Race To Control And Eliminate Neglected Tropical Diseases

As part of 2030 Sustainable Development Goals, several countries will join World Health Organisation (WHO) on January 30 to roll out new targets for controlling five of 20 Neglected Tropical Diseases (NTDs) by year end.

The challenge to combat NTDs, estimated to affect around 1.7 billion people in 149 countries, mostly poor population, involves considerable resources, coordination, awareness programmes and getting people and communities to co-operate. The aim of NTDs programme is to get millions of poor out of the cycle of poverty and disease.

These diseases may be acute or chronic, disabling, disfiguring and stigmatizing and some may cause death or contribute in causing death. They impair children’s physical and cognitive growth, promote poverty and as many of the drugs used in the treatment are toxic, they are difficult to administer.

During the Sustainable Development Goals event on January 30, which is being held in India, ten diseases will be targeted. Of these five - Bilharzia (schistosomiasis); Blinding trachoma; Elephantiasis (lymphatic filariasis); Intestinal worms (soil-transmitted helminths); River blindness (onchocerciasis) - are being targeted through mass drug administration (MDA) or treatment of all people living in high-risk areas for treatment and reducing risks of transmission.

The other five NTDs - Chagas disease; Guinea worm disease; Leprosy; Sleeping sickness and Visceral leishmaniasis or Kala Azar (KA) - are being targeted through innovative and intensified disease management (IDM), including individual diagnosis and treatment (surgery where needed), care, and rehabilitation of infected individuals.

BILHARZIAS

220 million required treatment for Bilharzia in 20017

96% people requiring preventive chemotherapy live in Africa

52 countries require preventive treatment

Bilharzia (also known as schistosomiasis or snail fever) is an illness that develops when people come into contact with water contaminated by certain snails that carry disease-causing parasites. These parasites can penetrate through a person’s skin and move through the body.

- Infection primarily affects the urinary or intestinal system, causing chronic ill health and, in some cases, death. 

- Children suffering from persistent and severe bilharzia infections are also likely to have chronic and irreversible diseases later in life, such as scarring (fibrosis) of the liver, bladder cancer or kidney failure.

- In women, bilharzia can lead lead to female genital schistosomiasis (FGS) which can cause complications in pregnancy and triple the risk of contracting HIV.

Target: Control by 2020

* Control morbidity and achieve treatment coverage of at least 75% of all school-age children by 2020

* Regional elimination in the Eastern Mediterranean Region, the Caribbean, Indonesia and the Mekong River Basin by 2015

* Regional elimination in the Americas Region, Western Pacific Region and in selected countries in the African Region by 2020.

Regional elimination in the Americas Region, Western Pacific Region and in selected countries in the African Region by 2020.

BLINDING TRACHOMA

177 million people live in areas endemic for blinding trachoma in 2018 

89.1 million people received antibiotics for blinding trachoma in 2018 

44 countries are endemic for blinding trachoma in 2019

Blinding trachoma is a disease caused by a contagious bacterial infection of the eye. It is commonly spread through contact with contaminated hands or clothing and by flies coming into contact with a person’s eyes or nose.

Blinding trachoma often begins in early childhood and progresses over the years due to episodes of reinfection, causing inflammation and scarring of the inner eyelid.

In some people, repeated infection damages the eyelids, causing the eyelashes to turn inwards and to painfully rub against the eye’s surface (a condition known as trichiasis).

People living in known endemic areas require treatment with antibiotics, facial cleanliness and environmental improvement for elimination of blinding trachoma as a public health problem.

If left untreated, a series of complications can lead to irreversible blindness.

Blinding trachoma is directly linked to poverty; communities without access to clean water or effective sanitation are the most vulnerable.

The disease has a devastating impact on livelihoods, as it limits access to education and prevents individuals from being able to work or care for themselves or their families.

* Target: Elimination of blinding trachoma as a public health problem by 2020 to join eight nations which have achieved the goal-- Oman (2012), Morocco (2016), Mexico (2017), Cambodia (2017), Laos (2017), Nepal (2018), Ghana (2018), Iran (2018)

CHAGAS DISEASE

Six - seven million are infected with chagas disease 

21 countries in Latin American are endemic 

75 million people are at risk of infection

Chagas disease is a parasitic infection caused by contact with the faeces of infected blood-sucking insects (called kissing bugs) which infest people’s homes.

The disease can also be passed on by eating food contaminated by kissing bugs, through blood transfusions or organ transplants, or to children during birth.

After an often mild acute phase of a few weeks – with non-specific symptoms such as fever, body aches, rashes, diarrhoea and vomiting – most people will go a long time without showing any signs of the disease, and are often unaware they have the illness.

An estimated 30% to 40% of infected people will eventually develop serious complications, including heart disease and enlargement of the colon and oesophagus, which can incapacitate and quite frequently result in death.

Target: Control by 2020

* By 2015, interrupted transmission by blood transfusion in the Americas, European and Western Pacific regions

* By 2020, interrupted transmission by intra-domiciliary vectors in Latin America

ELEPHANTIASIS/ LYMPHATIC FILARAISIS

36 million people live with a chronic condition 

886 million people are at risk of infection

Elephantiasis (which is also known as lymphatic filaraisis) is a mosquito-transmitted disease that is caused by parasitic worms and which damages the human lymph system.

The disease can cause severe and extensive swelling of the lower limbs (lymphedema), which can be accompanied by painful episodes of fever. People with lymphedema are prone to bacterial infections that can lead to a mobility-limiting condition where the skin thickens and hardens. In men, elephantiasis can also result in the swelling of the scrotum (hydrocele).

Elephantiasis affects the poorest communities, preventing individuals from living a productive working and social life, further trapping them in the cycle of poverty.

Since the London Declaration was signed in 2012 and partners committed to defeating neglected tropical diseases, the number of people receiving preventive chemotherapy for elephantiasis has increased considerably.

Target: Global elimination as public health problem by 2020. So far 14 countries have  eliminated elephantiasis since 2012: Maldives (2016), Sri Lanka (2016),Cambodia (2016), Cook Islands (2016), Niue (2016), Vanuatu (2016), Marshall Islands (2017), Togo (2017), Tonga (2017), Thailand (2017), Egypt (2018), Palau (2018),

Vietnam (2018), Wallis & Futuna (2018), Yemen (2019).

GUINEA WORM DISEASE/ DRACUNCULIASIS

3.5 million cases in 1985 

130,000 cases IN 2000 

28 cases in 2018

Guinea worm disease (also known as dracunculiasis) is on the verge of eradication with only 28 cases reported in 2018. There are now only four countries – all of them in Africa – that are endemic for Guinea worm disease.

Guinea worm disease is a parasitic illness which is caught by drinking water that contains fleas infected with Guinea worm larvae. Once in the body, the larvae reproduce.

Over the course of ten to 14 months in the body, female larvae can grow into worms that are over a meter long. Eventually, these worms begin to emerge from the skin through very painful blisters on the legs or feet. This is also accompanied by fever, nausea and vomiting.

Once a worm has emerged from the body, it must be carefully and slowly removed over several weeks. The wound caused often develops a secondary infection which increases the time it takes for an individual to resume normal activities.

If the worm is not removed, it can lead to septicaemia (infection across the whole body) and permanent disability for the person.

Target: Global eradication by 2020

INTESTINAL WORMS/ SOIL-TRANSMITTED HELMINTHS)

869 million children are at risk of contracting intestinal worms 

75% children at risk live in South-east Asia and Africa

Intestinal worms are a group of intestinal parasites that thrive in places where the soil is warm and humid but sanitation is poor.

The most common parasites, which affect people mainly in sub-Saharan Africa, the Americas, China and South-East Asia,  are roundworm, whipworm and hookworm.

People become infected with intestinal worms after they come into contact with soil contaminated with the parasites’ eggs.

Intestinal worms reduce the body’s ability to absorb nutrients and vitamins. This exacerbates malnutrition and leads to anaemia, increased susceptibility to other infectious diseases, stunted growth and impaired intellectual development.

Symptoms of intestinal worms become more evident as the number of worms, or size of the worms, in a person increases.

Intestinal worms are a poverty-related disease, linked to broader community development challenges, which severely limit the ability of those infected to live full and productive lives.

Target: Control by 2020 75% of pre-school and school-aged children in need are treated by 2020

Since the London Declaration  in 2012, the number of people receiving preventive chemotherapy and mass drug administration for intestinal worms has increased considerably.

LEPROSY/ HANSEN’S DISEASE 

80% of the global burden of leprosy in three countries including India

210,671 new cases were recorded IN 2017

Leprosy (also known as Hansen’s disease) is a chronic infectious disease caused by bacteria, which is often spread through droplets from the nose and mouth.

The disease, which can have a long incubation period, causes disfiguring lesions on the skin as well as nerve damage.

The first stage of leprosy leads to loss of sensation and muscle weakness in the facial muscles, hands and feet (this is known as Grade 1 disability).

If the disease is not diagnosed and treated, it progresses to a second stage that causes observable and permanent impairments, such as the shortening and/or loss of the fingers and toes, and blindness (known as Grade 2 disability).

Leprosy is most common in areas affected by poverty, where overcrowding and poor nutrition make people more vulnerable to infection. Leprosy continues to be a major source of disability and social exclusion for people living with the disease, and their families.

The consequences of leprosy can often persist beyond completion of treatment.

Brazil, India and Indonesia account for 80% of the global burden.

People affected by leprosy

Target: Global elimination by 2020

RIVER BLINDNESS/ ONCHOCERCIASIS

26 million people are infected with the river blindness 

200 million at risk of contracting river blindness 

99% of people infected live in Sub-Saharan Africa

River blindness (which is also known as onchocerciasis) is caused by an infection from a parasitic worm transmitted by blackflies, which breed in fast-flowing streams and rivers.

The worms produce larvae that move to the skin, eyes and other organs. This can lead to debilitating itching, disfiguring skin conditions and sight loss (including irreversible blindness).

With these conditions, river blindness has an enormous impact on the lives of those infected by reducing their ability to work and study in school.

Target: Elimination in selected African countries by 2020. So far four countries have eliminated river blindness since 2012: Colombia (2013), Ecuador (2014), Mexico (2015), Guatemala (2016).

SLEEPING SICKNESS / HUMAN AFRICAN TRYPANOSOMIASIS

98% of reported cases are from T. Brucei Gambiense

1,447 new cases were reported in 2017

78% of cases were from Democratic Republic of Congo in 2017

Sleeping sickness (also known as Human African trypanosomiasis) is caused by an infection, with parasites transmitted to humans through the bites of infected tsetse flies.

The disease manifests in two forms: chronic infection with Trypanosoma brucei gambiense (g-HAT) and acute infection with Trypanosoma brucei rhodesiense (r-HAT).

In the first stage, the parasites multiply in the body causing fever, headaches, joint pain and itching.

In the second stage, the parasites invade the central nervous system and brain, leading to behavioural changes, confusion, poor coordination, and sensory as well as sleep disturbances (giving the name ‘sleeping sickness’).

Without diagnosis and treatment, sleeping sickness is nearly universally fatal in humans.

Target: Global elimination as a public health problem by 2020. The elimination programmes.

VISCERAL LEISHMANIASIS/ KALA-AZAR

27% decrease in Indian subcontinent from 2015 to 2016 

22,145 cases reported in 2017

Visceral leishmaniasis (also known as kala-azar) is caused by the infected bites of sandflies that breed in and around homes or farms.

If visceral leishmaniasis progresses, it attacks the immune system and affects the bone marrow and internal organs (including enlargement and impaired function of the spleen and liver), as well as causing irregular bouts of fever, substantial weight loss and anaemia.

Without treatment, visceral leishmaniasis can have a fatality rate as high as 100% within two years.

The disease is linked to poverty.

Target: Regional elimination on the Indian subcontinent by 2020, achieve 100% case detection and treatment.