The Big Ten Tropical

Diseases.

Categorization and research

strategic emphases

Dr. Marcio Ulises Estrada Paneque.

Dr. Genco Estrada Vinajera.
Universidad Mdica de Granma.
Cuba.

Exchange Objectives:
To know a brief history, some facts,
impact and current Tropical Diseases
(TD) classification.
To approach the current research
strategic emphases of those illnesses.

The Big Ten. Clasification.

African Trypanosomiasis.
Dengue.
Leishmaniasis.
Malaria.
Tuberculosis.
Schistosomiasis
Onchocerciasis.
Leprosy.
Chagas disease.
Lymphatic filariasis

Category I

Category II

Category III

Classification due to
Category I: Emerging or uncontrolled
disease.
Category II: Control strategy available
but disease burden persists.
Category III: Control strategy proven
effective, disease burden falling, and
elimination planned.

Categorization . Why?
New knowledge about the biological, social,
economic, health system, and behavioral
determinants, for effective control.
New tools for use in prevention and control, e.g.
drugs, vaccines, diagnostics, epidemiological and
environmental tools.
Interventions methods for applying existing and
new tools at the clinical and community level.
Policies for large-scale implementation of existing
and new disease prevention and control strategies.

10 Big Tropical Diseases.

Some questions.
What is the size and nature of the disease burden
and what are the epidemiological trends?
What is the current disease control strategy?
What are the major problems and challenges for
disease control?
What research is needed to address these
problems /challenges?
What is currently being done in research and
development? What research opportunities exist?

Tropical diseases impact.

Conditions that contribute to the risk for becoming
infected with TD agent include biological factors related to
population density, rural vs. urban living, nutritional
status, climate and other environmental factors, as well as
socioeconomic circumstances. At one time, many of
today's tropical diseases also occurred in temperate
regions, since many of the same risk factors were found
there.
Illness and death due to infection remain all too frequent
in the tropics. Every minute three children die of malaria
alone. The burden imposed by these diseases, however,
extends beyond the sad story of young lives being lost.
They impede the capacity of children to grow and learn,
and of young adults to work and raise a family. They stifle
efforts for individual, community and national
advancement. They sap resources which would otherwise
be utilized for improving the human condition.

Health Research and Tropical Diseases

Setting priorities for the health
research is a difficult task, especially
for the neglected diseases of the poor.
A new approach to priority setting for
tropical diseases research must be
based on a comprehensive analysis of
research needs and research
opportunities for each of the ten major
tropical diseases in its portfolio.

African trypanosomiasis
African trypanosomiasis, also known as
Sleeping sickness, is a severe disease,
which is fatal if left untreated. It is closely
related to a widespread infection of cattle
known as Ngana, which restricts cattle
earing in many prime areas of Africa.
Sleeping sickness claims comparatively
few lives annually, but the risk of
major epidemics means that surveillance
and ongoing control measures must be
maintained.

Trypanosomiasis. Research emphases

New basic knowledge:
- Bioinformatics and applied genomics for identifying
targets for drugs and diagnostics
- Pathogenesis and host / pathogen interactions
- Socioeconomic impact of human African
trypanosomiasis and cost-benefit of control
- Effect of health systems and policy changes on
human African trypanosomiasis control, reemergence, and epidemics
- Factors influencing individual and community
participation in control
- Epidemiological significance of animal reservoirs
for Trypanosoma gambiense
- Tsetse genomics.

Dengue.
Dengue and dengue haemorrhagic fever have emerged
as a major public health problem.
The primary vector mosquito has spread throughout the
tropics and into susceptible human populations in
urban areas.
The urbanization process, which has left many without
adequate water, sewer systems or waste management,
and created new breeding grounds for the vector, has
hastened the spread of the disease.
Vector control has not halted the explosion in
transmission of the disease.

Research strategic
emphases for dengue.
New knowledge:
Molecular tools for Aedes transformation;
Vectorial resistance to dengue;
Aedes population genetics and ecology;
Host-pathogen interactions in dengue, including
pathogenesis, natural history, definition of high risk
groups .
Dynamics of virus transmission, and population
genetics (including modelling)
Social, economic, and biological factors related to
promotion and support of community-based
interventions; and release of transformed Aedes
vectors

Leishmaniasis
Leishmania parasites are named after W.B. Leishman,
who developed one of the earliest stains of Leishmania
in 1901. Widespread in 22 countries in the New World
and in 66 nations in Old World, leishmaniasis is not
found in South-east Asia.
Human infections are found in 16 countries in Europe,
including France, Italy Greece, Malta, Spain and
Portugal.
Occurring in several forms, the disease is generally
recognized for its cutaneous form which causes nonfatal, disfiguring lesions, although epidemics of the
potentially Fatal visceral form cause thousands of
deaths.

Leishmaniasis. Research emphases

New knowledge: a) Bioinformatics and

applied genomics for identifying targets for
drugs, vaccines, and diagnostics. b)
Socioeconomic, environmental, and
behavioral risk factors for infection and
disease, especially in refugee populations in
complex emergencies.
New and improved tools: a) Development of
Leishmania diagnostic tests. b) Development
of vaccine candidates (new adjuvants for
first generation vaccines; second generation
vaccine).

Malaria
Malaria is the most important tropical disease,
remaining widespread throughout the tropics, but also
occurring in many temperate regions.
It exacts a heavy toll of illness and death - especially
amongst children and pregnant women. It also poses a
risk to travelers and immigrants, with imported cases
increasing in non-endemic areas.
Treatment and control have become more difficult with
the spread of drug-resistant strains of parasites and
insecticide-resistant strains of mosquito vectors.

Malaria. Research emphases

New basic knowledge: a) Anopheles genome
sequencing and genetic manipulation for mosquito
vector control. b) Bioinformatics and applied
genomics for drugs, vaccines, and diagnostics. c)
Development of an applied genomic database for
the public domain d) Impact of health sector reform
on malaria understanding mechanisms of resistance
to drugs and insecticides.
New tools: a) Discovery and development of new
drugs, including combinations and drugs for use in
pregnancy. c) Discovery of malaria vaccine
candidate antigens. d) Development of vaccine
candidates. e) Development of non-invasive
approach to diagnostics for use close to the home

Tuberculosis
Tuberculosis threatens one-third of the worlds
population. The World Health Organization declared
tuberculosis a global health emergency since 1993.
The magnitude of the problem changed dramatically
during the 1990s due to deteriorating control in some
parts of the world (notably eastern Europe and the
former Soviet Union), the spread of HIV, and population
growth.
Without a coordinated control effort, tuberculosis will
infect an estimated 1 billion more people by 2020, killing
70 million.

TB. Research Emphases.

New basic knowledge: Bioinformatics and
applied genomics for identifying targets for
drugs, vaccines, and diagnostics. Impact of
health sector reform, globalization, and
inequality of access.
New and improved tools: - Diagnostic test
development; detection of disease,
rifampicin resistance, latent infection.
Discovery and development of new drugs.

Schistosomiasis
Schistosomiasis is also known as bilharzia after
Theodor Bilharz, who first identified the parasite in
Egypt in 1851.
Infection is widespread with a relatively low mortality
rate, but a high morbidity rate, causing severe
debilitating illness in millions of people.
The disease is often associated with water resource
development projects, such as dams and
irrigation schemes, where the snail intermediate
hosts of the parasite breed.

Schistosomiasis. Research emphases.

New basic knowledge: a) Bioinformatics and applied
genomics for identifying targets for drugs, vaccines,
and diagnostics. b) Pathogenesis (host-pathogen
interactions) focusing on reproductive health issues
and immunological aspects of co-infection. c) Social
economic impact and methodology for burden of
disease assessment
New and improved tools: a) Discovery and
development of new drugs. b) Evaluate safety and
efficacy of existing drugs that are potentially antischistosomal. c) Review of vaccine research and
development. d) Assess technical and use profiles of
available diagnostics

Onchocerciasis
Onchocerciasis is the worlds second leading infectious
cause of blindness. Rarely life-threatening, the disease
causes chronic suffering and severe disability.
In Africa, it constitutes a serious obstacle to
socioeconomic development. It is often called river
blindness because of its most extreme manifestation and
because the black flies that transmit the disease abound in
riverside areas, where they breed in fast-flowing waters.
Fertile riverine areas are frequently abandoned for fear of
the disease.

Onchocerciasis. Research
New basic knowledge: Understanding ivermectin
resistance mechanisms
New and improved tools:
a) Discovery and development of macrofilaricidal drugs
or drugs to permanently inhibit microfilariae production.
b) Development of diagnostics for surveillance.
c) Development of ivermectin resistance test.

Leprosy
Leprosy is occasionally known as
Hansens disease, after Armauer Hansen,
the Norwegian physician who first
identified the microorganism which causes
the disease.
Known and dreaded since biblical times
because of the severe deformities that can
occur, it was considered incurable until as
recently as the 1940s.

Leprosy emphases
New basic knowledge:
a) Bioinformatics and applied genomics for
identifying targets for diagnostics for infection
with ML
b) Pathogenesis of nerve reactions.
c) Social and behavioral constraints for leprosy
elimination.
New tools:
a) Rifampicin susceptibility test development.
b) Development of a test for infection with
Mycobacterium leprae.
c) Development of tools for early diagnosis and
treatment of leprosy reactions

Chagas disease
Chagas disease is found only in Latin
America. It is named after Carlos Chagas, a
Brazilian doctor who first described the
disease in 1909. He also described the lifecycle of the parasite, identified the insects
that transmit the parasite, identified small
mammals that act as reservoir hosts, and
suggested means to help prevent its
transmission.

Research emphases on
Chagas disease.
New basic knowledge:
a) Bioinformatics and applied genomics
for identifying targets for drugs and
elucidation of pathogenesis and risk
factors. b ) Genetic and entomological
studies on vectors (e.g. mechanisms of
resistance, adaptation to ecological
changes)
New tools: a) Development of candidate
drugs. b) Clinical research on proposed
prognostic markers of disease.

Lymphatic filariasis
Rarely life-threatening, lymphatic filariasis causes widespread
and chronic suffering, disability, and social stigma.
It can lead to grotesquely swollen limbs a condition known as
elephantiasis.

Lymphatic filariasis

Lymphatic filariasis emphases

New basic knowledge: a) Bioinformatics and
applied genomics for drugs. b) Progression /
reversibility of disease manifestations after
treatment, especially in children
New tools: a) Discovery and development of
macrofilaricidal drugs or drugs to
permanently inhibit microfilariae production.
b) Further development and evaluation of
diagnostics for Brugia malayi.

Tropical Diseases. Hopes?

To the fight against the HIV/AIDS, malaria, TB,
others TD, infectious illnesses of the
childhood, maternal and perinatal affections,
micronutrients deficits and others, is
necessary to add family planning,
reproductive and derived gender health
programs and other managed ones to the
prevention and attention of the non
transmitted diseases. The Third World is
economically insolvent to achieve it without
official financing for the development for the
countries of high entrance.

Tropical Diseases. Hopes?

That is necessary for a true sustainable
economic and social development, in a
healthy world, it is many times more than
what is affirmed.
To brake the monetary speculation and
the career arms, it the only measures able
to generate funds for the health and the
world development.

A better world is possible!