NTD 1 Flashcards
SARS
Dr and nurses catch it and die - infection uncontrollable and spreads
SARS-CoVs (severe acute respiratory syndrome coronavirus)
genome sequencing shows that genome of similar bat virus is almost identical
epidemic stopped by isolation - quarantine, get 1st symptom before it can be transmitted
fruit bats are eaten
unreported mortality in China - isolated hospitals
West nile virus
first in US in NY state in 1999 caused >19000 illness >750 deaths in US by 2009 mosquito work for vaccine is underway
HIV
similar to primate virus
immunotherapeutic treatment - triple therapy - target 3 genes
multiple introductions into humans
HIV 1 - human virus, mutation rate at each side along genome, back circulate when separated
in chimp SRV - RNA - no checks in replication
can’t get vaccine
malaria
evolutionary history of malaria
closest similar species chimp
few 1000yrs old
source wild animals
MERS
middle east respiratory syndrome coronavirus
livestock v domestic
high fatality rate
cases in Britain through travellers
no antiviral/vaccine - just have to let it run its course
Ebola
no commercial market for medication - companies serve western European virus
CEPI - Bill gates - develop vaccine for rare disease
manufacturing capability 1/3 of what needed to vaccinate all children for common viruses
internet surveillance - unusual events in space and time
isolate people who have contact trends
immunotherapies
trial vaccines but no vaccine because of the lack of commercial market
genetically stable virus
prosper in area of conflict - no health measures
Zika
brain fails to develop
forest in Uganda - where first found
common in tropical belt
sexually transmitted
difficult to produce vaccine - because autoimmune so risk a lot of adverse effects
trigger autoimmune response against neural cells
modulate human immune system pathway
need to prevent being bitten by a mosquito
reservoir in primates
1st trimester risk of microcephaly (brain failing to develop properly) 1%
2nd and 3rd trimester - negligible
risk of Gillian-Barre syndrome 4 in 100000 in adults - Autoimmune attacking nerve cells
Vaccination
have risks
US make you have vaccines to attend primary school
people see the risks of vaccines and delay having them
correlation between MMR and autism - websites designed to cause anxiety
in order to protect the community there has to be a basic level of immunity - have to encourage vaccinations
Measles
increasing outbreaks
vaccination rate should be 95-97% now it is 84%
pockets of outbreak in London - especially among communities where English isn’t the first language
pneumococcal infection
17 strains in vaccines - commonest strain in seral illness
human papilloma virus - many strains but all stable
vaccine provide strong selective force
strain replacement
rare cases are as important we just haven’t seen enough of them
NTD
give drugs freely to places where they need them
small protein production gene protrude in immune system - no acquired immunity - drug treatment required forever so need a vaccine - commercial market not viable
medical surveillance - internet surveillance and internet surveillance, report in newspaper and radio - unusual morbidity, people in Nigeria determine cause - this discovery phase could be the most difficult phase
what is generation time
average time from birth of female until she gives birth
Influenza a
trillion gene rotations
arms race in favour of the pathogens
modern medicine removes natural selection and puts it into our hands
generation of a vaccine
time from drug proof of principle to on market = 15yrs
for vaccine 10yrs
phase 1 - safety
phase 2 - evidence and efficacy
phase 3 - expensive, drug into clinical trial, complications
describe the disease-poverty cycle
> 1billion people live on
what are the 14 neglected tropical diseases
Protozoan: Human African Tyopanosomiasis (HAT) Chagas Disease Leishmaniasis Bacterial: Buruli Ulcer leprosy trachoma - eye infection Helminth: ascariasis hookworm infection trichuriasis schistosomiasis lymphatic filariasis onchocerciasis dracunculiasis podoconiosis
where has the highest prevalence of 9 of the NTD
sub Saharan Africa
90% schistosomiasis - used to be in china and south America
Asciariasis, hookworm and trichuriasis - intestinal worms, prevalent globally
what is mass drug administration
MDA
possible if: drugs are safe and effective, inexpensive or donated, diagnosis is difficult inaccurate or expensive and unpleasant
test sample - depending ion results offer MDA to sample or whole pop
target school aged children - annually
>1billion people treated in 2017
Praziquantel treats…
schistosomiasis and tapeworms
Albendazole treats
lymphatic filariasis and intestinal worms
mebendazole treats
intestinal worms
mecitzan treats
onchocerciasis and lymphatic filariasis and lymphatic filariasis
DEC treats
Lymphatic filariasis
zithromycin treats
trachoma
Schistosomiasis
AKA Bilharzia
worm
host is fresh water snail - from urine enter fresh water
>200 million in Africa infected
cause: blood in urine, bladder fibrosis (egg trapped in wall) and cancer, liver fibrosis (trapped in liver) , high Bp, and death from bleeding, rupture capillaries
kills some people who are more susceptible
Schistosomiasis treatment
snail control sanitation - urine not in water improved water supplies prevent people entering water praziquantel - done on weight and height, weight is inaccurate
Types of schistosomiasis eggs
s. mansoni - lateral spine, intestine, stool
s. haematobium - bladder, urine
each own type of snail
who is the target for treatment
school children annually
Soil transmitted helminths
STHs ascariasis 800 million cases trichuriasis 435 million cases Hookworm 451 million cases treated with albendazole cause stunted growth and reduced education - can be reversed
Lymphatic Filariasis
adult worms live in lymph nodes microfilariae found in blood only around midnight - when mosquito bites block lymphatic flow 120 million infected swelling from blocked lymph - secondary infection mostly SE Asia and Africa in SE Asia Culex main vector in Africa - anopheles main vector
treatment of lymphatic filariasis
albendazole and mectizan in Africa
albendazole and DEC in Asia and far east
annually
after 6 years could = elimination
vector control
wash with soap 3x a day - secondary infection removed
albendazole - sterilise the worm so noe eggs, adult only live 6 years then can get rid of it
Onchocerciasis
adult worms live in nodules under the skin
larvae - destroy retina and cause blindness, cause itching
mectizan sterilise adult worms
<15million infected
CEO of MERK give 100 million doses year until eliminated
Blinding trachoma
one of world’s leading causes of preventable viruses
84 million infected
conjunctivitis - scar eyelid, eyelash turn down and scratch cornea
treatment increased each year
The Guinea worm
in 2000 infected >3million individuals
with health education, filtering drinking water and spraying to kill crustacean host only 30 cases were detected in the world in 2017
parasite in body is 1m - forms blisters that burn - cool in water - eggs infect crustacean - drink water with crustacean in.
take it out with a matchstick
what are the united nations millennium development goals
eradicate extreme poverty
achieve universal primary education
promote gender inequality and empower women
reduce child mortality
improve maternal health
combat HIV/AIDs, malaria and other diseases
ensure env sustainability
develop a global partnership for development
Pharmaceutical companies and global health
Merch and Co - donate mectizan and praziquantel for as long as needed
gsk - albendazole and deworm school age children
Johnson Johnson - mebendazole
Pfizer - azithromyocin
Novartis - MDT for leprosy
EISAI - DEC
revie each year to say what they need
organisations and NTD
WHO world bank OCP - APOC - ESPEN international trachoma initiative global alliance for elimination of lymphatic filariasis global schisto alliance
How does SCI affect the sustainable development goals
eliminating NTD may = no poverty
STH deprives people of nutrition, increase malabsorbtion of nutrients and may reduce appetite
treating schisto and STH can reverse or prevent the damaging effects of infections
treating schisto and STH increase school attendance
with SCI supported treatment - equal to everyone
SCI works with WASH to have greatest impact in eliminating schisto and STH
increase future wages
SCI collaborates with many partners achieves goals of control and elimination schisto and STH
Reduction in DALYs due to 7 NTD
23%
What are the implementers for NGT
ministries of health supported by: RTI SCI Sightsavers Helen Keller CBM the ENDFUND Deworm the world Fred Hollows ESPEN
6 countries selected for Schistosomiasis control initiative
Niger Mali Burkina Faso Uganda Tanzania Zambia
current countries with SCI
Mauritania and Senegal Burkina Faso Cote d'loivre and Liberia chana Cameroon Burundi and Rwanda Mali Niger Nigeria Sudan DRC Zambia Zim Ethiopia Uganda Kenya Tanzania Malawi and Mozambique Madagascar
USAID
first award against NGT - billions for malaria an TB
$100 million over 5 years to RTI in 2006
$450 million in 2010 - 250 to Envision 200 to FHI
top up of $175 million in 2015
2018 new award ASCEND $400 million to RTI and FHI for next 5 years
NTD donors
Bill and Melinda Gates foundation - 2001 grants to SCI, GAELF, ITU recently STH
The world bank - responds to country requests
Children’s investment fund foundation - school based delivery of deworming and schisto treatment
The END FUND - $100 million in donations with 10 implementing partners
independent charity evaluators recommend deworming - followers donate to sight savers, the end fund, deworm the world and SCI
The british government
allocated £50 million over 5 years in 2008
new £200 million 5 year commitment in Jan 2012
request for bids on £200 million
