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FamiliesUSA
The Neglected Tropical Diseases
Peter Hotez MD PhD FAAP
The George Washington UniversitySabin Vaccine Institute
The Millennium Development Goals (MDGs) 1. Eradicate extreme poverty and hunger.2. Achieve universal primary education.3. Promote gender equality and empower women.4. Reduce child mortality.5. Improve maternal health.6. Combat HIV/AIDS, malaria and other diseases.7. Ensure environmental sustainability.8. Develop a global partnership for development.
The 2000 Millennium Declaration
The Neglected Tropical Diseases“Ancient Afflictions of Stigma and Poverty”
Core Group of 13
• Protozoan Infections– African
Trypanosomiasis– Chagas Disease– Leishmaniasis
• Bacterial Infections– Buruli Ulcer– Leprosy– Trachoma
• Helminth Infections– Ascariasis– Hookworm Infection– Trichuriasis– Schistosomiasis – Lymphatic Filariasis– Onchocerciasis– Dracunculiasis
Disease Number of Cases Population at-risk
Ascariasis 807 million 4.2 billion
Trichuriasis 604 million 3.2 billion
Hookworm 576 million 3.2 billion
Schistosomiasis 200 million 0.6 billion
Lymphatic Filariasis 120 million 1.0 billion
Trachoma 84 million 0.5 billion
Onchocerciasis 18-37 million 0.1 billion
Leishmaniasis 12 million 0.4 billion
Chagas Disease 8-9 million 0.025 billion
Leprosy 0.4 million ND
Trypanosomiasis 0.3 million ND
Dracunculiasis 0.01 million ND
The Most Common Infections of Poor People
Neglected Tropical DiseasesCOMMON FEATURES
• The Most Prevalent Infections of Poor People– Up to half of the 2.7 billion people who live on less than $2 per
day– Rural areas (slums and poor urban areas) of low-income
countries
• Non-Emerging Ancient Conditions • Indigenous Populations• Chronic Conditions Disabling Conditions
– Growth Delays– Blindness– Disfigurement– Stigma
• Poverty Promoting Conditions– Child development and education– Pregnancy outcome– Productive capacity
Buruli Ulcer Onchocerciasis
Leishmaniasis
“It’s quite a problem for me when I have to stand at work for long periods.”
“I am a fisherman. I can’t work
continuously. I am ill every other week
with renewed pain.”
“My parents brought me two suitors but neither decided to marry me.”
Lymphatic Filariasis in Sri Lanka
Ranking of Communicable Diseases By DALYs
Disease Condition Disease Burden
HIV-AIDS 84.5 million
Neglected Tropical Diseases 56.6 million
Malaria 46.5 million
Tuberculosis 34.7 million
Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, Ehrlich Sachs S, Sachs JDPLoS Medicine 2006; 3: e102
Version 2.0: Integrating Neglected Tropical Disease Control
Low Cost of Interventions
0 200 400 600 800 1000
Cost per patient treatment per year (US dollars)
'Rapid Impact'Package
Malaria
TB
HIV/ AIDS
Range of treatment costs per person per year
<$0.50 for packaged intervention – delivery
costs for donated drugs
Global Network for Neglected Tropical Diseaseshttp://www.GNNTDC.org
• Schistosomiasis Control Initiative • International Trachoma Initiative• Helen Keller International• Liverpool School - GAELF• Human Hookworm Vaccine Initiative• Earth Institute at Columbia Univ.• Task Force for Child Survival
– Mectizan Donation Program– Albendazole Donation Program– Mebendazole Donation Program
8 / 56 Countries
Geneva GlobalBurundiRwanda
Exxon MobilEquatorial Guinea
USAIDBurkina FasoGhanaMaliNiger Uganda
New NTD Control ProjectsThe Global Network for Neglected Tropical Disease Control
The Buzz on NTDs
“The world is now paying attention to these [neglected] diseases and making progress in unprecedented ways, with ambitious goals, excellent interventions, and growing evidence of multiple benefits for health. The attention to long-neglected diseases is a positive sign that health is a responsibility shared by the international community.” -Dr. Margaret Chan, Director-General of the World Health Organization
“Comprehensive, Africa-wide control of malaria and NTDs together would probably cost no more than $3 billion a year, or just two days of Pentagon spending. If each of the billion people in the rich world devoted the equivalent of one $3 coffee a year to the cause, several million children every year would be spared of death and debility, and world would be spared the grave risks when disease and despair run unchecked. A new Global Network for Neglected Tropical Disease Control is helping make this opportunity a reality.” - Jeffrey Sachs, Director of the Earth Institute, Scientific American January 2007
“It quickly became clear that this story is not just about the staggering numbers of the world’s citizens overwhelmed by HIV, AIDS, TB, and malaria. And it’s not just the story about one billion people who are afflicted with disabling, oftentimes stigmatizing, neglected tropical diseases, such as human hookworm infection and elephantiasis… it’s all about the faces of dying children and sick mothers who haunt those who have seen them...What struck me, and what I think struck us all…that these challenges are all interconnected.” - Clinton Global Initiative, Closing Remarks
VERSION 3.0: NEW TOOLS FOR DISEASE CONTROL
Days Since Treatment20 40 60 80 100 120 140 160 180
Days Since Treatment20 40 60 80 100 120 140 160 180
Ho
okw
orm
Bu
rden
Village A
Village BZanzibar, Tanzania
•Low efficacy of Mebendazole•Re-infection within 4-12 mos•Diminishing efficacy
Hookworm Re-Infection
Product Development Partnership
Sabin Vaccine InstituteGeorge Washington UniversityFIOCRUZInstituto ButantanLondon School Hyg. Trop. Med.Queensland Inst. Med. Res