Writing in PLoS Neglected Tropical Diseases, Peter Hotez, President of the Sabin Vaccine Institute and Distinguished Research Professor of The George Washington University Medical Center, and Bernard Pecoul, Executive Director of Drugs for Neglected Diseases initiative (DNDi), outline in eight points why the global community should increase financial support for NTD control and elimination efforts and research and development.

The manifesto states that:

·      All NTDs are “tool ready” with cost-efficient and effective interventions that could be implemented now, even if for some diseases such tools are far from being perfect or complete.

·      At the same time that NTDs are tool ready they are also tool deficient, signifying that the tools are incomplete, or inadequate, to sustain elimination efforts.

·      NTDs have received little attention from the international community during the past ten years despite their large disease burden.

·      Increasing evidence indicates an association between NTD prevalence and conflict and violation of human rights.

·      NTDs can be particularly destabilizing and disrupt agricultural productivity and food security. Many poor societies with high NTD burdens have been recently engaged in a civil or international conflict or are currently at war.

·      Sustained involvement by the WHO and other international health agencies is crucial for current and future NTD control and elimination efforts.

·      Nothing is more important to the success of global NTD control than the involvement of communities themselves and disease-endemic countries’ health ministries.

·      Achievement of Millennium Development Goal 8 (”develop a global partnership for development”) will rest with stakeholders — health ministries, affected communities, public–private partnerships, large and small non-governmental organizations, etc. — establishing a well-functioning international strategy for NTD control.

While acknowledging that policymakers are “slowly beginning to appreciate the importance of NTDs” — evidenced by the creation of a new department of Neglected Tropical Diseases at the World Health Organization; TDR’s 10-year strategic plan; and the identification, by NIH’s Francis Collins, of neglected diseases as a research priority, among other developments — Hotez and Pecoul argue that the challenge of NTDs calls for a manifesto — “a public declaration of motives by a government or by a person or group regarded as having some public importance.”

Moreover, they add, by doing more to tackle NTDs, the global health community can make progress toward Millennium Development Goals.

“[NTD control] activities have facilitated the delivery of additional interventions such as insecticide-treated bed nets, antimalarial drugs, micronutrients, and childhood immunizations,” they write.

The authors urge scientists working on NTDs to increase collaboration and identify funding opportunities and cost-efficient interventions.

“By highlighting important challenges in the fight against NTDs, this ‘manifesto’ calls on the global community for urgent, renewed, and innovative efforts.”

There were concerns that the women might not continue with the practice in the longer term. A follow-up study [2] now reports that, five years later, 31% of the women continued to filter their water, of whom 60% used a sari. Additionally, the researchers found that 26% of women in a control group, who did not receive any education or training in the first study, also filtered their water. Filtration has clearly impressed not only many of the women who were trained but also a good number of their neighbours.

Nevertheless, it is clear that without a continuing programme to promote the use of ’sari filtration’, many women will abandon the practice. The researchers looked at the incidence of cholera in households during the five-year follow-up period; the incidence of hospitalizations for cholera during the period reduced by 25% but this decline was not statistically significant.

The mechanism through which sari cloth seems to filter out Vibrio cholerae bacteria is likely to depend on the removal of particulate matter and zooplankton with which V. cholerae is associated.

The follow-up study appears in mBio, a new open access online journal published by the American Society for Microbiology. A summary also appears on the Society’s website.

Reference
1. Colwell R, Huq A, Islam M, Aziz K, Yunus M, Khan N, Mahmud A, Sack R, Nair G, Chakraborti J, Sack D, Russek-Cohen E (2003). Reduction of cholera in Bangladesh villages by simple filtration. Proc Natl Acad Sci USA; 100:1051-1055.
2. Huq A, Yunus M, Sohel SS, Bhuiya A, Emch M, Luby S, Russek-Cohen E, Nair B, Sack RB, Colwell R (2010). Simple Sari Cloth Filtration of Water Is Sustainable and Continues To Protect Villagers from Cholera in Matlab, Bangladesh. mBio; 1(1):e00034-10. Available from: http://mbio.asm.org/content/1/1/e00034-10.full?sid=fa50f8ec-e969-40b1-b30e-4c2710039a72

Reference
1. Spiegel JM, Dharamsi S, Wasan KM, Yassi A, Singer B, et al. (2010) Which New Approaches to Tackling Neglected Tropical Diseases Show Promise? PLoS Med 7(5): e1000255. Available from: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000255

In 1971, during a cholera outbreak in West Bengal among refugees of the Bangladesh “War of Liberation”, ORS proved itself a highly effective intervention, slashing the death rate from 50% to 3% of those infected. The article discusses the International Centre for Diarrhoeal Diseases Research (ICDDR,B) located in Dhaka, Bangladesh. Founded in 1978, ICDDR,B has trained more than 27,000 health professionals from more than 78 countries in the control of diarrhoeal diseases, epidemiology, biostatistics, family planning, demographic surveillance and child survival strategies. Current ICDDR,B projects encompass a broad range of issues, including child health and nutrition, HIV/AIDS and chronic and infectious diseases.

In collaboration with Massachusetts General Hospital (MGH) in the US, ICDDR,B clinical researchers are investigating the differences between naturally-acquired immunity from infection with cholera and immunity conferred by vaccination in the hopes that findings will lead to a vaccine protective for longer than those currently on the market. A recent article in Mass General Magazine describes the collaborative effort in detail, tracing it from its origins in the mid-1990s to the present day.

Victor Golpak, the government’s national response coordinator for cholera says that only a few cases are now being seen each week. He noted the importance of the assistance provided by international agencies in bringing the disease under control.

Nevertheless, 58% of PNG’s six million inhabitants still lack access to safe drinking water and experts have cautioned that until this situation is addressed the country will be at risk of further outbreaks.

The vaccine has been developed by the Institute for Microbial Technology, Chandigarh, and National Institute of Cholera and Enteric Diseases, Kolkata. Phase III trials of the vaccine are planned and the DBT believes that it could be available for use before the end of 2010.

AMP and the African Field Epidemiology Network (AFENET) will be the core members of the consortium, which will also include several other leading health organizations from around the world. AMP will expand cholera surveillance by actively mobilizing regional and international organizations. AFENET will be responsible for overseeing project implementation in several countries.

“AMP will rely on its extensive global network to bring to the table the most important organizations working on cholera prevention in resource-poor settings,” said Alfred da Silva, executive director of AMP. “It is only through such a collective effort that we will be able to establish the true burden of disease in sub-Saharan Africa.”

Further details are available in an AMP press release.

APM has also recently received a Gates grant to improve advocacy for vaccines and immunization systems in West Africa (press release).

Agence de Medecine Preventive
The Agency for Preventive Medicine is a nonprofit organization that aims to improve the quality of health service delivery in developing countries. It describes its mission as follows:
• to contribute to the analysis of the health problems of developing countries through operational and scientific research
• to participate in scientific and technical programmes based on the results of action research
• to collaborate with developing countries, research institutions and international organizations for effective implementation of recommendations
• to strengthening country capacity in health activities for the population, particularly mothers and children.

As survivors succumb to thirst and dehydration, they’ll likely turn to water distribution systems that have been compromised by the damage to infrastructure and the lack of sanitation in crowded camps. That can lead to massive outbreaks of water-borne diseases like cholera, a disease capable of ravaging refugee camps in a matter of hours. In the wake of the 1994 Rwandan genocide, for example, cholera killed some 45,000 people in less than three weeks.

Among the organizations responding to the crisis is the Haiti-based Deep Springs International (DSI). In collaboration with the US Centers for Disease Control and Prevention (CDC), DSI is working to develop an immediate implementation plan to respond to the country’s myriad clean water needs. DSI President and in-country director, Michael Ritter is based in Baudin, 30 miles southwest of Port-au-Prince, and is in contact with CDC’s Daniele Lantagne, a leading expert in diarrheal diseases.

To learn more about what Deep Springs International does, visit their site. Updates will follow as they become available.

The group plans to step up its activities against neglected infections, including Chagas disease, Buruli ulcer, cholera, dengue fever, sleeping sickness, lymphatic filariasis, trachoma and soil-transmitted helminths.

Information is also available on the MAP International website.

Tests are still being conducted to confirm that the disease is indeed cholera. Health promotion activities on cholera are also being stepped up in the Mukuru Kwa Njenga slum. Other reports say that unlicensed water sellers are being blamed for spreading the infection. The slum is served by several companies which supply water from tankers.

According to a report from Edie (Environmental Data Interactive Exchange), “While selling water is a tightly-regulated business in the city, with vendors required to apply for permits from the Nairobi City Water and Sewerage Company (NCWSC), many sidestep the rules as there is a market for cheaper, untested water”.

The Daily Nation says there have been nearly 4,000 cases and some 120 deaths from cholera since the epidemic began in December last year.