Nature is an international weekly journal of science focusing on medicine, health, and research. In the latest issue of their supplement, Nature Outlook, the journal highlights Chagas disease. Check out Nature’s open-access (aka free) supplement to get the full scoop on Chagas disease!
And to help combat Chagas and other NTDs, go to the Global Network website to get involved!
By: Alanna Shaikh
Two of the links that we just posted are concrete reminders that we understand the Neglected Tropical Diseases. We know what causes them and we know how to control them. Their path is predictable. What we need is the will to keep on fighting them.
Case A: Human African Trypanosomiasis, A Success Story
The WHO reported that Human African Trypanosomiasis is at a 50-year low. The number of new cases reported has now dropped below 10,000. The WHO attributes the success to “Strengthened control and surveillance efforts by national sleeping sickness programmes in endemic countries over the past 10 years…”
In other words, we knew what to do to fight the disease, and then we did it. Dr Hiroki Nakatani, WHO’s Assistant Director-General for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases, puts it a bit more elegantly, “It is a brilliant demonstration of what can be done with determined and clear day-to-day control efforts, particularly in the absence of new tools.”
In this case, the control effort included better surveillance and case reporting (which negated my fear that we were seeing fewer reported cases because reporting was getting worse), consistent donor support, drug donations, and a partnership with a pharmaceutical company. It’s clear we could apply those methods to more than just Trypanosomiasis. This is the magic formula for fighting many diseases, not just NTDs.
Case B: Dengue, A Frightening Portent of the Global Future
This one is not good news: Dengue fever has returned to the continental United States. This is not a case of people being infected with Dengue while traveling and then entering the US. This is actual infection within the United States. We haven’t seen that in 65 years, and it’s back.
It’s not a surprise. We knew this was going to happen. Here, the New York Times says it better than I could “The upsurge is not unexpected. Experts say more than half the world’s population will be at risk by 2085 because of greater urbanization, global travel and climate change.” (they go on to make a really stupid comment about DDT, which we shall ignore.) There is a reason that I wanted to rename NTDs to “Diseases that might be in hot countries right now, but with global warming they’ll soon be affecting you right there in Minneapolis.”
If we don’t put more work into fighting NTDs where they are endemic now, there are going to be endemic in a lot more places in the future. I wrote about this last week with regard to Chagas.
Maybe we can try to see this as a positive. Now that NTDs are starting to affect wealthy countries, we may see a lot more research and development of new drugs. There are no drugs for Dengue right now, but Sanofi Pasteur is working on a vaccine. Pairing a solid (solid like as much as a billion dollars solid) profit incentive with a humanitarian motive might be exactly what we need to get it to market.
Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.”
Reprinted with permission from: H5N1 – News and Resources about Influenza, Infectious Diseases and Public Health
By: Crawford Kilian
Via Médecins Sans Frontières: Colombia: Fighting a silent disease. Excerpt:
Chagas is widespread in Latin America, killing 14,000 people a year. In 2009, MSF started a treatment program in the region of Arauca, Colombia, near the border with Venezuela – however applying a 60 day treatment program in a conflict zone presents some unique challenges.
Angela lives in Genareros, an indigenous community in Arauca region, Colombia. In April 2010, two of her seven children completed their treatment for Chagas, a disease transmitted by an insect common in rural areas where people live in houses made of clay and straw. As Angela’s young children Yosney and Maryeli celebrated the end of their treatment, she found out that another two of her children also had the disease.
Chagas disease is endemic in most Latin American countries. In Colombia, Arauca is one of the most affected regions. The disease is caused by the trypanosoma cruzi parasite and transmitted mainly by the ‘kissing bug’, a blood-sucking insect known in Colombia as ‘pito’.
People with the disease may live for years without showing any symptoms. If untreated, however, Chagas can lead to serious health problems − mainly heart and intestinal complications − and even death.
Integrating the fight against Chagas into primary healthcare services
At the end of 2009, Médecins Sans Frontières (MSF) integrated Chagas screening and treatment into its primary healthcare services already carried out though mobile clinics in Arauca, a conflict-affected region bordering Venezuela. This is the first time that MSF has carried out Chagas treatment in a conflict context.
“It is a real challenge, because the treatment requires constant follow up for a period of two months, and there is always the concern that we will be unable to reach a community due to security constraints or because an armed group has stopped road movements in the region,” said Patrick Swartenbroekx, MSF field coordinator in Arauca.
The first community to undergo screening was Genareros, where Angela lives with her seven children. Out of the 97 blood samples taken from children between nine months and 18 years old, 11 were confirmed positive.
“We were surprised to find such a high rate in Genareros. Fortunately, we didn’t find the same rate when we extended the screening to other communities,” said Dr. Rafael Herazo, medical focal point for MSF’s project in Arauca.
Photo courtesty of Médecins Sans Frontières (http://www.msf.ca/news-media/news/2010/05/colombia-fighting-a-silent-disease/)
Sixty days of treatment
So far, the MSF team in Arauca has collected 1,617 blood samples in 10 different communities and completed laboratory tests for 514 samples. The lab results found that one in 28 people tested positive for Chagas.
Confirmed patients are given a medical check-up before they start a two-month long treatment. This is important to check whether the patients have already developed the disease. “If the person has developed a serious cardiac complication, for example, there is little we can do to treat the disease,” said Dr. Herazo.
Crawford Kilian is an online journalist and retired college instructor in Vancouver, B.C., Canada. He is the author of 21 published books and hundreds of articles. He has followed influenza since 2005 on his blog H5N1.
In their 12th annual list of Top Ten Humanitarian Crises, Doctors Without Borders/Médecins Sans Frontières (MSF) included a number of NTDs.
According to the press release:
“Other diseases, such as Chagas, kala azar, sleeping sickness, and Buruli ulcer continue to be neglected, with very few new commitments to expanding access to available treatment or carrying out research for much needed newer and more effective drugs.”
“The tremendous resources devoted to the H1N1 pandemic in developed countries illustrates the response capacity for global health threats when the political will exists,” said Dr. Fournier. “Regrettably, we fail to see the same commitments made to combat diseases claiming millions of more lives each year.”
Started in 1998, the “Top Ten” list “seeks to generate greater awareness of the magnitude and severity of crises that may or may not be reflected in media accounts.”
To view the press release and the “Top Ten” List visit: http://www.doctorswithoutborders.org/publications/topten/2009/
We applaud MSF for including NTDs in their annual list, and hope that more attention, advocacy and political will, will work towards preventing NTDs from being a humantarian crisis in the years to come.
