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Research priorities for a

strategic agenda in
Leishmaniasis in Americas
Dr. Zaida Yadon
Regional Advisor on Communicable Diseases Research
Communicable Diseases and Health Analysis Department
Pan American Health Organization
Why define priorities?
10/90 Gap (2004)
Only 10 per cent of global health research is devoted to conditions that
account for 90 per cent of the global disease burden – the so-called ‘10/90
Gap’.
Virtually all diseases prevalent in low income countries are ‘neglected’ and
that the pharmaceutical industry has invested almost nothing in research
and development (R&D) for these diseases.
PAHO Resolution CD 49 R.19
October 2009: Member States
committed to:

• Eliminate or reduce neglected


diseases and other infections (NID)
related to poverty for which tools
exist, to levels such that these
diseases are no longer considered
public health problems by 2015

• Review or develop the existing


specific national plans to control or
eliminate these diseases

4
Why define priorities?
•Strategy and Plan of Action for Leishmaniasis

•Limited resources available at global, regional and


national level for research

•Optimize health benefits, and impact from scarce


research resources.

•To convince donors of priority areas for allocation of


resources
How define priorities?

• Systematic reviews on the state of art (VL)

• Consensus meeting (VL research agenda Reseach


Agenda, Fos Iguazu meeting, 2009)

• Survey to identify priorities for a research agenda


(all leishmanianias)
Systematic review
• Prior to the meeting, a Systematic review of the
estate of the art of VL control strategies in Latin
America were carried out. Aspect reviewed were:

• Diagnosis
• Treatment
• Dog interventions, and
• Vector control
Systematic review
The survey aims to identify:
• Successes in the last 5 years (research and
interventions).
• Progress on leishmaniasis research topics and
interventions.
• Elicitation of criteria for research
prioritization.
Survey Results
• 68/229 people of whom 65 answered

• 27 countries around the world.

• American Region, 51 responses from 14 countries


– Brazil (28), Colombia (4), Venezuela (4), Argentina (3), Mexico (2),
Honduras (2), Costa Rica (2), Peru (2). Bolivia, El Salvador, Guatemala,
Paraguay, Ecuador and USA (1 each one.)

• Europe with 8 countries with 9 replies (Spain – 2, Switzerland, Czech


Republic, Serbia, United Kingdom, France, Belgium, The Netherlands – 1
each one);

• Asia: China and Bangladesh, Eastern Mediterranean Iran and Palestine


Africa Kenya
Results
Area Priority
Treatment • New and improved drugs (low toxicity
and adverse effects)
• Alternative treatment scheme
(combination of drugs)
• Multicenter trial
• Dog treatment studies
• Diagnostic marker for drug resistance
Diagnostic tools Human • Standardization and development
sensitive, specific, inexpensive
diagnostic test
• Diagnostic test at point of care
• Methods to differentiate species
• Prognosis and therapeutic markers
Diagnostic tools Dogs • Rapid diagnostic test
• Tools to differentiate active infection
and vaccine response
• Diagnostic tools for asymptomatic dogs
Area
Results
Priorities
Vector Control • Natural history and vector capacity
• Population dynamic and genetic studies
• New /Improved surveillance system
• Operational research on integrated disease and
vector control
Dog Control • Evaluation of interventions (use of collars,
treatment, insecticides, culling)
• Research to assess the importance of
asymptomatic infection
Prevention • Health education
• Research on vaccines to prevent Leishmania
infection and disease, and vaccines to block
transmission of Leishmania.
• Integrated control methods including community
participation
Epidemiological surveillance • Study to characterize transmission cycles
• Characterization of the parasite
• Identification of Vectors
Biggest challenges for control
Thank you!
Gracias!
Contact:
Tel.: + 55 21 3661 9056 - VOIP 49056
yadonzai@paho.org

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