Tuberculosis has featured strongly in TropIKA.net in the last couple of weeks. This is appropriate as World TB Day (24th March) will soon be with us. There are many issues that must be urgently addressed if further progress is to be made in controlling this disease, which kills over one and a half million people every year. There are particular concerns over the growing numbers of cases of drug-resistant forms of TB and new understanding [1] of the mechanism of action of two drugs active against multiple-drug resistant TB may help inform the search for the new drugs that are so desperately needed.

A neglected area of TB research has been diagnosis. Sputum microscopy – sometimes referred to as the “gold standard” for diagnosing TB – is time consuming, can only be conducted in the lab and often gives incorrect results. A rapid test that can be used on the front line is required. News of new funding [2] provided by the Gates Foundation to a non-profit group that focuses on this issue is much to be welcomed. Interestingly, a manufacturer of breath tests for disease diagnostics says it has developed a simple test that can diagnose active pulmonary TB within minutes – see TropIKA.net News in brief [3].

The importance of partnership is always stressed in TB control efforts. Important partners in the delivery of care include the private health care sector and it is disappointing that in India [4] many private practitioners do not apparently provide the recommended TB treatment DOTS (directly-observed therapy short course.)

Good news

Several recent TropIKA.net articles report good news concerning other infectious diseases of poverty. For example, a trial in India [5] found that a single transfusion of the drug amphotericin B, for which patients stayed in hospital for just 24 hours, was as effective in the treatment of visceral leishmaniasis (VL) as a course of treatment requiring a one-month hospital stay. This finding could have major implications; it would be possible to significantly increase the number of VL patients who receive treatment.

When new drugs are introduced they are not always popular with patients and this is bound to affect their compliance with the treatments they are prescribed – something that is not always taken into consideration when implementing new programmes. Much depends on the switch to artemisinin-combination therapy (ACT) as the standard treatment for uncomplicated malaria and it is reassuring to learn [6] that the introduction of the ACT Coartem in Dar es Salaam, Tanzania has met with a positive reception from the local community, including mothers whose children have been treated for malaria.

A TropIKA “Research in brief” article [7] includes further welcome news: a new insecticide could be in prospect for mosquito control, research at the “basic” level could lead on to the development of treatments for cholera and for the kinetoplastid diseases, and a drug already in use in veterinary medicine could be developed as a new treatment for onchocerciasis.

Looking to the future, research into sleeping sickness (human African trypanosomiasis) will be boosted by new Gates funding, and the Australian government has made new grants to researchers working on malaria [8]. In both these cases the research will be based in institutions located in developed countries, but there is a pressing need for more research to be done in disease-endemic countries themselves and for it to be conducted by nationals of those countries. This was the theme of the African Expert Meeting on Pharmaceutical Innovation in Africa, held in Pretoria, South Africa [9], where a call was made for support to enable the development and production of medicines, “in Africa, by Africans”. The registration in African countries of new drugs shown to be effective against the infectious diseases of poverty was also discussed at this meeting [10]. Robust registration procedures are of course necessary but they must not lead to unnecessary delays in bringing the fruits of scientific research to those who most need them.

One of the barriers to increasing the level of support for research and control of the infectious diseases of poverty (IDPs) is a widespread view that many of these infections are already in decline, and that little more needs to be done before they are eliminated. Leprosy is a case in point; this year’s World Leprosy Day has already been and gone, but attracted little media attention. Here on TropIKA.net, however, we have argued [1] that the battle against leprosy is far from over and that there is a need for further research; we seek to identify the research gaps that need filling.

Thankfully, some other IDPs are now receiving increased attention and there is good news to report. New findings from southern Africa and from Mexico [2] provide further evidence that the introduction of rotavirus vaccines into immunization programmes can lead to substantial reductions in diarrhoeal morbidity and mortality. (Diarrhoeal disease is, after pneumonia, the second biggest killer of children in poor countries.) Getting the vaccine to all those who need it is now the challenge.

The search for a vaccine that will protect against dengue fever [3] has been stepped up, with another candidate vaccine entering Phase 1 trials. There are now at least five potential dengue vaccines under development. Some of the countries in Asia and South America reporting increased numbers of dengue cases are amongst the world’s most rapidly growing economies. There will certainly be a significant market for products that prevent or treat dengue and thus there is an economic incentive for research and development efforts that is lacking for many other IDPs.

Many infectious diseases have now been studied using the techniques of mathematical modelling but it remains a controversial area of research. In one of our regular series of Profile interviews, Tatum Anderson speaks with one of the leaders in this field – Professor Sir Roy Anderson [4].

But probably the most influential figure in IDP research is now Bill Gates, who has been much in the news in recent days. The publication of his Annual Letter is likely to come to be regarded as a yearly landmark, as it sets out – in an informal fashion – the Gates Foundation’s own current plans and priorities, and it will have an influence on the actions taken by other donor organizations. The letter – and the announcement of major new Gates funding for vaccine research that followed a few days later – are discussed in TropIKA.net News [5].

The TropIKA.net Blog [6] continues to highlight new developments that have been reported elsewhere on the Internet. China has been reported to have made good progress against tuberculosis [7] and market research has shown it to offer enormous potential for the sale of TB drugs [8]. The achievements of China contrast with the situation in South Africa where TB rates in children are claimed to be the highest ever reported [9].

Another item of interest on the blog is the news that drug giant Novartis has been trying to create a fund that companies and institutions could draw upon to finance the development of drugs against neglected diseases. But after two years of approaching potential donors Novartis says it has not raised a cent for its proposal [10]. Industry has a major role to play in the development of new tools to control the infectious diseases of poverty and it is to be hoped that Novartis will find other ways in which it can make a contribution.

Paul Chinnock
Editor, TropIKA.net

The first month of 2010 has seen important developments in the world of malaria research. GlaxoSmithKline is putting into the public domain details of 13,500 “confirmed-hit structures” – compounds that other researchers will be free to screen for their potential use as antimalarials [1]. Meanwhile, the genome has been mapped of the plant from which the key antimalarial artemisinin is produced [2], which should pay the way for the development of higher yielding varieties. Also announced has been an extension of efforts to develop a so-called transmission blocking vaccine [3] active against the sexual stages of the malaria parasite.

Such research, at the “basic” level, is essential if new tools active against malaria are to be developed, but putting effective interventions into practice is not easy. Research is also therefore needed at the implementation stage. A study in Tanzania [4] found that only a minority of women receiving bednets in a distribution programme were actually sleeping under them; studies like this one help to identify the points at which such programmes can fail.

The implementation of another new antimalarial tool – the rapid diagnostic test (RDT) – also continues to be the subject of research. A Nigerian study [5] asked people whether, if they were ill, they would pay to be tested with an RDT. The majority said they would do so and, on average, the amount they were prepared to pay was greater than the current cost of an RDT in Nigeria (about $1.25). Nevertheless, the study’s findings indicate that many people would not be willing (or could not afford) to be tested. It is therefore important that testing should be available free of charge. Further research in Tanzania [6] suggests that the introduction of RDTs could cut health care costs; malaria is considerably over-diagnosed and many antimalarials are given to patients who do not need them. (Tanzania is, by the way, one country where anti-malaria programmes are being significantly stepped up [7]).

But programmes to treat and control malaria must be integrated with those for other infectious diseases. It is good to hear of new funding that will enable the Malaria Consortium [8] to demonstrate how government-led integrated community case management programmes (iCCM) can be scaled up, so that more children with malaria, pneumonia and diarrhoeal diseases receive appropriate treatment.

A worrying story relating to the epidemiology of malaria has also been in the news during the last few days. It has become commonplace in the debate on climate change - which is likely to increase cases of many infectious diseases - to cite the rise of malaria in the East Africa highlands in order to demonstrate that global warming has already had such an impact. But where is the evidence that malaria has become more common in this part of Africa? When the UK government’s Department for International Development (DFID) issued a statement referring to the increase, an environmental campaigner asked to see the research on which the claim was based [9]. What he was sent was certainly not convincing. The need for reliable evidence on the prevalence of malaria has thus, once more, been underlined.

Also in TropIKA.net
News on other infectious diseases of poverty also appearing on TropIKA.net within the last few days has included an analysis of the funding provided for tuberculosis research worldwide [10] – it is growing but is still nowhere near the level that is required. It has also been demonstrated in a new study [11] that individuals with a low birth weight are particularly susceptible to TB.

Recent months have seen major outbreaks of cholera across Africa for reasons that are by no means clear. A new surveillance programme [12] is therefore a welcome development.

Leptospirosis is an important zoonosis (a disease of animals that can spread to people) in many countries but rarely receives attention from researchers. A study in India [13] suggests that the disease in people is spreading northwards.

And a TropIKA.net opinion article [14] looks at WHO’s response to the appearance of H1N1 (“swine”) flu. This infection seemed likely to pose greater dangers for people living in the world’s poorest countries. Did WHO exaggerate the threat or was it correct to err on the side of caution?

Paul Chinnock
Editor, TropIKA.net

Once again, the TropIKA.net team has been out and about. We have provided in-depth coverage of Forum 2009, the latest conference of the Global Forum for Health Research (GFHR) held in Cuba. Highlights from our in-depth reports include interviews with Anthony Mbewu, President of the Medical Research Council, South Africa and next Executive Director of GFHR. He described his plans for moving the global health research agenda forward and also the steps now being taken to establish a biotechnology platform in South Africa.

Also interviewed was Carlos Morel, Director of the Center for Technological Development in Health at Fiocruz, Brazil. He discussed the difficulties in transferring innovations in health technology developed in one part of the South to other countries, where circumstances may be very different.

Forum 2009 made it possible for delegates to exchange their sometimes very different views on innovative approaches to health. For example a session on digital health care in rural India led to some lively exchanges.

Testing the tests

Rapid diagnostic tests (RDTs) will, it is hoped, play a major part in advancing efforts towards the elimination of malaria. The successful management of other infectious diseases of poverty would also benefit from the development of simple, affordable tests that can be used on the front line of care. However, such tests must themselves be tested for their accuracy and, when tests are tested, rigour is required both in the conduct of the work involved and in its reporting. It is therefore disturbing to read the findings of a review evaluating the quality and reporting of diagnostic accuracy studies in TB, HIV and malaria. It would appear that the required rigour has been lacking in much of the testing so far conducted. This does of course raise again the question of how much we can depend on the RDTs themselves.

The dependability of the drug supply has for many years been a topic of great concern – a large proportion of the drugs available in developing countries are faked or substandard. It is good news that efforts to control counterfeiting are to receive a boost with new support from USAID.

For some neglected infections, the drugs that are really needed do not yet exist. This is particularly the case for the three kinetoplastid diseases: Chagas disease, human African trypanosomiasis and leishmaniasis. The Drugs for Neglected Diseases initiative (DNDi) continues its remarkable work in the search for new treatments and a few days ago announced a collaboration with drug giant Pfizer, which will allow screening of its library of compounds to identify any that may have potential for use against these three diseases.

Other new developments also featured on TropIKA.net include Brazilian research demonstrating that the movement of people may be more important than previously thought in the transmission of dengue fever; the findings suggest that the disease is often transmitted outside the home, for example at school or in public spaces. And from Nigeria there is worrying news that the savannah-dwelling blackflies that transmit blinding onchocerciasis are becoming more common in the southwest of the country. Meanwhile, from southeast Asia comes the unwelcome, though predictable, news that resistance to the key antimalarial artemisinin has now spread from the Cambodia–Thailand border to China, Myanmar and Vietnam.

Facilitating communication between professionals seeking to address the infectious diseases of poverty is at the centre of our efforts on TropIKA.net and we are well aware of the dominance of English as the medium in which most communication on global health takes place. We welcome the news that the Portuguese-speaking health community will benefit from a newly launched email forum.

Paul Chinnock
Editor, TropIKA.net

The infectious diseases of poverty exact a massive burden on the populations of Asia and Africa, but their impact in the Americas is often forgotten. (The extent of this neglect was made clear in a research article published a year ago in PLoS Neglected Tropical Diseases).

It is therefore encouraging to learn that the Inter-American Development Bank and the Global Network for Neglected Tropical Diseases intend to mobilize $30 million from the public and private sectors to raise awareness and funding for the control and elimination of neglected tropical diseases (NTDs) in the region – see TropIKA.net Blog. We also report in TropIKA.net News of new efforts to eliminate malaria and filariasis from the Americas.

Meanwhile, the Drugs for Neglected Diseases initiative has announced that it has established a cooperative agreement with a pharmaceutical company for the clinical development of a drug that has been shown in lab tests to have activity against Trypanosma cruzi, the pathogen responsible for Chagas disease. This disease is confined to the Americans and kills at least 200,000 people every year. There is no vaccine and no specific treatment. Control of the disease vectors (triatomine bugs) remains the main focus of efforts to fight the disease and findings reported in a new research article will help guide control programmes in deciding when it is best to spray insecticide.

Oceania is another part of the world where infectious diseases remain an important cause of ill-health but receive little attention from the international media. Nevertheless, efforts are being pursued to control or eliminate these conditions and it is heartening to read a recent report of major successes achieved against malaria in Vanuatu and Solomon Islands.

TropIKA.net continues to highlight and comment upon new research findings, wherever the studies have been conducted. Our recent selections have included an important step forward in understanding how the parasite responsible for leishmaniasis establishes itself in its human host, a prevalence study that confirms the return of yaws to the Democratic Republic of Congo, and a study from China which examines the factors explaining why so many tuberculosis patients fail to complete their course of treatment. An Ethiopian study provides an illustration of the poor performance that is often seen in TB programmes, thus demonstrating the importance of monitoring and evaluation.

The TropIKA.net team cannot, of course, identify all the new reports of research into the infectious disease of poverty that are of particular significance. We need the help of our readers. If a new paper strikes you as being of exceptional importance, let us know about it.

One piece of good news is that an increasing amount of research is being conducted in developing countries. There has been an encouraging rise in the number of researchers in these countries, which doubled in a five-year period according to a report from the UNESCO Institute for Statistics. There is still of course a long way to go for the South to catch up. One initiative that should further speed up progress is the African Network for Drugs and Diagnostics Innovation (ANDI). The network aims to increase new health products developed in Africa by Africans. The ANDI 2009 meeting, which took place in South Africa this month, received in-depth coverage on TropIKA.net.

But sometimes the problem is not a lack of basic research. We highlight an opinion article which argues that the lack of progress against schistosomiasis in Africa represents one of this decade’s greatest failures. Cheap and effective treatments already exist for this disease, the second most common parasitic condition after malaria, but only 5% of Africans who need treatment actually receive it. Progress against the infectious diseases of poverty requires that the needs of neglected people should be met, in whichever part of the world they may live.

Paul Chinnock
Editor, TropIKA.net

How many research papers have we all read that conclude with a statement that further progress against an infectious disease, while technically possible, is hampered by a lack of “political commitment”?

African presidents, in common with heads of state in other parts of the world, have varied in their level of commitment to the welfare of their people and in their position on the proportion of the national budget that should be devoted to health care. The creation of the African Leaders Malaria Alliance (see TropIKA.net News) must therefore be welcomed. ALMA is the first alliance at head-of-state level to combat the disease and has the potential both to improve the efficiency of control efforts, through international cooperation, and to mobilize national populations to work towards the elimination of malaria.

But commitments made by politicians are not always honoured. African presidents have previously pledged to spend 15% of their budgets on healthcare but few have delivered. Western leaders have also in many cases failed to provide the full level of development support that they have promised. Given the continuing global economic difficulties, there may be disappointments ahead. But malaria must surely be regarded as a special case. The disease burden is so great and the prospects for progress towards elimination are so much better than ever before that, if ever there were a time for commitments to be honoured, it must surely be now.

Meningitis also claims many lives in Africa. The latest of our TropIKA.net Profile articles features an interview with Marc LaForce, head of the Meningitis Vaccination Project. He describes how, once the final few hurdles have been cleared, a new vaccine designed specifically for Africa will become widely available.

Buruli ulcer (BU) is one of the most severely neglected of all the infectious diseases of poverty, but there have been modest increases in the funding available for research into this dreadful condition. We report on new genomic research on BU and on a planned study that should advance knowledge on the BU disease reservoir.

One way we can increase the attention paid to neglected conditions is to feature them in the media, but this has to be done in the right way – accurately and without scaremongering. Pakistan is one of many countries where the media has rightly highlighted the steady advance of dengue fever, but in such a way that a dengue diagnosis is now often interpreted by patients as being a death sentence. (The case fatality rate with dengue is of course very, very small.) Somehow a balance must be struck by the media to create sufficient public concern to prompt preventive action, without leading to widespread panic.

The TropIKA.net blog seeks to highlight items in the news that you may have missed. In recent days, these have ranged from the bizarre to the tragic. Some South African TB patients are reported to be selling their sputum to healthy people, who use it to fake a diagnosis of the disease and to be awarded a disability grant. In Papua New Guinea, which is experiencing its first cholera epidemic on record, fear of the disease is such that patients are said have been left to die at the side of the road, as no one is willing to take them to hospital.

For progress to be made against the infectious diseases of poverty we need, not only commitment, but also a better understanding - at all levels - of the true nature of the dangers they pose.

Paul Chinnock
Editor, TropIKA.net

In the English-speaking parts of the northern hemisphere, the time of the year around August when many of the working population are on holiday is known to the media as “the silly season”. There is a lack of hard news to report and much of what gets published is of a trivial nature.

Infectious diseases do not, however, take a holiday. The world’s poorest countries continue to suffer from the ravages of many infections. As we have reported on TropIKA.net, in Zimbabwe one of the worst cholera epidemics of recent years appears to be over but several other African countries, including Ethiopia and Kenya, are still coping with epidemic cholera. Zimbabwe itself may face a return of the disease in the forthcoming rainy season.

Dengue fever continues to wreak havoc in many parts of the tropics; a report from an expert group in the Philippines concludes that many cases are treated inappropriately. The impact that swine flu will have in developing countries is not yet clear.

TropIKA.net News has reported over the last few weeks on a number of initiatives to tackle the infectious diseases of poverty. Diagnosis is generally a neglected area, receiving less attention than prevention and treatment. However, the Stop TB Partnership’s New Diagnostics Working Group has launched new web resource called Evidence-based Tuberculosis Diagnosis. Also several African nations are drawing up plans to revamp their laboratories to qualify for World Health Organization laboratory accreditation under a new scheme designed specifically for developing countries.

There has been formal publication of data confirming the emergence of resistance to artemisinin - the drug that is the now the recommended treatment for malaria. A major international effort is already under way to combat this new public health crisis. The use of insecticide-treated bednets is another cornerstone of malaria control programmes and massive net distribution programmes now exist in many countries, but a recent study shows that many of the nets distributed are not used by the families who receive them.

More encouraging news includes advances in the understanding of how the parasite responsible for leishmaniasis manages to evade the human immune system so successfully. Leishmaniasis receives woefully inadequate attention and progress of this kind is to be welcomed. We also report that a new Chinese drug could be used to kill parasitic intestinal worms in regions where parasites are developing resistance to the widely used deworming drug albendazole. And efforts to develop a new tuberculosis vaccine will be stepped up thanks to new funding.

TropIKA.net’s Funding section includes details of opportunities that have come to our attention. Silly season or not, several new grants have become available in the last few weeks.

Every few days there seems to be an announcement of the launch of a new programme or a new organization that seeks to address in some way the infectious diseases of poverty. When one considers the previous neglect of the disease burden in the world’s poorest countries, new initiatives are to be welcomed. One result, however, is that the so-called “institutional landscape” of global health is growing ever more complicated.

A study in the Lancet, highlighted on TropIKA.net analysed the flow of funding for global health programmes and one of its findings was that the role of the UN system has been diluted in recent years, since the launch of new programmes and agencies. An accompanying editorial asked, “Who runs global health?” The same study confirmed the dominance of HIV/AIDS, malaria and tuberculosis in the funding provided for global health, and another Lancet study bears out the view that big programmes focusing on these diseases can harm the ability of health systems to provide comprehensive health care. There is cause for concern that the proliferation of agencies and programmes, each with their own agenda, may have harms as well as benefits. Are there now too many institutions in the landscape?

Could there also be too many conferences? There are numerous TB conferences and when the annual Pacific Health Summit also chose to focus this year on drug-resistant TB one delegate told the meeting that she was tired of attending expensive gatherings hearing the same people say the same things – see TropIKA.net News. The organizers of this event did have a specific aim in mind – to get industry more involved in efforts to beat drug resistance and – while phrases like “stakeholder engagement” seem to many of us to be the worst sort of jargon – the activity they describe is important and international meetings are a part of the process. That said, many will have sympathy with the view that the global health conference circuit is getting out of hand.

Does it all lead to advances in research, and to progress in the control and treatment of diseases on the front line of health care? There has certainly been no shortage of progress for us to report on TropIKA.net in recent days. There has been media interest in the continuing phase 3 trials of the most advanced vaccine under development for malaria, RTS,S. The development of further malaria vaccines may be assisted by the resources for immunologists made available by the US National Institute of Allergy and Infectious Diseases on the new website of its malaria research programme. Meanwhile, a dengue candidate vaccine is soon to enter a phase 1 trial. The TB Alliance will provide support for the further development of a promising new TB drug.

Vaccination against pneumococcal disease in developing countries has come a step closer with the announcement of a $1.5 billion “Advance Market Commitment” [8].

Reports from Ethiopia describe the successful integration of trachoma and malaria control campaigns. Community level action has been shown in a study to be effective in controlling the mosquito vector of dengue fever in Cuba, and from India there are encouraging reports of community level projects for TB. All this is a long way from complex institutional landscapes and expensive conferences. However, if constant new initiatives and meetings at a global level really are essential to progress on the front line, then we shall have to learn to live with them.

Paul Chinnock
Editor-in-Chief, TropIKA.net

A Chinese medical team expects to be able to announce soon that it has eliminated malaria from Mohéli, an island in the Indian Ocean. The team says its methods – mandatory mass drug administration using artemisinin combination therapy – would also be successful if used across Africa and globally, but the approach is not favoured by Western scientists. Will it lead to artemisinin resistance? Is it unethical? Is it only feasible in a small-island setting? It would be a pity if the experience gained in Mohéli were to be rejected entirely out of hand, and sadder still if a great divide were to open up in malaria elimination, between those who favour the currently accepted strategy and those opting for the new ideas put into practice by this Chinese team.

China itself has a malaria problem in parts of the country, although it is not on the scale faced by Africa. The Chinese government has announced that, using more conventional methods, it expects to be able to eliminate malaria as a public health problem by 2015.

New ideas on cholera are badly needed, given the current African epidemic (see our report on the situation in Mozambique) and the high case numbers still found in many parts of Asia. No one believes that the global threat of cholera can be resolved solely through the development and deployment of an effective vaccine; this is truly a disease of poverty and it will be with us as long as millions of people are denied the right to safe water and sanitation. Nevertheless, an effective vaccine would make a major contribution and the low effectiveness of cholera vaccines in the field has always been disappointing. A possible explanation comes from a study in Bangladesh which indicates that people infected with intestinal worms have a reduced response to V. cholerae. Deworming programmes, important in their own right, could become an important part of cholera prevention efforts. The study has been published at a time when a new cholera vaccine is about to be brought into use in India. This vaccine was found to be 70% effective in an Indian trial and its performance within a public health programme will be followed with great interest.

New threats require policy makers to act swiftly and appropriately. Health systems have so far responded too slowly to the worsening problem of drug-resistant forms of tuberculosis. It is thought that fewer than 5% of cases are detected and fewer than 3% are treated according to WHO standards. In Beijing a meeting of representatives of 27 countries facing a high burden of drug-resistant TB heard the current situation described as “potentially explosive”.

New information on Buruli ulcer is sadly in short supply. There is considerable public alarm in many countries regarding this dreadful condition but at a conference in Cotonou it emerged that there is still no clear understanding as to how it spreads or even how commonly it occurs.

Regular readers of my Editor’s choice blog will know that I like to conclude by highlighting a new success in disease control. The encouraging progress made against onchocerciasis in Guatemala is a suitable way for me to sign off, but the last word must belong to the readers TropIKA.net. We are an interactive platform so please use the ‘Leave a Reply’ function below in order to share your views on some of these new developments.

Paul Chinnock
Editor-in-Chief, TropIKA.net

What impact will the global economic decline have on the lives of the poor? Will it reduce the already inadequate funding for research and control programmes devoted to the infectious diseases of poverty?

Kofi Annan fears that it may indeed be the poor who suffer most and he calls for a “coordinated global stimulus” which will benefit the least developed countries. But there is simply less money around just now. No one can avoid the effects of the financial crisis – sadly not even the Gates Foundation, which plays such a crucial role in global efforts to eliminate infectious disease.

Infectious diseases add of course to the economic burdens faced by developing nations. Nevertheless, it is hard to quantify their impact. TropIKA.net has recently published a summary of preliminary calculations made by the Indian Institute of Management, Ahmedabad seeking to calculate the economic cost of dengue fever. This comes at a time when there are indications that, in Asia, dengue may be more common than shown in official figures.

The prevalence and incidence of many other diseases may also be under-estimated. A recent survey suggests that India’s progress towards the elimination of leprosy may be less impressive than has been claimed. It is good to know therefore that a useful dialogue on issues related to leprosy still continues. Playing a part in this is the Leprosy Mailing List, one of the mailing lists featured in our Networking section.

It is not disputed that rates of tuberculosis are high in China but the consequences may be even more serious than recognised. A new study provides evidence that the infection increases the risk of lung cancer.

My selection of new content on TropIKA.net does seem to have focused on the bad news this time around, so let me finish with a positive research finding – chloroquine, once the mainstay of malaria treatment, has been found to be active against two emerging threats to health, the Nipah and Hendra viruses. This is a drug which should not be consigned to history. At a time like this we need some old friends around us!

Paul Chinnock
Editor-in-Chief, TropIKA.net