Transcript Neglected Tropical Diseases: an Overview

Neglected Tropical
Diseases:
Control & Research
P.Olliaro, WHO/TDR
NTDs in poor populations
Previously
neglected
diseases
TB
Neglected tropical diseases
HIV/AIDS
Malaria
Anthrax
Soil transmitted
helminthiasis
Schistosomiasis
Bovine tuberculosis
Lymphatic filariasis Cysticercosis
Onchocerciasis
Brucellosis
Leprosy
Trachoma
Echinococcosis
Leishmaniasis
Zoonotic trypanosomiasis
Buruli ulcer
Chagas disease
Rabies
HAT
Dengue
Neglected zoonoses
…
Global distribution of NTDs
.
~ 1 billion people have >1 NTDs
Burden of disease (DALYs) for
infectious & parasitic diseases
others infectious
diseases, 87.2,
24%
helminth infections,
49.9, 14%
"others"
= 29.6 %
neglected tropical
diseases, 56.6,
16%
HIV/AIDS, 84.5,
23%
malaria, 46.5,
13%
tuberculosis, 34.7,
10%
"big three"
= 46.1%
Countries affected by NTDs by income
group
High-income
group, 10%
Upper middleincome group, 17%
Lower middleincome group, 32%
Low-income
group, 41%
 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
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
Large scale interventions
 Lymphatic filariasis
 Leprosy
 Onchocerciasis
 Schistosomiasis
 Helminthiasis
 Trachoma
 Yaws
Case management and
development of new tools
 Human African
trypanosomiasis
 Chagas diseases
 Buruli ulcer
 Leishmaniasis
 Dengue
Rapid Impact Interventions
Improving access
Focused interventions
Improving innovation
Dengue
Dengue is the most common mosquito-borne viral disease of humans
that in recent years has become a major international public health
concern. Globally, 2.5 billion people live in areas where dengue viruses
can be transmitted. The geographical spread of both the mosquito
vectors and the viruses has led to the global resurgence of epidemic
dengue fever and emergence of dengue hemorrhagic fever
(dengue/DHF) in the past 25 years with the development of
hyperendemicity in many urban centers of the tropics.
Human African trypanosomiasis
Spread by the bite of the tsetse fly, the disease flourishes in
impoverished rural parts of Africa. Untreated, the disease is invariably
fatal. Death follows prolonged agony. In 2006
some 70 000 people are estimated to be infected.
Leishmaniasis
12 millions are currently infected and 350 million people are at risk of
infection. Around 1.5 million to 2 million new infections occur each year.
Buruli ulcer
BU has been reported from 30 countries, left untreated, the disease
progresses to massive destruction of the skin and, in some cases, of
bone, eyes, and other tissues. Limb amputations may be needed to
save a patient's life.
Trachoma
Blinding trachoma affects more than 80 million people around the world.
Children are mainly concerned by the infection, and every 4 people
blind from trachoma 3 are women. Africa is the continent with the
greatest number of endemic countries, but America, Middle-East and
Asia are also endemic. SAFE strategy (Surgery, Antibiotics, Facial
cleanliness, Environmental improvement) has proven its effectiveness
in eliminating this scourge from humanity.
Leprosy
Leprosy is considered shameful and people hid their symptoms for fear of
ostracism despite free and effective multidrug therapy. Today, the
diagnosis and treatment of leprosy is easy. MDT treatment has been made
available by WHO free of charge to all patients worldwide since 1995, and
provides a simple yet highly effective cure for all types of leprosy.
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 and Ivermectin are
donated by GlaxoSmithKline and Merck & C for mass administration
to at-risk populations.
Schistosomiasis
Schistosoma haematobium is endemic in 53 countries in the Middle East
and most of the African continent including the islands of Madagascar and
Mauritius. In sub-Saharan Africa alone there are reckoned to be 112
million infections with S. haematobium. Praziquantel at the single dose of
40 mg/Kg body weight is a very safe and effective treatment against S.
haematobium and the cost of treatment is less than 0.15 Euro.
Hookworms
Hookworms infect one billion people. It is calculated that 500 million women
are infected by hookworms and at globally least 44 million are pregnant and
infected at any time. Safe single dose treatment costs < 0.02 Euro a dose.
Free and timely access to high-quality
medicines
Medicine
Donator
Conditions
Albendazole
GlaxoSmithKline
Unlimited quantity for lymphatic filariasis only (not for soil-transmitted
helminthiasis)
Eflornithine
sanofi-aventis
Unlimited quantity by 2012 for human African trypanosomiasis
Melarsoprol
sanofi-aventis
Unlimited quantity by 2012 for human African trypanosomiasis
Extract from the opening speech by DG
Nifurtimox
Bayer
Pentamidine
sanofi-aventis
Unlimited quantity by 2012 for human African trypanosomiasis
Praziquantel
Merck KGaA
200 million tablets 2008-2017 for Schistosomiasis
Suramine
Bayer
Unlimited quantity by 2012 for human African trypanosomiasis
Triclabendazole
Novartis
600 000 tablets 2007-2009 for fascioliasis
"Industry
is&present.
YourDirectly
donations
oflymphatic
drugs
andandother
Merck
Co
Inc.
to
countries
for
filariasis
onchocerciasis
Ivermectin *
support opened
an opportunity
which public health has
MDT and Clofazimine
Novartis
Unlimited quantity for Leprosy and its complications
seized. Your engagement
has given us the tools to take
50 million tablets in 2007 for Soil-transmitted helminths control programmes
Johnson
&
Johnson
Mebendazole *
for children
action on an unprecedented scale."
* Donation made not directly to WHO
500
000
tablets
(120
mg) permeeting
year byon
2012
for19-20
treatment
Chagas disease
at the
first
WHO
global
partners'
NTD,
Aprilof2007
RESEARCH:
Develop new tools
Pharmaceutical gap
Existing tools:
Optimise
Improve use/access
Operational gap
FINANCING RESEARCH
PARTNERING TO CONDUCT RESEARCH
Ascariasis
Trichuriasis
Hookworm disease
Modified from Ridley D. et al Health Affairs 2006
Drug R&D investments, pipeline
& burden
log DALY (millions)
100
Tuberculosis , 7
Intestinal nematodes
10
M alaria , 15
Lymphatic filariasis
Schistosomiasis
Trachoma
Onchocerciasis
1
Leishmaniasis
African Trypanosomiasis
Vs. R&D costs ?
Chagas disease
0
0
50
100
150
Drug R&D investments (million $)
200
250
Research needs
Innovation/
pharmaceutical
Gap
Basic
science
Product
discovery
"Operational"
Research
Health
Systems
Product
Development
(R&D)
Product use
Schools,
Communities
"Tool deficient"
"Tool ready"
Human African trypanosomiasis, Chagas dis. Lymphatic filariasis, Leprosy, Onchocerciasis,
Buruli ulcer, Leishmaniasis, Dengue
Schistosomiasis, Helminthiasis, Trachoma, Yaws
(VL in Indian subcontinent)
"Vulnerable diseases"
Lymphatic filariasis, Onchocerciasis,
Schistosomiasis, (Helminthiases)
Current global R&D portfolio
disease
Onchocerciasis
potential candidates
emodepside
lymphatic filariasis
Schistosomiasis
L-praziquantel
Soil-transmitted
Helminths
Human African
Trypanosomiasis
product from animal
health?
DB backups
fexinidazole backups
Chagas disease
DEVELOPMENT
moxidectin (Ph3)
[WHO/TDR + Wyeth]
OPTIMIZATION
albendazole/Loaloa
praziquantel dosing
praziquantel combos?
fexinidazole (Ph1)
[DNDi + sanofi-aventis]
Nifurtimox+eflornithine
(approved EML)
pentamidine shortened Rx
pediatric benznidazole
Leishmaniasis
buparvaquone
oral AmphoB
Dengue
options considered
combinations:
AmBisome+Miltefosine
AmBisome+Paromomycin
Miltefosine+Paromomycin