TROPICAL MEDICINE EGLECTED TROPICAL DISEASES Ana Maria Gémez J. MD. Msc. PhD(c) INDEX 1. Definition 2. Public Health aproach 3. WHO Assembly 4. Selected NTD for world erradication4 1. DEFINITION OF NEGLECTED TROPICAL DISEASES A diverse group of communicable diseases that prevail in tropical and subtropical conditions in 149 countries — affect more than one billion people and cost developing economies billions of dollars every year. Populations living in poverty, without adequate sanitation and in close contact with infectious vectors and domestic animals and livestock are those worst affected.5. e.PUBLIC HEALTH APROACH Preventive chemotherapy - the large-scale delivery of free and safe, single-dose, quality- assured medicines, either alone or in combination, at regular intervals to treat selected diseases; Innovative and intensified disease management - the management of diseases that are difficult to diagnose and treat and which can, in most cases, trigger severe clinical manifestations and complications; Vector control and pesticide management - the safe and judicious management of public- health pesticides to achieve vector control through integrated vector management; Safe drinking-water, basic sanitation and hygiene services, and education - the prioritization of improved sanitation combined with delivering preventive chemotherapy and health education to sustain reductions in prevalence of many of these diseases; Zoonotic disease management - the application of veterinary sciences and interventions to protect and improve human health (also referred to as veterinary public-health).PREVENTIVE CHEMOTHERAPY } DEFINITION EXAMPLES Preventive Chemotherapy and * Cysticercosis, dracunculiasis Transmission Control (PCT) (guinea-worm disease), foodborne Rationale PCT focuses on diseases for which a strategy trematode infections, lymphatic filariasis, onchocerciasis, schistosomiasis and soil- exists as well as on tools and transmitted helminthiasis. the availability of safe and * Blinding trachoma control through effective drugs that make it the SAFE strategy - combining drug treatment with hygiene and feasible to implement large- environmental management scale preventive chemotherapy. < PREVENTIVE CHEMOTHERAPY ONCHOCERCIASIS Despite civil unrest, almost half a million Yemenis treated for onchocerciasis 14 February 2019 | Geneva ICairo | Sana'a — Health-care workers in Yemen have defied the odds and distributed medicines to people at risk of onchoverciasis through a large-scale treatment campaign in 33 districts ofthe country’s eight governorates. The three-day campaign, on 28-31 January 2019, was led by the Yemen Ministry of Public Health and the Woe Health Organization (WHO), with the support of the Expanded Special Projact for Elimination of Neglected Tropical Diseases (ESPEN) and financial assistance from various sources. Full storyINNOVATIVE AND INTENSIFIED DISEASE MANAGEMENT (IDM) DEFINITION IDM focuses on diseases for which cost- effective control tools do not exist and where large-scale use of existing tools is limited. The diseases include Buruli ulcer, Chagas disease, human African trypanosomiasis, leishmaniasis and yaws and share the following characteristics: Difficult and costly to manage - diagnosis, treatment and follow up: Burden is poorly understood; Lack of appropriate control tools Relatively lower investment in research and development; People affected often live in remote rural areas with limited access to diagnosis and treatment. INNOVATIVE AND INTENSIFIED DISEASE MANAGEMENT (IDM) the neglect of LEISHMANIASIS + The leishmaniases are a group of diseases caused by protozoan parasites from more than 20 Leishmania species. These parasites are transmitted to humans by the bite of an infected male phlebotomine sandfly. There are three main forms of the disease: + cutaneous leishmaniasis (CL), visceral leishmaniasis (VL), also known as kala azar, and mucocutaneous leishmaniasis (MCL). In 2018, 92 and 83 countries or territories were jered endemic for, or had pre reported cases of, CLand VL, respectively. Today, than 1 billion people live in areas endemic leishmaniasis and are at risk of infection. over billion people at risk in endemic areas TransmissionINNOVATIVE AND INTENSIFIED DISEASE MANAGEMENT (IDM) Goal To provide national programmes with technical guidelines that emphasize a coordinated, cost-effective approach to the implementation of national elimination and control activities where preventive chemotherapy is the main tool, i.e. regular anthelminthic drug administration to all people at risk of morbidity due to helminthic diseases, starting early in life. Objectives * To develop technical guidelines and tools. * To build capacity through development of training tools, workshops and guidelines. * To advocate for a coordinated approach to preventive chemotherapy. * To build new partnerships and expand those that already exist. 3, WHO ASSEMBLYWHO ASSEMBLY Effective control can be achieved when selected public health approaches are combined. + Interventions are guided by the local epidemiology and the availability of appropriate measures to detect, prevent and control diseases. + Implementation of appropriate measures with high coverage will contzibute to achieving the targets of the WHO NTD Roadmap on neglected tropical diseases, resulting in the elimination of many and the eradication of at least two by 2020, + 2016 the 63th Assembly: Addressing the burden of mycetoma gins tem 3 2st 2018 Addressing the burden of mycetoma WHO ASSEMBLY Table 2. Resolutions of the World Health Assembly (WHA) on elimination and eradication of selected neglected tropical diseases ‘Endemic treponematoses(yaws) — WHA1.58. ‘Control of endemic treponcmatoses 1978 (Chagas disease WHA6320 ‘Chagas disease: control and elimination 2010 ‘Leishmaniasis WHA60.13 Control of leishmaniasis 2007 ‘Lymphatic filariasis WHA S029 ‘Elimination of lymphatic filariasis asa publichealth problem 1997 Schistosomiasis and WHAS4I19 ‘Schistosomiasis and soil-transmitted helminth infections 20016 4, SELECTED NEGLECTED TROPICAL DISEASES FOR WORLD ERRADICATION NTDs in poor populations qe) Neglected tropical diseases ” ravaios Malaria This arbitrary classification elucidates principles governing the population dynamics, epidemiology and courses of infection of pathogens that severely impair Hiss human health.NTD FOR WORLD ERRADICATION DENGUE RABIES BLINDING ENDEMIC TRACHOMA Flavivirus pibdbvmusarn TREPONEMATOSES systemic febrile zoonotic Chlamydia Genus Treponema: T. syndrome encephalitis trachomatis —_Pallidurn, T. carateum. T. pallidum (syphilis) Yaws, endemic syphilis, and pinta, respectively NTD FOR WORLD ERRADICATION SP om First etiology of blindness in the BURULI ULCER LEPROSY TRYPANOSOMIASIS LEISHMANIASIS ‘Mycobacterium EhowreasPansedis Trypanosoma brucei Leishmania spp. ulcerans disease. Long-term gambiense accounts for Protozoan. There are 3 Painless open wounds, infection by more than 98% of cases. Isa £F™s of leishmaniases - most commonly on the — Mycobacterium leprae vector transtnitted disease VISCE#! (kala-azar), limbs or Mycobacterium by tsetse flies. Known as cutaneous {most Jepromatosis. ” -gleepinginicketiess common) and mucocutaneousNTD FOR WORLD ERRADICATION CHAGAS CYSTICERCOSIS ECHINOCOCCOCIS GUINEA WORM DISEASE DISEASE NTD FOR WORLD ERRADICATION all FOODBORNE LYMPHATIC ONCHOCERCOSIS SCHISTOSOMIASIS TREMATODE FYLARIASIS INFECTIONS NTD FOR WORLD ERRADICATION SOIL TRANSMITTED HELMIANTHIASIS.