Neglected Tropical Diseases and Neglected Populations: an Overview Dr Francesco Rio Department of Co

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Neglected Tropical Diseases and Neglected
Populationsan OverviewDr Francesco Rio
Department of Control of Neglected Tropical
Diseases World Health Organization
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Main features of neglected tropical diseases
Affects one third of the global population but
remains hidden

• Poor populations living in remote rural areas or
  urban slums ? no political voice
• Linked to poverty unsafe water, poor
  sanitation, substandard housing, poor education,
  reservoirs for insects and other vector-borne
  diseases
• 100 of low-income countries are affected
  simultaneously by more than 5 diseases
• Communicable diseases but hardly travelling thus
  not perceived as a threat to the developed
  countries
• Mostly disabling and disfiguring but also
  killing
• Low priority given by national health
  programmes, lack of data and statistics
• Social stigmatization and discrimination
• Control strategies not always well formulated

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Neglected Tropical Diseases

• Protozoan Infections
• Leishmaniasis (VL, CL and MCL)
• Human African trypanosomiasis (sleeping sickness)
• Chagas disease
• Helminth Infections
• Soil-transmitted helminth infections
• Ascariasis-Trichuriasis-Hookworm
• Lymphatic filariasis (elephantiasis)
• Onchocerciasis (river blindness)
• Schistosomiasis
• Dracunculiasis (guinea-worm disease)
• Cysticercosis and other zoonotic helminthiasis
• Viral Infections
• Dengue dengue haemorrhagic fever
• Bacterial Infections
• Leprosy
• Trachoma
• Buruli ulcer

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Global distribution of NTDs
.
Approximately 1 billion people are affected by
more than one of NTDs
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Countries affected by NTDs by income group

• More than 70 of countries and territories
  affected by neglected tropical diseases are
  low-income and low middle-income countries
• 100 of low-income countries are affected by at
  least 5 neglected tropical diseases

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The Burden
Deaths
DALYs
STDs excluding HIV
STDs excluding HIV
Diarrhoeal diseases
Diarrhoeal diseases
HIV/Aids
HIV/Aids
Childhood vaccine preventable diseases
Childhood vaccine preventable diseases
TB
TB
Malaria
Other infectious and parasitic diseases
Other infectious and parasitic diseases
Malaria
African trypanosomiasis, Chagas disease,
schistosomiasis, leishmaniasis, lymphatic
filariasis, onchocerciasis, leprosy, dengue,
japanese encephalitis, trachoma, STH
Source World Health Report 2002
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Neglected tropical diseases (NTDs)a
right-to-health issue

• NTDs almost exclusively affects poor and
  marginalized people in low-income countries, in
  rural areas and settings where poverty is
  widespread
• Discrimination is both cause and consequence of
  NTDs
• Health interventions and research and development
  have long been inadequate and under funded and
  the picture has changed only in recent years
• Some of the essential drugs against NTD are now
  available but other are still inadequate or
  unavailable

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Health and poverty

• Ill health is both a cause and a consequence of
  poverty sick people are more likely to become
  poor and the poor are more vulnerable to disease
  and disability
• Good health is central to creating and sustaining
  the capabilities that poor people need to escape
  from poverty
• Good health is not just an outcome of
  development it is a way of achieving development

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Millennium Development Goals (MDGs)and health

• Of the eight MDGs, four are health-related
• By the year 2015, to have reduced under-5 child
  mortality by two thirds of its current rate (MDG
  4)
• By the year 2015, to have reduced maternal
  mortality by three quarters of its current rate
  (MDG 5)
• By 2015, to have halted and begun to reverse the
  spread of HIV/AIDS, the scourge of malaria and
  other major diseases that afflict humanity (MDG
  6)
• To ensure environmental sustainability (MDG 7)

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WHO and its partners propose a new approach
Rapid impact interventions with long-lasting
results

• Focus on populations to improve access to
  essential interventions
• Integrate "strategies" to improve effectiveness
• Education, environment, local empowerment core
  for success
• All-round care, no "bits and pieces"
• Preventive chemotherapy on large scale
• PHC reinforcement, capacitating and development
• Focused interventions and innovation
• Empowering peripheral system through training and
  equipment
• Advocate for access to care and mainstream
  society for the neglected
• Measure diseases and development indicators

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Buruli ulcer
Left untreated, the disease progresses to massive
destruction of the skin and, in some cases, of
bone, eyes, and other tissues. Limb amputations
may be needed to save a patient's life. This
severe skin disease remains shrouded in mystery.
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Dengue and DHF
Dengue is transmitted by the bite of an Aedes
mosquito infected with any one of the four dengue
viruses. It occurs in tropical and sub-tropical
areas of the world. Symptoms appear 3-14 days
after the infective bite. Dengue fever is a
febrile illness that affects infants, young
children and adults. Symptoms range from a mild
fever, to incapacitating high fever, with severe
headache, pain behind the eyes, muscle and joint
pain and rash.
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Guinea-worm disease
The disease exists only in Africa and is
transmitted exclusively by drinking contaminated
water. When a safe water supply is not available,
the disease can be prevented or eradicated by the
use of filters for drinking water.
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Hookworms
Hookworms infect one billion people. It is
calculated that 500 million women are infected by
hookworms and at globally least 44 million are
pregnant and infected at any time. Safe single
dose treatment costs lt 3 cents a dose.
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Human African trypanosomiasis
Spread by the bite of the tsetse fly, the disease
flourishes in impoverished rural parts of Africa.
Untreated, the disease is invariably fatal. Death
follows prolonged agony. In 2006 some 70 000
people are estimated to be infected.
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Leishmaniasis
12 millions are currently infected and 350
million people are at risk of infection. Around
1.5 million to 2 million new infections occur
each year.
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Leprosy
Leprosy is considered shameful and people hid
their symptoms for fear of ostracism despite free
and effective multidrug therapy.
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Lymphatic filariasis (LF)
Over 120 million people are currently infected
and around 1.3 billion people in more than 80
countries are at risk of infection. Drugs used
against lymphatic filariasis are either donated
albendazole and ivermectin, or very inexpensive
DEC. Albendazole is donated to WHO by
GlaxoSmithKline for mass administration to
at-risk populations.
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Schistosomiasis
Schistosoma haematobium is endemic in 53
countries in the Middle East and most of the
African continent including the islands of
Madagascar and Mauritius. In sub-Saharan Africa
alone there are reckoned to be 112 million
infections with S. haematobium. Praziquantel at
the single dose of 40 mg/Kg body weight is a very
safe and effective treatment against S.
haematobium.
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Trachoma
Blinding trachoma affects more than 80 million
people around the world. Children are mainly
concerned by the infection, and every 4 people
blind from trachoma 3 are women. Africa is the
continent with the greatest number of endemic
countries, but America, Middle-East and Asia are
also endemic. SAFE strategy (Surgery,
Antibiotics, Facial cleanliness, Environmental
improvement) has proven its effectiveness in
eliminating this scourge from humanity.
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Thank you for your attention
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Buruli ulcer, Chagas disease, human African
trypanosomiasis, leishmaniasis
Common characteristics

• Affected populations are the poorest and most
  isolated
• Different epidemiological patterns difficult to
  detect with a unified approach
• Diagnostic procedures and case management are
  expensive, difficult to implement in
  resource-limited field settings and require
  expertise
• The diseases cannot benefit from preventive
  treatment

Innovative and Intensified Disease Management
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Paris 11 septembre 2006
Control with current tools
What do we need?
Diagnostic procedures are not sensitive, cannot
be used at field level and are expensive Treatmen
t is costly, difficult to administer, can have
serious side-effects and can become resistant
Simple, efficient and
inexpensive diagnostic tools Oral, inexpensive
drugs that do not have side-effects
Need for specialized services
Integration within existing health structures is
possible
Integration is not possible
Sustained control/elimination is feasible
Sustained control/elimination is difficult
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Onchocerciasis, LF, schistosomiasis, STH
London 04 May 2006
Management with existing tools
No individual diagnosis required Safe, single
dose, free or cheap drugs
Integrated management by local health capacities
X
Specialized services
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Preventive chemotherapy
Existing field-applicable tools
Simple, cheap community diagnosis Large scale
treatment of groups or communities in need
Regular "preventive" treatment
Coordinated use of a few drugs will have an
impact on many diseases
Sustained control / elimination