The Big Ten Tropical Diseases. Categorization and research strategic emphases

1
The Big Ten Tropical Diseases. Categorization
and research strategic emphases

• Dr. Marcio Ulises Estrada Paneque.
• Dr. Genco Estrada Vinajera.
• Universidad Médica de Granma.
• Cuba.

2
Exchange Objectives

• To know a brief history, some facts, impact and
  current Tropical Diseases
• (TD) classification.
• To approach the current research strategic
  emphases of those illnesses.

3
The Big Ten. Clasification.

• African Trypanosomiasis.
• Dengue.
  Category I
• Leishmaniasis.
• Malaria.
• Tuberculosis. Category
  II
• Schistosomiasis
• Onchocerciasis.
• Leprosy.
  Category III
• Chagas disease.
• Lymphatic filariasis

4
Classification due to

• Category I Emerging or uncontrolled disease.
• Category II Control strategy available but
  disease burden persists.
• Category III Control strategy proven effective,
  disease burden falling, and elimination planned.

5
Categorization . Why?

• New knowledge about the biological, social,
  economic, health system, and behavioral
  determinants, for effective control.
• New tools for use in prevention and control, e.g.
  drugs, vaccines, diagnostics, epidemiological and
  environmental tools.
• Interventions methods for applying existing and
  new tools at the clinical and community level.
• Policies for large-scale implementation of
  existing and new disease prevention and control
  strategies.

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10 Big Tropical Diseases. Some questions.

• What is the size and nature of the disease burden
  and what are the epidemiological trends?
• What is the current disease control strategy?
• What are the major problems and challenges for
  disease control?
• What research is needed to address these problems
  /challenges?
• What is currently being done in research and
  development? What research opportunities exist?
  

7
Tropical diseases impact.

• Conditions that contribute to the risk for
  becoming infected with TD agent include
  biological factors related to population density,
  rural vs. urban living, nutritional status,
  climate and other environmental factors, as well
  as socioeconomic circumstances. At one time, many
  of today's tropical diseases also occurred in
  temperate regions, since many of the same risk
  factors were found there.
• Illness and death due to infection remain all too
  frequent in the tropics. Every minute three
  children die of malaria alone. The burden imposed
  by these diseases, however, extends beyond the
  sad story of young lives being lost. They impede
  the capacity of children to grow and learn, and
  of young adults to work and raise a family. They
  stifle efforts for individual, community and
  national advancement. They sap resources which
  would otherwise be utilized for improving the
  human condition.

8
Health Research and Tropical Diseases

• Setting priorities for the health research is a
  difficult task, especially for the neglected
  diseases of the poor.
• A new approach to priority setting for tropical
  diseases research must be based on a
  comprehensive analysis of research needs and
  research opportunities for each of the ten major
  tropical diseases in its portfolio.

9
African trypanosomiasis

• African trypanosomiasis, also known as
• Sleeping sickness, is a severe disease,
• which is fatal if left untreated. It is
  closely
• related to a widespread infection of cattle
• known as Ngana, which restricts cattle
• earing in many prime areas of Africa.
• Sleeping sickness claims comparatively few lives
  annually, but the risk of
  major epidemics means that surveillance and
  ongoing control measures must be maintained.

10
Trypanosomiasis. Research emphases

• New basic knowledge
• Bioinformatics and applied genomics for
  identifying targets for drugs and diagnostics
• Pathogenesis and host / pathogen interactions
• Socioeconomic impact of human African
  trypanosomiasis and cost-benefit of control
• Effect of health systems and policy changes on
  human African trypanosomiasis control,
  re-emergence, and epidemics
• Factors influencing individual and community
  participation in control
• Epidemiological significance of animal reservoirs
  for Trypanosoma gambiense
• Tsetse genomics.

11
Dengue.

• Dengue and dengue haemorrhagic fever have emerged
  as a major public health problem.
• The primary vector mosquito has spread throughout
  the tropics and into susceptible human
  populations in urban areas.
• The urbanization process, which has left many
  without adequate water, sewer systems or waste
  management, and created new breeding grounds for
  the vector, has hastened the spread of the
  disease.
• Vector control has not halted the explosion in
  transmission of the disease.

12
Research strategic emphases for dengue.

• New knowledge
• Molecular tools for Aedes transformation
• Vectorial resistance to dengue
• Aedes population genetics and ecology
• Host-pathogen interactions in dengue, including
  pathogenesis, natural history, definition of high
  risk groups .
• Dynamics of virus transmission, and population
  genetics (including modelling)
• Social, economic, and biological factors related
  to promotion and support of community-based
  interventions and release of transformed Aedes
  vectors

13
Leishmaniasis

• Leishmania parasites are named after W.B.
  Leishman, who developed one of the earliest
  stains of Leishmania in 1901. Widespread in 22
  countries in the New World and in 66 nations in
  Old World, leishmaniasis is not found in
  South-east Asia.
• Human infections are found in 16 countries in
  Europe, including France, Italy Greece, Malta,
  Spain and Portugal.
• Occurring in several forms, the disease is
  generally
• recognized for its cutaneous form which
  causes non-fatal, disfiguring lesions, although
  epidemics of the potentially Fatal visceral form
  cause thousands of deaths.

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Leishmaniasis. Research emphases

• New knowledge a) Bioinformatics and applied
  genomics for identifying targets for drugs,
  vaccines, and diagnostics. b) Socioeconomic,
  environmental, and behavioral risk factors for
  infection and disease, especially in refugee
  populations in complex emergencies.
• New and improved tools a) Development of
  Leishmania diagnostic tests. b) Development of
  vaccine candidates (new adjuvants for first
  generation vaccines second generation vaccine).

15
Malaria

• Malaria is the most important tropical disease,
  remaining widespread throughout the tropics, but
  also occurring in many temperate regions.
• It exacts a heavy toll of illness and death -
  especially amongst children and pregnant women.
  It also poses a risk to travelers and immigrants,
  with imported cases increasing in non-endemic
  areas.
• Treatment and control have become more difficult
  with the spread of drug-resistant strains of
  parasites and insecticide-resistant strains of
  mosquito vectors.

16
Malaria. Research emphases

• New basic knowledge a) Anopheles genome
  sequencing and genetic manipulation for mosquito
  vector control. b) Bioinformatics and applied
  genomics for drugs, vaccines, and diagnostics. c)
  Development of an applied genomic database for
  the public domain d) Impact of health sector
  reform on malaria understanding mechanisms of
  resistance to drugs and insecticides.
• 
  
• New tools a) Discovery and development of
  new drugs, including combinations and drugs for
  use in pregnancy. c) Discovery of malaria vaccine
  candidate antigens. d) Development of vaccine
  candidates. e) Development of non-invasive
  approach to diagnostics for use close to the home
• 
  

17
Tuberculosis

• Tuberculosis threatens one-third of the worlds
  population. The World Health Organization
  declared tuberculosis a global health emergency
  since 1993.
• The magnitude of the problem changed dramatically
  during the 1990s due to deteriorating control in
  some parts of the world (notably eastern Europe
  and the former Soviet Union), the spread of HIV,
  and population growth.
• Without a coordinated control effort,
  tuberculosis will infect an estimated 1 billion
  more people by 2020, killing 70 million.

18
TB. Research Emphases.

• New basic knowledge Bioinformatics and applied
  genomics for identifying targets for drugs,
  vaccines, and diagnostics. Impact of health
  sector reform, globalization, and inequality of
  access.
• 
  
• New and improved tools - Diagnostic test
  development detection of disease, rifampicin
  resistance, latent infection. Discovery and
  development of new drugs.

19
Schistosomiasis

• Schistosomiasis is also known as bilharzia after
  Theodor Bilharz, who first identified the
  parasite in Egypt in 1851.
• Infection is widespread with a relatively low
  mortality rate, but a high morbidity rate,
  causing severe debilitating illness in millions
  of people.
• The disease is often associated with water
  resource development
  projects, such as dams and irrigation schemes,
  where the snail intermediate hosts of the
  parasite breed.

20
Schistosomiasis. Research emphases.

• New basic knowledge a) Bioinformatics and
  applied genomics for identifying targets for
  drugs, vaccines, and diagnostics. b) Pathogenesis
  (host-pathogen interactions) focusing on
  reproductive health issues and immunological
  aspects of co-infection. c) Social economic
  impact and methodology for burden of disease
  assessment
• 
  
• New and improved tools a) Discovery and
  development of new drugs. b) Evaluate safety and
  efficacy of existing drugs that are potentially
  anti- schistosomal. c) Review of vaccine research
  and development. d) Assess technical and use
  profiles of available diagnostics
• 
  

21
Onchocerciasis

• Onchocerciasis is the worlds second leading
  infectious cause of blindness. Rarely
  life-threatening, the disease causes chronic
  suffering and severe disability.
• In Africa, it constitutes a serious obstacle to
  socioeconomic development. It is often called
  river blindness because of its most extreme
  manifestation and because the black flies that
  transmit the disease abound in riverside areas,
  where they breed in fast-flowing waters.
• Fertile riverine areas are frequently abandoned
  for fear of the disease.

22
Onchocerciasis. Research

• New basic knowledge Understanding ivermectin
  resistance mechanisms
• New and improved tools
• a) Discovery and development of
  macrofilaricidal drugs or drugs to permanently
  inhibit microfilariae production.
• b) Development of diagnostics for
  surveillance.
• c) Development of ivermectin resistance test.

23
Leprosy

• Leprosy is occasionally known as Hansens
  disease, after Armauer Hansen, the Norwegian
  physician who first identified the microorganism
  which causes the disease.
• Known and dreaded since biblical times because
  of the severe deformities that can occur, it was
  considered incurable until as recently as the
  1940s.

24
Leprosy emphases

• New basic knowledge
• a) Bioinformatics and applied genomics for
• identifying targets for diagnostics for
  infection
• with ML
• b) Pathogenesis of nerve reactions.
• c) Social and behavioral constraints for
  leprosy
• elimination.
• New tools
• a) Rifampicin susceptibility test
  development.
• b) Development of a test for infection with
  
• Mycobacterium leprae.
• c) Development of tools for early diagnosis
  and
• treatment of leprosy reactions

25
Chagas disease

• Chagas disease is found only in Latin America.
  It is named after Carlos Chagas, a Brazilian
  doctor who first described the disease in 1909.
  He also described the life-cycle of the parasite,
  identified the insects that transmit the
  parasite, identified small mammals that act as
  reservoir hosts, and suggested means to help
  prevent its transmission.

26
Research emphases on Chagas disease.

• New basic knowledge
• a) Bioinformatics and applied genomics for
  identifying targets for drugs and elucidation of
  pathogenesis and risk factors. b ) Genetic and
  entomological studies on vectors (e.g. mechanisms
  of resistance, adaptation to ecological changes)
• New tools a) Development of candidate drugs. b)
  Clinical research on proposed prognostic markers
  of disease.

27
Lymphatic filariasis

• Rarely life-threatening, lymphatic filariasis
  causes widespread and chronic suffering,
  disability, and social stigma.
• It can lead to grotesquely swollen limbs a
  condition known as elephantiasis.

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Lymphatic filariasis emphases

• New basic knowledge a) Bioinformatics and
  applied genomics for drugs. b) Progression /
  reversibility of disease manifestations after
  treatment, especially in children
• 
  
• New tools a) Discovery and development of
  macrofilaricidal drugs or drugs to permanently
  inhibit microfilariae production. b) Further
  development and evaluation of diagnostics for
  Brugia malayi.
  

29
Tropical Diseases. Hopes?

• To the fight against the HIV/AIDS, malaria,
  TB, others TD, infectious illnesses of the
  childhood, maternal and perinatal affections,
  micronutrients deficits and others, is necessary
  to add family planning, reproductive and derived
  gender health programs and other managed ones to
  the prevention and attention of the non
  transmitted diseases. The Third World is
  economically insolvent to achieve it without
  official financing for the development for the
  countries of high entrance.

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Tropical Diseases. Hopes?

• That is necessary for a true sustainable economic
  and social development, in a healthy world, it is
  many times more than what is affirmed.
• To brake the monetary speculation and the career
  arms, it the only measures able to generate funds
  for the health and the world development.
• A better world is possible!