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.”

The report comes from the Pacific nation of Vanuatu, where the disease had been thought to have been eradicated. Tests by researchers have, however, indicated that it is once again present, though perhaps in a milder form than previously. The authors of the study suggest that use of oral azithromycin to treat cases would be appropriate, as such treatment could easily be incorporated into primary health care activities.

Reference
1. Fegan D, Glennon MJ, Thami Y, Pakoa G (2010). Resurgence of yaws in Tanna, Vanuatu: time for a new approach? Trop Doct; 40(2):68-69.

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 Viet Nam success was achieved through introduction of the non-indigenous predatory crustacean Mesocyclops, which reduced mosquito numbers by 80-90%. It is claimed that the 90,000 inhabitants of the 12 communes where Mesocyclops was introduced no longer face any risk of dengue infection. Some 100,000 Vietnamese people live in other parts of the country where the risk remains.

AusAID, the Australian government’s development agency, believes that introduction of Mesocyclops and the use of a community-based approach could also be effective in other dengue-endemic areas across the tropical world.

Meanwhile, news reports continue to suggest that 2010 will be a bad year for dengue case numbers. Some Central American and Caribbean countries have declared epidemics, which is unusual for this time of year, according to a report from the Center for Infectious Disease Research and Policy, USA.

The Asia Pacific Malaria Elimination Network (APMEN) commemorates the third World Malaria Day, on April 25th, 2010, with the launch of the APMEN Fellowship Program. The Asia Pacific Malaria Elimination Network brings together ten founding countries in the Asia Pacific region who are working to eliminate malaria.

The APMEN Fellowship Program aims to help to equip the next generation of leaders and health workers from the Asia Pacific region with the tools and training to guide malaria elimination in the critical coming decades. The Fellowships will strengthen the exchanges and lesson sharing among APMEN Country Malaria Control Programs and research institutions in the region. Up to five Fellows from the ten APMEN partner countries will be selected each year for one to three month, short-term training opportunities with a partner country malaria program or institution.

Malaria elimination in the Asia Pacific will require a multi-pronged strategy involving diverse interventions and numerous communities, organizations, companies and governments. A commentary in the Lancet, to be released April 24th, describes the role of APMEN in the region’s efforts toward malaria elimination, highlighting the special challenge of Plasmodium vivax in the region.

Further information regarding APMEN, the Fellowship Program, and the Lancet commentary can be viewed at apmen.org.

Professor Cowman believes that there is one protein that “decides” how all of these proteins are to be exported. He hopes that this protein - plasmepsin V - will turn out to be the Achilles heel of malaria and that a new type of malaria drug can be developed that works by targeting plasmepsin V.

The study appears in Nature in the same issue as a paper by US malaria researchers who report [2] they have found more than two dozen smell receptors in the malaria-transmitting mosquito Anopheles gambiae that enables the insect to home in on human sweat. They believe that some of the receptors “could be excellent targets” for chemicals to snare mosquitoes or repel them,

References
1. Boddey JA, Hodder AN, Günther S, Gilson PR, Patsiouras H, Kapp EA, Pearce JA, de Koning-Ward TF, Simpson RJ, Crabb BS, Cowman AF (2010). An aspartyl protease directs malaria effector proteins to the host cell. Nature; 463(7281):627-631.
2. Carey AF, Wang G, Su CY, Zwiebel LJ, Carlson JR (2010). Odorant reception in the malaria mosquito Anopheles gambiae. Nature; Feb 3. [Epub ahead of print]

ICMR also intends to create a National Virology Network to monitor the outbreak of all viral diseases throughout India.

Chikungunya - viral disease, carried by Aedes aegypti mosquitoes - was first reported in the 1950s and in recent years has steadily become more common in Africa, Asia and the Pacific islands, with the first European cases seen in 2007. It has similar symptoms to dengue, making diagnosis difficult. The fever lasts only a few days but severe joint pains and fatigue can persist for many months. The disease has also recently been shown to cause severe blistering of the skin of infected children (1). No vaccine or specific treatment exists for Chikungunya. There are concerns that the increasing frequency of the infection will cause problems for blood transfusion services in many parts of the world (2), although improved blood tests are under development (3).

References

1. Robin S, Ramful D, Zettor J, Benhamou L, Jaffar-Bandjee MC, Rivière JP, Marichy J, Ezzedine K, Alessandri JL (2010). Severe bullous skin lesions associated with Chikungunya virus infection in small infants. Eur J Pediatr; 169(1):67-72.
2. Petersen LR, Stramer SL, Powers AM (2010). Chikungunya virus: possible impact on transfusion medicine. Transfus Med Rev. 2010 Jan;24(1):15-21.
3. Sharma S, Dash PK, Santhosh SR, Shukla J, Parida M, Lakshmana Rao PV (2010). Development of a Quantitative Competitive Reverse Transcription Polymerase Chain Reaction (QC-RT-PCR) for Detection and Quantitation of Chikungunya Virus.

It is necessary for at least three years to pass without notification of a case before WHO will certify a country as being guinea worm free. As recently reported on TropIKA.net, over a year has gone by since a case was seen in Nigeria. Neighbouring Niger is in a similar position. WHO considers that both nations have interrupted transmission and it is hoped that they are well on the way towards elimination of the disease.

Ethiopia, Ghana, Mali and Sudan are the four remaining ountries where transmission has yet to be interrupted.

Further details are available in a WHO press note.

The article says the reduction in case numbers is attributed to improved vector control (both the distribution of insecticide-treated bednets and house spraying), earlier case detection, and more readily available treatment.

The Secretariat of the Pacific Community’s public health programme manager, Dr Thierry Jubeau, says the two countries are now able to focus on eliminating the illness, rather than just controlling it.

A report from IRIN notes that 2009, an El Niño year, has seen the first recorded cases of cholera in Papua New Guinea, in addition to serious epidemics in Africa. (During the 1997-98 El Niño, a rise in sea surface temperature coupled with excessive flooding emerged as two significant factors in cholera epidemics in Bangladesh, Djibouti, Somalia, Kenya, Tanzania, and Mozambique.)

The IRIN article includes comments from several climate specialists includung US scientist Rita Colwell, who says: “My hypothesis, which we are in the process of testing, is that climate changes (sea surface temperature, sea surface height, rainfall, etc.) have influenced the cholera epidemics in East Africa, notably Mozambique.” She stresses that deterioration in the water purification and delivery in Zimbabwe was the main factor responsible for that country’s massive cholera outbreak but she believes that climate changes also had an influence.

An increasing number of studies are supporting the notion of a climate-cholera link. However, we must guard against any suggestion to the effect that “It’s all down to the climate, so there’s nothing we can do”. Poverty reduction efforts and water and sanitation projects must not be weakened. Dengue fever is another disease with a climate change link and here too it must be remembered that a bigger role is played by other factors, such as increased urbanisation and inadequate mosquito control.