Neglected Tropical Diseases: Control & Research
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Transcript of Neglected Tropical Diseases: Control & Research
Neglected Tropical Diseases:
Control & Research
Neglected Tropical Diseases:
Control & Research
P.Olliaro, WHO/TDR
Soil transmitted helminthiasis
SchistosomiasisLymphatic filariasis
OnchocerciasisLeprosy
Trachoma Leishmaniasis
Buruli ulcerChagas disease
HATDengue
…
Malaria
TB
Neglected zoonoses
HIV/AIDS
Previously neglected diseases
Neglected tropical diseases
NTDs in poor populations NTDs in poor populations NTDs in poor populations NTDs in poor populations
Cysticercosis
Echinococcosis
Rabies
Anthrax
Bovine tuberculosis
Brucellosis
Zoonotic trypanosomiasis
Global distribution of NTDsGlobal distribution of NTDsGlobal distribution of NTDsGlobal distribution of NTDs.
~ 1 billion people have >1 NTDs
Burden of disease (DALYs) for infectious & parasitic diseasesBurden of disease (DALYs) for infectious & parasitic diseases
HIV/AIDS, 84.5, 23%
malaria, 46.5, 13%
tuberculosis, 34.7, 10%
neglected tropical diseases, 56.6,
16%
helminth infections, 49.9, 14%
others infectious diseases, 87.2,
24%
"big three"= 46.1%
"others"= 29.6 %
Countries affected by NTDs by Countries affected by NTDs by income groupincome group
Countries affected by NTDs by Countries affected by NTDs by income groupincome group
More than 70% of countries and territories affected by neglected tropical diseases are low-income and low middle-income countries
100% of low-income countries are affected by at least 5 neglected tropical diseases
Health and povertyHealth and poverty
Ill health is both a cause and a consequence of poverty: sick people are more likely to become poor and the poor are more vulnerable to disease and disability
Good health is central to creating and sustaining the capabilities that poor people need to escape from poverty
Good health is not just an outcome of development: it is a way of achieving development
Rapid Impact InterventionsImproving access
Focused interventionsImproving innovation
Large scale interventions
Lymphatic filariasis Leprosy Onchocerciasis Schistosomiasis Helminthiasis Trachoma Yaws
Case management and development of new tools
Human African trypanosomiasis Chagas diseases Buruli ulcer Leishmaniasis Dengue
DengueDengueDengueDengueDengue is the most common mosquito-borne viral disease of humans that in recent years has become a major international public health concern. Globally, 2.5 billion people live in areas where dengue viruses can be transmitted. The geographical spread of both the mosquito vectors and the viruses has led to the global resurgence of epidemic dengue fever and emergence of dengue hemorrhagic fever (dengue/DHF) in the past 25 years with the development of hyperendemicity in many urban centers of the tropics.
Human African Human African trypanosomiasistrypanosomiasisHuman African Human African
trypanosomiasistrypanosomiasisSpread by the bite of the tsetse fly, the disease flourishes in impoverished rural parts of Africa. Untreated, the disease is invariably fatal. Death follows prolonged agony. In 2006 some 70 000 people are estimated to be infected.
LeishmaniasisLeishmaniasisLeishmaniasisLeishmaniasis12 millions are currently infected and 350 million people are at risk of infection. Around 1.5 million to 2 million new infections occur each year.
Buruli ulcerBuruli ulcerBuruli ulcerBuruli ulcer
BU has been reported from 30 countries, left untreated, the disease progresses to massive destruction of the skin and, in some cases, of bone, eyes, and other tissues. Limb amputations may be needed to save a patient's life.
TrachomaTrachomaTrachomaTrachomaBlinding trachoma affects more than 80 million people around the world. Children are mainly concerned by the infection, and every 4 people blind from trachoma 3 are women. Africa is the continent with the greatest number of endemic countries, but America, Middle-East and Asia are also endemic. SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) has proven its effectiveness in eliminating this scourge from humanity.
LeprosyLeprosyLeprosyLeprosyLeprosy is considered shameful and people hid their symptoms for fear of ostracism despite free and effective multidrug therapy. Today, the diagnosis and treatment of leprosy is easy. MDT treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy.
Lymphatic filariasis (LF)Lymphatic filariasis (LF)Lymphatic filariasis (LF)Lymphatic filariasis (LF)Over 120 million people are currently infected and around 1.3 billion people in more than 80 countries are at risk of infection. Drugs used against lymphatic filariasis are either donated – albendazole and ivermectin, or very inexpensive DEC. Albendazole and Ivermectin are donated by GlaxoSmithKline and Merck & C for mass administration to at-risk populations.
SchistosomiasisSchistosomiasisSchistosomiasisSchistosomiasis
Schistosoma haematobium is endemic in 53 countries in the Middle East and most of the African continent including the islands of Madagascar and Mauritius. In sub-Saharan Africa alone there are reckoned to be 112 million infections with S. haematobium. Praziquantel at the single dose of 40 mg/Kg body weight is a very safe and effective treatment against S.
haematobium and the cost of treatment is less than 0.15 Euro.
HookwormsHookwormsHookwormsHookwormsHookworms infect one billion people. It is calculated that 500 million women are infected by hookworms and at globally least 44 million are pregnant and
infected at any time. Safe single dose treatment costs < 0.02 Euro a dose .
"Industry is present. Your donations of drugs and other support opened an opportunity which public health has seized. Your engagement has given us the tools to take action on an unprecedented scale."
Extract from the opening speech by DG
at the first WHO global partners' meeting on NTD, 19-20 April 2007
Free and timely access to high-quality Free and timely access to high-quality medicinesmedicines
Novartis
Bayer
Merck KGaA
sanofi-aventis
Bayer
sanofi-aventis
Johnson & Johnson
Novartis
Merck & Co Inc.
sanofi-aventis
GlaxoSmithKline
Donator
Unlimited quantity by 2012 for human African trypanosomiasisPentamidine
200 million tablets 2008-2017 for SchistosomiasisPraziquantel
Unlimited quantity by 2012 for human African trypanosomiasisSuramine
600 000 tablets 2007-2009 for fascioliasisTriclabendazole
500 000 tablets (120 mg) per year by 2012 for treatment of Chagas diseaseNifurtimox
Unlimited quantity by 2012 for human African trypanosomiasisMelarsoprol
50 million tablets in 2007 for Soil-transmitted helminths control programmes for childrenMebendazole *
Unlimited quantity for Leprosy and its complicationsMDT and Clofazimine
Directly to countries for lymphatic filariasis and onchocerciasis Ivermectin *
Unlimited quantity by 2012 for human African trypanosomiasisEflornithine
Unlimited quantity for lymphatic filariasis only (not for soil-transmitted helminthiasis)
Albendazole
Conditions Medicine
* Donation made not directly to WHO
RESEARCH:
Develop new tools
Existing tools: Optimise Improve use/access
RESEARCH:
Develop new tools
Existing tools: Optimise Improve use/access
Pharmaceutical gap
Operational gapFINANCING RESEARCH
PARTNERING TO CONDUCT RESEARCH
Modified from Ridley D. et al Health Affairs 2006
Ascariasis
Trichuriasis
Hookworm disease
Leishmaniasis
Malaria , 15
Tuberculosis , 7
African Trypanosomiasis
Chagas disease
Schistosomiasis
Lymphatic filariasis
Onchocerciasis
Trachoma
Intestinal nematodes
0
1
10
100
0 50 100 150 200 250
Drug R&D investments (million $)
log
DA
LY (m
illio
ns)
Drug R&D investments, pipeline
& burden
Drug R&D investments, pipeline
& burden
Vs. R&D costs ?
Research needsResearch needsInnovation/
pharmaceutical Gap
Basic science
Product discovery
Product Development
(R&D)Product use
Schools, Communities
HealthSystems
"Operational"Research
"Tool ready"Lymphatic filariasis, Leprosy, Onchocerciasis,
Schistosomiasis, Helminthiasis, Trachoma, Yaws (VL in Indian subcontinent)
"Tool deficient" Human African trypanosomiasis, Chagas dis.
Buruli ulcer, Leishmaniasis, Dengue
"Vulnerable diseases"Lymphatic filariasis, Onchocerciasis,
Schistosomiasis, (Helminthiases)
Current global R&D portfolioCurrent global R&D portfoliodisease potential candidates DEVELOPMENT OPTIMIZATION
Onchocerciasis emodepside moxidectin (Ph3)[WHO/TDR + Wyeth]
albendazole/Loaloa
lymphatic filariasisSchistosomiasis L-praziquantel praziquantel dosing
praziquantel combos?Soil-transmitted Helminths
product from animal health?
Human African Trypanosomiasis
DB backupsfexinidazole backups
fexinidazole (Ph1)[DNDi + sanofi-aventis]
Nifurtimox+eflornithine (approved EML)pentamidine shortened Rx
Chagas disease pediatric benznidazole
Leishmaniasis buparvaquoneoral AmphoB
combinations:AmBisome+MiltefosineAmBisome+ParomomycinMiltefosine+Paromomycin
Dengue options considered