that despite the complexity of the NTDs, the targets are achievable. The Declaration commits partners to sustain and expand resources to achieve ambitious but welldefined and obtainable eradication, elimination or control targets. Partners will advance research and development, enhance collaboration on NTDs at national and international levels, work more effectively together, enable adequate funding for endemic countries to implement programmes, provide the technical support for evaluation and monitoring and provide regular updates towards the 2020 goals. The diseases embraced by this global movement do not have any formally structured single partnership but all constituencies share a strong commitment to support WHO’s strategies, goals and targets. These diseases have not suddenly emerged; they have been the subject of studies since the earliest days of the discipline of Tropical Medicine where the father of that discipline, Sir Patrick Manson, first discovered that insects were capable of transmitting infective agents when he discovered the mosquito transmission of filarial infections in China in 1879. During the last 8 years the messages articulated by advocates of NTD eradication, elimination and control have gradually been recognised by global health leaders and policy makers as amongst the best investments that a health dollar can buy. The term Neglected Diseases emerged in the 1980’s when the late Dr Ken Warren as Head of the Rockefeller health department introduced the term Great Neglected Diseases. The term fell into abeyance until it was adopted at the Berlin meetings of 2003 and 2004 organised by WHO and Deutsche Gesellschaft fur Correspondence: david.molyneux@liv.ac.uk Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK Molyneux Parasites & Vectors 2012, 5:23 http://www.parasitesandvectors.com/content/5/1/23

Enlarging the “Audacious Goal”: Elimination of the world's high prevalence neglected tropical diseases

The high prevalence neglected tropical diseases (NTDs) exhibit a global disease burden that exceeds malaria, tuberculosis, and other better known global health conditions; they also represent a potent force in trapping the world's poorest people in poverty. Through extremely low cost national programs of disease mapping and mass drug administration (MDA) for the seven most common NTDs, integrated NTD control and elimination efforts are now in place in more than 14 countries through the support of the United States Agency for International Development (USAID), the British Department for International Development (DFID), and the Global Network for NTDs and its partners. The World Health Organization (WHO) estimates that in 2008 some 670 million people in 75 countries received NTD treatments through these and other sponsored programs. With continued successes the next decade could witness the global elimination of blinding trachoma, human Africa trypanosomiasis (HAT), lymphatic filariasis (LF), onchocerciasis, trachoma, and leprosy as public health problems, in addition to the eradication of dracunculiasis. For other high prevalence NTDs, including hookworm infection, schistosomiasis, Chagas disease and leishmaniasis, new drugs and vaccines may still be required. Increasingly it is recognized that the high prevalence NTDs exhibit extensive geographic overlap and polyparasitism is commonly found throughout the world's low income countries. Therefore, global elimination will also require integrated packages of drugs together with vaccine-linked chemotherapy. Ultimately, the global elimination of the high prevalence NTDs will require continued large-scale support from the U.S. Government and selected European governments, however, the emerging market economies, such as Brazil, China, India, Mexico, and Nigeria, and wealthy countries in the Middle East will also have to substantially contribute.

Neglected Tropical Diseases and the 2012 US Presidential Election

Neglected Tropical Diseases and the 2012 US Presidential Election

Linking Global HIV/AIDS Treatments with National Programs for the Control and Elimination of the Neglected Tropical Diseases

Emerging evidence provides a scientific rationale for combining treatment programs for neglected tropical diseases (NTDs) with programs for the treatment of HIV/AIDS. Engaging the major stakeholders to establish operational links between HIV/AIDS and NTD control and elimination activities, especially in sub-Saharan Africa, could increase the efficiency and cost-effectiveness of both HIV/AIDS and NTD efforts.