Neglected Infectious Diseases in The Perspective of Global Health

dr. Bintari Dwihardiani, MPH Center for Tropical Medicine, Gadjah Mada University

Definition

Infectious diseases which attack the poorest population in the developing countries

Neglected Infectious Diseases

Neglected Infectious Diseases

Neglected Infectious Diseases

Core: Soil transmitted helminthes infection (STH) lymphatic filariasis Onchocerciasis Dracunculiasis Schistosomiasis Leishmaniasis chagas disease Human African trypanasomiasis (HAT) buruli ulcer Leprosy trachoma Others: Strongyloidiasis, toxocariasis, loiasis, taeniasis, echinococcosis Amoebiasis, giardiasis, balantidiasis Bartonellosis, bovine tuberculosis, leptospirosis, relapsing fever, rheumatic fever, treponematosis Dengue fever, yellow fever, Japanese encephalitis, rabies, haemorrhagic fever Mycetoma, paracoccidiomycosis Scabies, myiasis, tungiasis 5

Neglected?

There are effective control strategies but are not implemented globally Inadequate effort to develop diagnostics, drugs, or vaccines, and second line medicines Inadequate research into pathogens biology and the bodys response R & D expense in 2007 (estimates 2.56 billion): HIV/AIDS, TB, malaria spent 75% of total expense; helminthes, leprosy, buruli ulcer, trachoma, chagas, leishmaniasis, trypanasomiasis spent 7.3%

Failure to put the issues in the national or international policy level

Determinants
Geographically

concentrated Extreme poverty Poor hygiene and sanitation Poor access to clean water Non stable health system (in conflict)

Burden

Burden

Affect 1.2 billion people who earn less than 2$/day Disability: blindness, limb dysfunction, face disfiguration Impaired childrens growth, development, and physical fitness Pain, blood loss, liver and bladder disease Estimates for 2002: 177,000 deaths worldwide and 20 million DALYs (1.3% of the global burden of disease) Economic lost
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Estimates for Indonesia (2003)

Diseases Ascariasis Trichuriasis Hookworm Schistosomiasis Leprosy People affected (prevalence) 90 million (42%) 95 million (44%) 62 million (28%) < 0.1 million (< 1%) 21,430
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Current Control strategy

Mass drugs administration (for helminthes infections) Challenge: low coverage, drug resistance, re-infection, long term program, sustainability Case management Challenge: inadequate medicine and diagnosis methods, access to medicine Vector control Challenge: resistance to insecticide, low coverage Sanitation and hygiene improvement Challenge: funding limitation Lymphatic filariasis, leprosy, onchocerciasis, and chagas diseases are targeted for elimination Elimination is possible

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International Initiatives and Partnership

Global

Network for Neglected Tropical Diseases Global Alliance to eliminate lymphatic filariasis Onchocerciasis Elimination Program for the America Partners for parasite control Schistosomiasis control initiative International trachoma initiative
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International Initiatives and Partnership

Mectizan

donation programme for fighting river blindness Bill and Melinda Gates Foundation Drugs for neglected diseases initiatives Carter center

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New strategies elements

1. 2. 3. 4. 5. 6.

a comprehensive, multifaceted, community-based program using all available control tools well-articulated, transparent, and independent monitoring and evaluation intensification of basic investigation of NTDs discovery and development of new diagnostic, therapeutic, and preventive approaches; expanded and qualified human capacity to guide, lead, and implement these strategies at the local level. As the presence of the diseases related to development, it would be sustainable to integrate the control of the diseases and development action

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Millennium Development Goal

End poverty and hunger Universal education Gender equality Child health Maternal health Combat HIV/AIDS, malaria, and other diseases Environmental sustainability Global partnership
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In Relation with Millennium Development Goal

The disabling impact of NID lead to poverty: reduce the possibility to earn income and the productivity. STH and schistosomiasis impair childrens growth, development, and physical fitness Hookworm and schistosomiasis cause anemia during pregnancy Infected pregnant women pass parasite antigens to the fetus, affecting the childs immune system so the vaccination is less effective Female genital schistosomiasis infection increases HIV risk STH, shistosomiasis, lymphatic filariasis promote susceptibility to other diseases including TB and HIV/AIDS

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Reference List
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Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Sachs SE, Sachs JD et al. Control of neglected tropical diseases. N Engl J Med 2007; 357(10):1018-1027. Hotez PJ. The neglected tropical diseases and their devastating health and economic impact on the member nations of the Organisation of the Islamic Conference. PLoS Negl Trop Dis 2009; 3(10):e539. Hotez PJ, Fenwick A, Savioli L, Molyneux DH. Rescuing the bottom billion through control of neglected tropical diseases. Lancet 2009 373(9674):1570-1575. Mahmoud A, Zerhouni E. Neglected tropical diseases: moving beyond mass drug treatment to understanding the science. Health Aff (Millwood ) 2009; 28(6):1726-1733. Musgrove P, Hotez PJ. Turning neglected tropical diseases into forgotten maladies. Health Aff (Millwood ) 2009; 28(6):1691-1706. Moran M, Guzman J, Ropars AL, McDonald A, Jameson N, Omune B et al. Neglected disease research and development: how much are we really spending? PLoS Med 2009; 6(2):e30. Mathers CD, Ezzati M, Lopez AD. Measuring the burden of neglected tropical diseases: the global burden of disease framework. PLoS Negl Trop Dis 2007; 1(2):e114. 18 www.dndi.org