As we embark on the last few days of Hannukah, End the Neglect would like to take a look back on how we celebrated Hannukah in 2009. For each of the seven nights of the holiday, we spotlighted the seven most common NTDs – ascariasis, trichuriasis, hookworm, schistosomiasis, lymphatic filariasis, onchocerciasis, and trachoma. Click here and take a look back at 2009′s Hannukah celebration!
Posts Tagged ‘Hannukah’
End the Neglect Celebrates Hannukah
December 7th, 2010Night 7: Schistosomiasis
December 18th, 2009By Dr. Alan Fenwick, Director, Schistosomiasis Control Initiative at Imperial College London
Schistosomiasis, which is also known as bilharzia or snail fever, is another of the most common NTDs with an estimated 200 million people infected globally, and many more at risk – especially in sub-Saharan Africa.
The serious effects of schistosomiasis can be controlled by regular treatment of early infections with the drug praziquantel; this treatment is usually better directed at children who have recently acquired infections before symptoms can develop. Before the year 2000, praziquantel had successfully been used in China and Egypt, but it was expensive at $1 per tablet. The price today from generic manufacturers is a more affordable 8 cents a tablet. Since 2002 the Schistosomiasis Control Initiative has expanded the number of countries with control programmes thanks to support from the Bill & Melinda Gates Foundation, Legatum, and more recently the USAID. WHO has identified the need for them to take a great interest in schistosomiasis because expansion of coverage has been slower than with the other NTDs mainly due to the absence of a large scale drug donation program. It is estimated that during 2009 less than 10% of those in need of treatment will actually have access to praziquantel, despite investment by USAID and the emergence of other NGOs taking an interest in treating schistosomiasis.
During the next 5 years if the MDGs are to be achieved it will be necessary for the world to donate more money for praziquantel and its distribution so that children can be given a healthy start to their life and perform better at school.
Night 5: Onchocerciasis
December 16th, 2009Onchocerciciasis, one of the most common neglected tropical diseases known as “river blindness”, is a major contributor to visual impairment and blindness in sub-Saharan Africa. Onchocerciasis also causes lesions, skin depigmentation, and debilitating itching, all of which foster stigmatization and social isolation. Beyond its health impacts, onchocerciasis has also instilled a fear of blindness in affected communities, prompting them to abandon fertile river valleys in Africa, thereby reducing agricultural productivity and increasing poverty.
Approximately 37 million people around the world are infected with onchocerciasis; over 102 million people are at risk for the disease in 19 countries. 500,000 of those infected with onchocerciasis are severely visually impaired, and another 270,000 have been rendered permanently blind from the disease.
Fortunately, there are African-led efforts underway to control and eliminate this disease that can serve as a model for community-led health interventions and health systems strengthening efforts around the developing world. The African Programme for Onchocerciasis Control (APOC) was established in 1995 to eliminate onchocerciasis as a disease of public health importance in Africa. At the core of APOC’s strategy to eliminate the disease is community-directed treatment with ivermectin (CDTI), a strategy largely pioneered by APOC’s dynamic director, Dr. Uche Amazigo.
In 1997, APOC formally adopted the CDTI strategy to deliver ivermectin to infected and at-risk communities, and in the years since it has rapidly scaled up and expanded its efforts. Over 600,165 trained CDDs have been trained and engaged in CDTI projects since APOC’s inception, and they have delivered nearly (965,000,000) ivermectin tablets in 11 years (1997-2007). Millions more have benefitted from other health interventions implemented simultaneously with CDTI, including home-based management of malaria, distribution of insecticide treated bed nets, Vitamin A supplementation, and management of HIV/AIDS as well as awareness campaigns involving the support of CDDs.
A map of health interventions delivered through the CDTi mechanism across Africa
Night 4: Lymphatic Filariasis
December 15th, 2009By Fr. Tom Streit, Director–University of Notre Dame Haiti Program, on behalf of those working on LF in Haiti
The program to eliminate lymphatic filariasis (LF) is the largest public health program you never heard about. In fact, most people who work in global health are shocked when they hear that more than 500 million people in over 40 countries were treated last year. That is an impressive number, but it still represents less than one half of the total number that will need to receive annual treatment (for five or more years) if LF is to be eliminated.
These parasites are transmitted by mosquitoes and are best recognized as a cause of elephantiasis. Adult worms live in the lymphatic vessels in humans and the female worms release motile stages called microfilaria into the blood. It is this stage that is picked up by mosquitoes when the mosquito takes a blood meal. After maturation in the mosquito, a process that takes one to two weeks, the larval stage is ready to infect another person during a blood meal. For most people, the infection has no apparent symptoms, but some are incapacitated. People with elephantiasis or men with scrotal swelling (also called hydrocele) can be so disabled by LF that they are unable to work or support their families. They are often ostracized in their communities because of the fear and misunderstanding about the cause of the disease.
As scientists, we continue to be fascinated by these parasites at the same time we have committed to getting rid of them. I recognize the paradox here, but if we can reduce the suffering associated with LF and other NTDs, we should, even if it leaves the scientific community with a number of unanswered questions, including a few I’d like to share with you.
In many parts of the world, the microfilaria stage of the parasite is only found in the blood at night – when the mosquitoes are most likely to take a blood meal. How does this work? What signals is the parasite using to do this?
Why do only a relatively small percentage of people get elephantiasis? We know that elephantiasis tends to occur in families, but why? Is this related to genetic effects, environmental conditions or a combination? Why does the parasite disappear from most of these people as the swelling develops?
On the opposite side of that question, why are some people more likely to acquire infection and maintain microfilaria in their blood for years or decades? How does the worm avoid the host immune response? For LF and many infections, we believe that children are more likely to acquire infection if their mothers were infected during pregnancy. How does this affect other immune responses?
In truth, we don’t need to know the answers to these questions to eliminate LF. China and Korea have succeeded; we also know that LF disappears on its own following economic development as it did in the United States. We are now faced with an historic opportunity – as with small pox and now polio and guinea worm – to make a conscious effort to remove the threat of LF permanently. I, for one, can live with unanswered questions.
