Neglected Tropical Diseases

1. Neglected Tropical Diseases:an OverviewDepartment of Control of Neglected Tropical DiseasesWorld Health Organization

2. 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

3. NTDs in poor populations Previously neglected diseases Neglected tropical diseases TB HIV/AIDS Soil transmitted helminthiasis Schistosomiasis Lymphatic filariasis Onchocerciasis Leprosy Trachoma Leishmaniasis Buruli ulcer Chagas disease Human African trypanosomiasis Dengue & DHF … Anthrax Malaria Bovine tuberculosis Cysticercosis Echinococcosis Brucellosis Zoonotic trypanosomiasis Rabies Neglected zoonoses … or poor populations and (all) their (undermining) diseases ? Impact on poverty making interventions cost-effective

4. Global distribution of NTDs . Approximately 1 billion people are affected by more than one of NTDs

5. 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

6. 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 Other infectious and parasitic diseases Malaria 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

7. Annual deaths due to NTDs Revised estimates (The Lancet) Schistosomiasis 150,000 – 200,000 Leishmaniasis 100,000 Trypanosomiasis 100,000 Hookworm 65,000 Ascariasis/Trichuriasis 35,000 Dengue (DHF) 20,000 Chagas Disease 14,000 Leprosy 6,000 LF 0 Onchocerciasis 0 Trachoma 0 Total > 500,000

8. 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

9. 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

10. Large scale interventions • Lymphatic filariasis • Leprosy • Onchocerciasis • Schistosomiasis • Helminthiasis • Trachoma • Yaws Rapid Impact Interventions Improving access • Case management and development of new tools • Human African trypanosomiasis • Chagas diseases • Buruli ulcer • Leishmaniasis • Dengue Focused interventions Improving innovation

11. 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

12. 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 Treatment 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 difficult Sustained control/elimination is feasible

13. 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

14. 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

15. MDA1= MDA with IVM + ALB once/year T1 = ALB or MBD + PZQ, 6 months after, targeted to school age children LF+ ONCHO+ SCHISTO+ STH high MDA1T1

16. T1= ALB or MBD + PZQ, once/year, targeted to school age children T3 = ALB or MBD, 6 months after, targeted to school age children LF- ONCHO- SCHISTO+ STH high T1T3

17. 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

18. 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.

19. Thank you for your attention