Transcript The Big Ten. Caregorization and estrategegic em

The Big Ten Tropical
Diseases.
Categorization and research
strategic emphases
Dr. Marcio Ulises Estrada Paneque.
Dr. Genco Estrada Vinajera.
Universidad Médica 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.
Category I
Malaria.
Tuberculosis.
Schistosomiasis
Category II
Onchocerciasis.
Leprosy.
Chagas disease.
Lymphatic filariasis
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
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 N’gana, 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 world’s
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 (hostpathogen interactions) focusing on reproductive
health issues and immunological aspects of coinfection. 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 world’s 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
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
Hansen’s 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 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!