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Chapt12Slides.pptxCommunicable Disease
Chapter 12
Chapter 12: Communicable Disease
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The Importance of Communicable Diseases
31% of the burden of disease in low- and middle-income countries and 40% of all DALYS.
Disproportionately affect the poor.
Enormous economic consequence.
Relevance to MDGs.
Burden of communicable disease is unnecessary, many can be prevented or treated.
| Disease | Mortality |
| HIV/AIDS | 1.5 million |
| TB | 1.5 million |
| Diarrhea | 800,000 |
| Malaria | 550,000 |
Communicable disease account for 31% of the disease burden in low and middle income countries. This burden is disproportionately high in Africa and in low income people. People with higher education are more likely to protect themselves from the disease in compare to low income and less educated people. The economic consequences of infectious diseases are high. In addition to the high cost of the treatment which forces people to live below the poverty level, it also has negative consequences of the economic growth of the country. This high burden of the disease in unnecessary because many of these condition could easily be prevented with low cost interventions like vaccinations.
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Key Terms, Definitions, and Concepts
Communicable diseases are the ones that are transmitted from human to human, animal to animal, and animal to human. They could be transmitted directly such as through inhalation or indirectly through a vector like mosquito. The control of communicable disease also depends on a number of factors. Among them are vaccination, vector control, improved sanitation, chemotherapy, disease recognition and improved care seeking, and behavioral change.
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Communicable disease- transmitted from animal to animal, animal to human, or human to human
Spread (direct and indirect) and contracted through food, water, bodily fluids, vector, inhalation, non-traumatic contact, and traumatic contact
Controlled with vaccination, mass chemotherapy, vector control, improved water and sanitation, improved care seeking and disease recognition, case management, and behavioral change
This table contains communicable disease key terms which we need to be familiar with as it relates to the discussion on communicable diseases.
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The Burden of Communicable Diseases
31% of total deaths, 40% of total DALYs lost annually in low- and middle-income countries
Relative importance compared to non-communicable diseases and injuries varies by region (refer to slide 6-7).
South Asia and sub-Saharan Africa have highest relative burden of deaths from communicable diseases.
Relative importance of specific communicable diseases varies by age, too.
In low and middle income countries, 36% of total deaths and 40% of total DALYs lost annually because of communicable diseases.
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Deaths from Selected Infections and Parasitic Diseases, as Percent of Total Deaths, by Region 2008
Source: http://vizhub.healthdata.org/gbd-compare / Accessed Jan 19 2016, .
South Asia and Sub-Saharan Africa shares the highest relative burden form communicable diseases.
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Cause of death by country
Source: http://vizhub.healthdata.org/gbd-compare/ Accessed Jan 19 2016, .
Here you can see the leading causes of death specific to several countries, as measured by gender per 100,000 DALYS.
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Leading Causes of Death in Low- and Middle-Income Countries by Broad Age Groups
Source: http://vizhub.healthdata.org/gbd-compare/ Accessed Jan 19 2016, .
However, the importance of communicable disease in global health in respect to non-communicable and injury related mortality and morbidity, varies across age groups.
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The Costs and Consequences of Communicable Diseases
Constrain health and development of children, having an effect on education and productivity.
Strong stigma and discrimination associated with HIV, TB, and others.
Limit productivity of adult workers.
Costs of treatment burden families.
High rates reduce investment in a country’s development.
The cost and consequences of communicable diseases are very high. It constrains health and development of children, having an effect on education and productivity. It is associated with strong stigma and discrimination associated with HIV, TB, and others. Communicable diseases limit productivity of adult workers and the costs of treatment burden families. Lastly, high rates reduce investment in a country’s development.
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(1) have not occurred in humans before (this type of emergence is difficult to establish and is probably rare);
(2) have occurred previously but affected only small numbers of people in isolated places (AIDS and Ebola hemorrhagic fever are examples); or
(3) have occurred throughout human history but have only recently been recognized as distinct diseases due to an infectious agent (Lyme disease and gastric ulcers are examples).
Question: Do you know what SARS and MERS stands for?
The Leading Burdens of Communicable Diseases
| Outbreak Year | Disease | Place |
| 1967 | Marburg | Germany & Yugoslavia |
| 1976 | Ebola | Zaire(Democratic Republic of Congo) |
| 1993 | Cryptosporidiasis | Milwaukee,US |
| 1993 | Hantavirus | New Mexico, Arizona, Colorado |
| 1996 | Mad Cow Disease | UK |
| 1997 | H5N1(avian influenza) | HongKong, China |
| 1999 | Nipah virus | Malaysia & Singapore |
| 2002 | SARS | China |
| 2012 | MERS | Arabian Peninsula |
Emerging Infectious Diseases
Global health has been threatened from time to time with the emerging of new infectious disease. The emerging infectious diseases are the ones that have not occurred in humans before (this type of emergence is difficult to establish and is probably rare); have occurred previously but affected only small numbers of people in isolated places (e.g. AIDS); or have occurred throughout human history but have only recently been recognized as distinct diseases due to an infectious agent (Lyme disease and gastric ulcers are examples).
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Are diseases that once were major health problems globally or in a particular country, and then declined dramatically, but are again becoming health problems for a significant proportion of the population (malaria and tuberculosis are examples).
They have spread to the places in which they had not appeared before .
Have taken on new forms.
The Leading Burdens of Communicable Diseases
| Year of Outbreak | Disease | Place |
| 1994 | Plague | India |
| 1997 | Cholera | Peru |
| 1998 | Rift Valley Fever | Ethiopia |
| 2003 | Human monkeypox | Texas , US |
| 2009 | Dengue | Florida, US |
| 2014 | Ebola | West Africa |
Re-emerging Infectious Diseases
Reemerging infectious disease are the ones that once were major health problems globally or in a particular country, and then declined dramatically, but are again becoming health problems for a significant proportion of the population (malaria and tuberculosis are examples) or they have spread to the places in which they had not appeared before and or have taken on new forms.
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The Burden of Emerging and Re-Emerging Infectious Diseases
Resistant forms of disease emerge or re-emerge when bacteria, parasites, and viruses are genetically altered.
Critical global health problems because they can arise anywhere, at anytime, and spread rapidly.
Drug resistance limits ability to treat infection.
Study findings 1940-2004
60% of the infectious diseases were related to Zoonoses.
23% were related to vector borne disease.
Emerging and reemerging infectious diseases are critical global health problem as they can happen anywhere anytime and can spread rapidly within and across countries. Diseases have emerged from the genetic alteration of the disease agents, from the increased drug resistance and due to a number of factors that we are going to see in next slides.
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Outbreak Example: SARS in 2003
Dr. KANUPRIYA CHATURVEDI
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This map is showing how SARS, an emerging disease, spread so quickly throughout the world.
SARS was first recognized at the end of February 2003 in Hanoi, Viet Nam. A middle-aged man business man who has traveled extensively in South-East Asia before becoming unwell, was admitted to hospital in Hanoi on 26 February 2003 with a high fever, dry cough, myalgia and mild sore throat. Over the following 4 days he developed symptoms of adult respiratory distress syndrome, requiring ventilator support, and severe thrombocytopenia. Despite intensive therapy he died on March 13 after being transferred to an isolation facility in Hong Kong SAR. On the basis of data from the SARS foci in Hanoi and Hong Kong SAR, the incubation period has been estimated to be 2.7 days, but usually 3.5 days. Attack rates of >56% among health care workers caring for patients with SARS is consistent in both the Hong Kong and Hanoi foci.
The table here listed some of the reasons that have contributed to the epidemics of emerging and reemerging diseases.
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Consequences of Emerging and Re-Emerging Infectious Diseases
Direct costs of treating disease.
Indirect costs include declines in tourism and trade.
Increased costs of treating a drug resistant case.
The cost of emerging and reemerging diseases could be enormous on the low and middle income countries. In addition to the direct cost of treating the disease which includes medicine and hospitalization, it leads to bigger economic consequences. For example, 1991 cholera epidemic in Peru lead a decline in the tourist business of that country that plays a major role in country’s economic sector. The plague in India in 1994 resulted major short-term decline in trade and commerce between India and rest of the world. For Mad cow disease, UK government had to kill many livestock in order to convince the world that beef would be safe in future.
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Addressing Emerging and Re-Emerging Infectious Diseases
Sensitive surveillance systems.
Rapid detection of new outbreaks.
Mechanisms for effective containment.
Willingness to share information with other countries.
To address the challenges of EID (emerging infectious disease) and re-EID national and international actions are very much required. Highly sensitive national surveillance systems and public health laboratories could identify the outbreaks in a timely manner. Proper sharing of the information by the affected countries will make the mechanics for containment easier.
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The Leading Burdens of Communicable Diseases
Future Challenges
Impact of economic crisis on governments’ ability to fund public health functions.
Rapidly evolving pathogens, population growth, climate change will increase number of emerging diseases.
Possibility of a major pandemic .
Accelerating drug resistance.
Limited number of anti-infective drugs being developed.
Though there is concern regarding the economic impact of government’s willingness or ability to fund public health functions to address the crisis, however, it is more profitable to fund programs that are capable of addressing the challenges of possible disease outbreaks because the economic burden of facing the outbreak will not be any less distress than the funded one. The challenges are perpetual one because of the rapidly changing pathogens, population growth, and the climate changes. All these trends are becoming worse by poverty, war, environmental degradation and raise the possibility of major pandemic.
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HIV/AIDS
The Burden of HIV/AIDS
Spread through unprotected sex, birth or breastfeeding, blood, or transplanted tissues.
Attacks the immune system, leaving the body susceptible to opportunistic infections.
Main routes of transmission vary by location.
Highest rates are in Central and Southern Africa.
The epidemic of this time attacks the human immune system. The time from becoming infected to getting diagnosed with HIV/AIDS vary from 1 year to 15 years. The efficacy of the transmission depends on various routes. Blood transfusion risk of HIV is significantly higher. Sharing needles also carries relatively higher risk. In case of sexual transmission, type of sexual act and the gender of the affected person plays role in determining the risk. The route of transmission varies by location too. In high income countries and Brazil the epidemic started among men who have sex with man. In Sub-Saharan Africa the diseases had started through having unprotected sex with those who are engaged in high risk behavior like having sex with commercial sex workers and having sex with multiple partner. In China the epidemic was centered in a group of people who received HIV infected transfusion of blood. In former Soviet Union the epidemic was being driven by injecting drug users who are HIV positive.
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Read about 10 facts on HIV: http://www.who.int/features/factfiles/hiv/facts/en/
HIV/AIDS remains one of the world's most significant public health challenges, particularly in low- and middle-income countries.
As a result of recent advances in access to antiretroviral therapy (ART), HIV-positive people now live longer and healthier lives. In addition, it has been confirmed that ART prevents onward transmission of HIV.
At the end of 2014, 14.9 million people were receiving ART worldwide; this represents 40% [37–45%] of the 36.9 million [34.3–41.4 million] people living with HIV.
Progress has also been made in preventing and eliminating mother-to-child transmission and keeping mothers alive. In 2014, a little over 7 out of 10 pregnant women living with HIV, or 1 070 000 women, received antiretrovirals (ARVs).
HIV/AIDS
There are 35 million people living with HIV/AIDS today.
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HIV/AIDS,
Cost and consequences
HIV has social and economic consequences. Its effects go beyond morbidity and mortality and affects almost each of the sector of life. In the absence of treatment, the infected person becomes sicker every day, progress to full blown AIDS and dies from opportunistic infections. The cost of treatment, longer hospital stay affects an individual’s income and at the same time the burden becomes heavy on government. As prevalence of disease go up , there is more demand for treatment, more usage of health service facility , increased demand for hospital bed which cumulatively account for significant expenditure for government. HIV infected person lose their job, or work with limited productivity that leads to limited family income. Since the expenditure for treatment become more and more, there is decreased spending for education or other basic necessities.
From the social perspective HIV is considered with stigma in low income countries as the believe that people acquire HIV through high risk behavior that society disapproves for instance injecting drug use, having sex with commercial sex workers. This stigma led to an unwillingness to allow people with HIV to attend school or to be employed, to get health care or to live in certain places.
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Cost of care
Longer hospital stay
In Sub Saharan Africa >50% hospital beds occupied with HIV related disease
Increased demand of care
Shortage of Beds
A full blown AIDS cannot work and become completely dependent on others for care
Decreased family income
Decreased spending on basic necessities, education
Create exceptional number of orphans
Decrease in school enrollment
Children become caretaker of those sick with HIV
Children in the workforce to make up for lost income
Decline life expectancy
Health sector /Direct Cost
Household Burden
Educational and social sector
Addressing the Burden of HIV/AIDS
Focus on prevention of new infections.
Successful efforts have included strong political leadership and open communication.
Approach to prevention must vary with nature of epidemic.
Efforts need to combine education and behavioral change, bio-medical approaches, and structural approaches.
VIDEO: HIV Treatment: Saving Lives, Preventing New Infections (5:27)
http:// www.cdc.gov/globalhealth/video/hiv_treatment/hiv_treatment.htm
VIDEO: Alicia Keys, Empowering women with HIV/AIDS (28:00)
https:// www.youtube.com/watch?v=5oF9nq8ykek
To address the burden of HIV/AIDS we need to focus on prevention of new infections. We need to find out the nature of epidemic whether it is concentrated one or generalized one and to design interventions accordingly. Approach to prevention must vary with nature of epidemic. Combination of approaches with different weight given on different activities depending on the nature of epidemic is crucial. Efforts need to combine education and behavioral change, bio-medical approaches, and structural approaches
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Critical Challenges in HIV/AIDS
Developing a vaccine to prevent the 1.5 million new infections per year.
Cost-effective approaches to prevention in different settings.
Universal treatment for all those who are eligible.
Management of TB and HIV co-infection.
HIV/AIDS faces a number of challenges. First, we are seeing the difficulty in finding a vaccine for HIV. Given that there are 1.5 million new infections every year, the importance of searching for a vaccine bears importance. Greater attention should be paid to prevent new infections. To learn about cost-effective approaches to prevention in different settings will have impact on incidence reduction. The effort to provide universal treatment for all those who are eligible should continue. Finally, the management of TB and HIV co infection is essential to face the HIV/AIDS challenge.
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Tuberculosis
11 million people living with TB.
Spread through aerosol droplets.
HIV dramatically increases chance of developing active TB.
Risk factors include living in crowded circumstances, undernutrition, inadequate health care.
Increase in multi-drug resistant cases.
11 million people are living with TB, caused by bacteria Mycobacterium tuberculosis. It spreads through aerosol droplets which is why living in a crowded environment with a TB infected person raises the risk for quick transmission. Other risk factors for TB include under-nutrition, inadequate health care, infection with HIV, weakened immune system. HIV dramatically increases chance of developing active TB. There is also increased incidence in multi-drug resistant cases.
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About one third of the world’s population is infected with tuberculosis (TB) bacteria. Only a small proportion of those infected will become sick with TB.
People with weakened immune systems have a much greater risk of falling ill from TB. A person living with HIV is about 26 to 31 times more likely to develop active TB.
The Millennium Development Goal to reverse the tuberculosis epidemic by 2015 has been achieved. The WHO End TB Strategy, adopted by the World Health Assembly in May 2014, is a blueprint for countries to end the TB epidemic by driving down TB deaths and TB incidence. It includes global impact targets to reduce TB deaths by 90% and to cut new cases by 80% between 2015 and 2030, and to ensure that no family is burdened with catastrophic costs due to TB.
Tuberculosis
Read about 10 facts on TB:
http://www.who.int/features/factfiles/tb_facts/en/
These are current facts relating to TB incidence in the world. Currently, there are 11 million people living with TB and 9 million new TB cases every year. There are 1.5 million deaths resulting from TB.
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The Costs and Consequences of TB
Costs to families, communities, and countries is very high.
Large number of people sick, long course of illness
Stigmatized condition.
Economic growth of a country inversely correlated with the rate of TB.
The costs of TB to families, communities, and countries are very high. Large number of people sick with TB, long course of illness and stigmatized condition make the disease a challenge for individual and for country’s health system. Several studies have shown that people who are infected with TB lost their wages, took debt to pay the care for TB, and spent significant amount of money in compare to national income per capita. Economic growth of a country inversely correlated with the rate of TB.
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Addressing the Burden of TB
Directly Observed Therapy, Short-Course (DOTS)
Political commitment to TB program.
Access to quality-assured sputum spears and microscopy.
Standardized regimens of directly observed chemotherapy.
Regular supply of TB drugs.
Monitoring and evaluation for program supervision.
The treatment strategy for TB is known as DOTS or Directly Observed Therapy, Short-Course (DOTS). It has five essential components which are:
Political commitment to TB program
Access to quality-assured sputum spears and microscopy
Standardized regimens of directly observed chemotherapy
Regular supply of TB drugs
Monitoring and evaluation for program supervision
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TB in the world
The map here shows TB distribution in the world with highest prevalence in Sub-Saharan Africa. More than half the new cases occur in South-East Asia and the Western Pacific. India accounts for about 24 percent of new cases. 60 percent of cases are among men.
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Management of TB/HIV Co-infection
TB is an opportunistic infection of HIV.
Leading cause of death of adults who are HIV-positive and not on antiretroviral therapy.
WHO recommends testing all HIV-positive people for TB, and all those with TB for HIV.
TB is an opportunistic infection of HIV. As the immune system of an HIV positive person decline, TB can develop specially people with latent TB infection. It is a leading cause of death of adults who are HIV-positive and not on antiretroviral therapy. WHO recommends testing all HIV-positive people for TB, and all those with TB for HIV.
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Challenges in TB Control
Need for more effective vaccines, inexpensive and rapid diagnostics, and drug therapy that will lessen duration of treatment.
Improving identification and treatment of MDR-TB and XDR-TB.
Linking providers of TB diagnosis and treatment with a national TB control program.
Even though we had progress in TB diagnostics, there is need for more effective vaccines, inexpensive and rapid diagnostics, and drug therapy that will lessen duration of treatment. In regions of Eastern Europe and Central Asia there is a large gap in diagnosis multidrug resistance TB (MDR-TB) and extended drug resistance TB (XDR-TB). Efforts need to address improving identification and treatment of MDR-TB and XDR-TB. A significant amount of TB diagnosis and treatment is carried out in the private sector that often does not follow the guidelines. There is an increased need for linking providers of TB diagnosis and treatment with a national TB control program.
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Malaria
2.2% of global DALYs lost annually.
10th leading cause of death in low- and middle-income countries.
Malaria is the leading cause of DALYs in sub-Saharan Africa in all age groups.
Caused by parasites carried from one person to another by Anopheles mosquito.
Pregnant women and fetuses are at high-risk of anemia and death from malaria.
Malaria is responsible for 2.2% of global DALYs lost annually . It is the 10th leading cause of death in low- and middle-income countries. Malaria is caused by parasites carried from one person to another by Anopheles mosquito. The most important risk factor for malaria is being bitten by mosquitos that carry malaria parasite. Pregnant women and fetuses are at high-risk of anemia and death from malaria. 45 million of pregnancies are occurred in malaria endemic countries like Africa and causes malaria related anemia in mother and low birth weight in babies.
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WHO report on malaria
Cases
214 million malaria cases reported worldwide in 2015
Incidence
37% global decrease in malaria incidence between 2000 and 2015
Mortality
60%decrease in global malaria mortality rates between 2000 and 2015
The WHO has the most recent numbers on malaria.
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The map here shows the condition of malaria worldwide
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Costs and Consequences of Malaria
Individuals often have malaria up to 5 times per year.
Indirect costs are greater than direct costs of treatment because due to lost days of work.
Roll Back Malaria suggests that economic costs in countries with a high burden are equal to 1.3% of GDP per year
Progress towards objectives: Azerbaijan and Sri Lanka reported 0 indigenous cases for the first time and 11 other countries maintained 0 cases.
| Cost to individual & families | Purchase of drugs Expense for travel to , and treatment at dispensaries and clinic, Lost days of work Absent from school Expense for preventive measure Expense for burial in case of death |
| Cost to Government | Maintenance of health facilities Purchase of drugs and supplies Public health interventions such as insecticide spraying or distribution of insecticide treated bed nets Lost opportunities for joint economic ventures and tourism |
| Direct Cost | Has been estimated to be at last US$12 billion/ year |
The cost of malaria is substantial because there are cases of reinfection frequently. Individuals lost work from malaria, loss school. There is also indirect cost of dealing with illness more than the direct cost of treatments and each episodes of malaria probably cost an adult 2% of his annual income.
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Cost of malaria
Available funds are unlikely to increase at the necessary pace to achieve the goals for malaria control and elimination proposed by the Roll Back Malaria.
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Addressing the Burden of Malaria
Prompt treatment of those infected.
Intermittent preventative therapy for pregnant women.
Long-lasting insecticide-treated bed nets for people living in malarial zones.
Indoor residual spraying of homes.
Getting artemisinin into use to delay advent of resistance.
VIDEO: Herbs and Empires: A Brief, Animated History of Malaria Drugs (2:45)
http:// www.npr.org/blogs/health/2012/12/13/167188333/herbs-and-empires-a-brief-animated-history-of-malaria-drugs
There is a widespread agreement on the key interventions for addressing the burden of malaria. The interventions include
Prompt treatment of those infected
Intermittent preventative therapy for pregnant women
Long-lasting insecticide-treated bed nets for people living in malarial zones
Indoor residual spraying of homes
Getting artemisinin into use to delay advent of resistance
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Challenges in Addressing Malaria
100% coverage for people at risk with bed nets, indoor residual spraying, and intermittent therapy for pregnant women.
Encouraging behavioral change to ensure bed nets are being used properly.
Bridging gaps in diagnosis and treatment.
Developing a safe, effective, affordable vaccine.
New drugs to keep up with drug resistance.
Interventions like 100% coverage for people at risk with bed nets, indoor residual spraying, and intermittent therapy for pregnant women have much significance in reducing malaria burden. It is also essential to encourage behavioral change to ensure bed nets are being used properly. There are substantial gaps in the diagnosis and treatment of malaria so bridging gaps in diagnosis and treatment is another step needs to be taken. Finally, the look out of for malaria vaccine should continue with the goals of developing a safe, effective, affordable vaccine. In addition, new drugs to keep up with drug resistance are critical given the speed with which malaria has developed resistance to the present drugs.
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Diarrheal Disease
The Burden of Diarrheal Disease
760,000 deaths in 2013.
Significant decline over past 30 years due to better nutrition, disease recognition, oral rehydration therapy.
Most significantly impacts the poor because of poor housing, lack of refrigeration, poor personal and community hygiene.
There were 760,000 deaths due to diarrheal disease in 2013. There has been significant decline over past 30 years due to better nutrition, disease recognition, and oral rehydration therapy. As we have discussed previously, this disease caused by bacteria, virus, and/or parasites that are transmitted by contaminated water or food through the fecal oral route. It can also spread through dirty utensils, dirty hands and flies. This disease most significantly impacts the poor because of poor housing, lack of refrigeration, poor personal and community hygiene.
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The map here lists 10 high diarrhea burden countries in the world, 2008.
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Addressing the Burden of Diarrhea
There are five major disease prevention strategies for diarrhea, which include promotion of exclusive breastfeeding for the first 6 months, improved complementary feeding, and introduced at 6 months, rotavirus immunization, measles immunization and access to clean water supply and sanitation. The case management interventions can significantly reduce the severity and mortality of diarrheal disease. The use of ORT is the most cost effective one especially if it is a home -made one. Zinc supplement during an acute diarrhea has proven to be effective. Antibiotic is given in the cases of bloody diarrhea that are caused by bacteria.
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Disease prevention strategies
Promotion of exclusive breastfeeding for the first 6 months
Case management interventions
Oral rehydration therapy
Improved complementary feeding, introduced at 6 months
Rotavirus immunization
Measles immunization
Access to clean water supply and sanitation
Zinc supplementation
Antibiotic
Neglected Tropical Diseases
The Burden of Neglected Tropical Diseases
More than 1 billion people infected with one or more of the NTDs.
Most common afflictions of world’s poorest people.
Impede child development, harm pregnant women, cause long-term debilitating illness.
More than 1 billion people,1/6th of world’s population infected with one or more of the NTDs. Thirteen diseases which are shown in next slide are called as neglected tropical diseases which affect world’s poorest population. NTDs have dire effects on health including impede child development, harm pregnant women, and causing long-term debilitating illness .
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NTD facts
General Fast Facts
One hundred percent of low-income countries are affected by at least five neglected tropical diseases simultaneously
Worldwide, 149 countries and territories are affected by at least one neglected tropical disease (NTD)
Neglected tropical diseases kill an estimated 534,000 people worldwide every year
NTDs are a major cause of disease burden, resulting in approximately 57 million years of life lost due to premature disability and death
Individuals are often afflicted with more than one parasite or infection
Treatment cost for most NTD mass drug administration programs is estimated at less than US fifty cents per person per year
Source: http://www.cdc.gov/globalhealth/ntd/fastfacts.html
NTD fast facts as reported by the CDC.
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Neglected Tropical Diseases, by ranking
Ascariasis
Trichuriasis
Hookworm infection
Schistosomiasis
Lymphatic filariasis
Onchocerciasis
Trachoma
Chagas disease
Leishmaniasis
Leprosy
Human African trypanosomiasis
Buruli ulcer
Dracunculiasis
The table here lists the major NTDS that are ranked by prevalence.
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Small amount of money could gain significant health in the battle against NTDs. The existing rapid impact package of four drugs is capable to treat seven or more NTDS. USAID and a number of organizations have coordinated to eliminate or control 10 NTDs by the end of the decade.
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A number of vectors are responsible for transmission of NTDs. To eliminate or to eradicate NTDs one of the goal is to eradicate the breeding places for the vectors. The pictures here show vectors that are spreading the diseases among affected population.
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Countries with Five or More Neglected Tropical Diseases
This map shows the distribution of NTDs around the world.
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The Consequences of the Neglected Tropical Diseases
Major impact on health including, but not limited to blindness, anemia, growth retardation, and permanent disability.
Increase susceptibility to other infectious diseases, people are often simultaneously infected with two or more diseases.
Social stigma.
Impact on productivity.
NTDs and poverty follow a cycle.
NTDs have major impact on health including, but not limited to blindness, anemia, growth retardation, and permanent disability. It increase susceptibility to other infectious diseases, people are often simultaneously infected with two or more diseases. NTDs coexist with poverty because they thrive where access to clean water and sanitation are limited and people live without protection from disease vectors. The NTDs also are recognized as a contributor to poverty since they can impair intellectual development in children, reduce school enrollment, and hinder economic productivity by limiting the ability of infected individuals to work Social stigma associated with disfigurement and disability result in individual being shunned by their families and communities. NTDs also has impact on productivity of individual in the form of missed work, missed school, drop out from school or poor school performance.
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Interventions addressing NTDs
Rapid-impact package of drugs for the seven most common NTDs.
Guinea worm- teaching people to filter water.
Trachoma- SAFE strategy.
Lymphatic filariasis- annual administration of donated drugs.
Periodic de-worming of young children.
Considerable progress has been achieved in NTDs. Onchocerciasis has been eliminated from 10 countries in West Africa. Guinea worm is nearing eradication through efforts that focused on health education and teaching people to filter their water through finely woven cloth. To combat Trachoma WHO had developed a strategy known as SAFE through which world’s trachoma incidence has declined significantly. Lymphatic filariais has been controlled in China, Thailand, Sri Lanka, Suriname and Solomon Islands. Periodic deworming of the children is considered as a best buy in global health since it is the single most cost effective means to improve school attendance, cognitive skills and higher productivity among adults.
These photos show community members in line to receive drugs during a mass drug administration (MDA) in Mali and a young boy during a free de-worming from Nandir Williams, during a campaign program for under-five-year-olds organized by Global Medical Missions in Zarazon, Nigeria.
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Future Challenges
Hookworm and schistosomiasis vaccine.
Develop new drugs to combat the NTDs more effectively and combat resistance.
Introduce underlying risks such as hygiene, unsafe water supply, worm and parasite breeding sites.
It is important to invest in technologies that could help to address NTDs in more effective ways. There is work underway to produce vaccines for Hookworm and schistosomiasis. It is also critical to develop new drugs to combat the NTDs more effectively and combat resistance. At the same time we need to address some underlying risk associated with NTDs that are prevalent in poor communities. Unsanitary living conditions as inadequate hygiene, unsafe water supply, worm and parasite breeding sites are some important issue that communities to need to understand and work together to improve the situation to reduce the morbidity burden of NTDs.
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Ebola
Key facts
Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in West Africa has involved major urban as well as rural areas.
Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.
Early supportive care with rehydration, symptomatic treatment improves survival. There is as yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation.
Source: http://www.who.int/mediacentre/factsheets/fs103/en/
Case fatality of Ebola has been as high as 90% and can occur rapidly, from 2 to 21 days.
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Ebola control
Controlling infection in health-care settings:
Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.
Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).
Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Ebola infection should be handled by trained staff and processed in suitably equipped laboratories.
Source: http://www.who.int/mediacentre/factsheets/fs103/en/
Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.
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Future Challenges to the Control of Communicable Diseases
Continued cooperation in and among countries to combat infectious diseases.
Strengthening health systems in low- and middle-income countries.
Sustained political and financial support.
Strengthening surveillance at local, national and global levels.
Adequately trained and appropriately deployed human resources.
Reaching a balance between prevention and treatment.
Technical challenges including new vaccines, treatment and diagnostics.
To address the challenges of communicable disease as a whole there is a number of challenges still remain. It is critical to continue cooperation in and among countries to combat infectious diseases. As low and middle income countries share the burden of communicable diseases more, it is important to strengthening health systems in low- and middle-income countries. Some other area that are of importance to address the challenges are to have sustained political and financial support, to strengthening surveillance at local, national and global levels, to adequately trained and appropriately deployed human resources, and to reaching a balance between prevention and treatment. Some of the technical challenges including new vaccines, treatment and diagnostics are also issues of concern in global health.
This photo shows a Ugandan family in who benefits from USAID’s support for NTD control.
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SARS Cases 19 Februaryto5 July 2003China (5326)Singapore (206)Hong Kong (1755)Viet Nam (63)Europe:10 countries (38)Thailand (9)Brazil (3)Malaysia (5)South Africa (Canada (243)USA (72)Colombia (1)Kuwait (1)South Africa (1)Korea Rep. (3)Macao (1)Philippines (14)Indonesia (2)Mongolia (9)India (3)Australia (5)New Zealand (1)Taiwan (698)Mongolia (9)Russian Fed. (1)Total: 8,439 cases, 812 deaths,30 countries in 7-8 months Source: www.who.int.csr/sars
SARS Cases
19 February to 5 July 2003
China (5326)
Singapore (206)
Hong Kong (1755)
Viet Nam (63)
Europe:
10 countries (38)
Thailand (9)
Brazil (3)
Malaysia (5)
South Africa (
Canada (243)
USA (72)
Colombia (1)
Kuwait (1)
South Africa (1)
Korea Rep. (3)
Macao (1)
Philippines (14)
Indonesia (2)
Mongolia (9)
India (3)
Australia (5)
New Zealand (1)
Taiwan (698)
Mongolia (9)
Russian Fed. (1)
Total: 8,439 cases, 812 deaths,
30 countries in 7-8 months
Source: www.who.int.csr/sars
