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NTDs 1 Flashcards

1
Q

Describe the scale of poverty in the world, and why this is the case

A

Over ONE BILLION people worldwide – one in six of the human population
Why ?
Partly because they suffer from parasite infections which afflict the poorest people – disabling and disfiguring them – promoting the cycle of poverty and disease

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2
Q

List some neglected protozoan infections

A

Human African Trypanosomiasis (HAT)
Chagas Disease
Leishmaniasis

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3
Q

List some neglected bacterial infections

A

Buruli Ulcer
Leprosy
Trachoma

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4
Q

List some neglected helminth infections

A 
Ascariasis
Hookworm Infection
Trichuriasis
Schistosomiasis 
Lymphatic Filariasis
Onchocerciasis
Dracunculiasis
Podoconiosis
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5
Q

What are the 9 neglected tropical diseases

A

Condition Cases in Africa Global Prevalence
Ascariasis 173 million 800 million
Hookworm 198 million 451 million
Trichuriasis 162 million 435 million
Schistosomiasis 200 million 220 million
Trachoma 33 million 80 million
Lymphatic Filariasis 46 million 120 million
Onchocerciasis 18 million 18 million
Trypanosomiasis 0.5 million
Dracunculiasis less then 25

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6
Q

Which region has the highest prevalence of the 9 NTDs

A

Sub-Saharan Africa

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7
Q

When is Mass Drug Administration possible

A

Drugs are safe and effective
Drugs are inexpensive or donated
Diagnosis is difficult, inaccurate and/or expensive

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8
Q

How do we determine whether MDA is possible

A

So we test a sample of population
Depending on the results we offer MDA to either the full population or a sample
(eg School Aged Children SAC) usually annually

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9
Q

What are the 6 miracle drugs

A

Praziquantel, - Schistosomiasis and Tapeworms

Albendazole, - Lymphatic Filariasis and Intestinal Worms

Mebendazole, - Intestinal Worms

Mectizan - Onchocerciasis and Lymphatic Filariasis (with albendazole)

DEC - Lymphatic Filariasis (with albendazole)

Zithromycin - Trachoma

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10
Q

What is schistosomiasis

A

Also known as Bilharzia
A worm which infects humans
The intermediate host is a fresh water snail
Over 200 million rural poor in Africa are infected
The worms and their eggs cause blood in urine, bladder fibrosis and cancer, liver fibrosis, high blood pressure and death from bleeding

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11
Q

How can schistosomiasis be treated or prevented

A

Treatment with praziquantel
Miracle Drug #1

Snail Control

Sanitation

Improved water supplies

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12
Q

How many people are infected with schistosomiasis in Africa

A

200 million people infected in Africa

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13
Q

What are the helminths in schistosomiasis

A

S.mansoni and S. haematobium- linked with HIV

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14
Q

What is the vector for schistosomiasis

A

Snails

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15
Q

Why is height used to calculate dosage instead of weight for Praziquantel

A

Due to difficulty in obtaining accurate data for weight.

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16
Q

What are the soil transmitted helminths (worms)

A

Ascariasis, Trichuriasis, Hookworm

800 million, 435 million and 451 million cases respectively.

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17
Q

What do STHs cause

A

Stunting and Decreased School Performance in Children

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18
Q

Describe Lymphatic Filariasis

A

Wucheraria bancrofti and Brugia Malayi- parasites
Adult worms live in Lymphatic nodes and cause the symptoms

Microfilariae found in blood only around midnight
Transmitted by mosquitoes
The 2nd most disabling disease worldwide after depression

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19
Q

Describe the extent of the burden of LF

A

1.3 billion at risk

120 million infected

83 million suffering with disabling symptoms

15 million with lymphodoema
23 million men with hydrocele

SE Asia - 9 countries - 874 million at risk

60 million infected – Culex the main vector

Africa - 39 endemic countries - 405 million at risk

46 million infected – Anopheles the main vector

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20
Q

Describe the treatment of LF

A

Albendazole with Mectizan in Africa
Albendazole with DEC in Asia and Far East

Annual treatment prevents new infections
After 6 years good coverage could lead to elimination

Vector control (ITNs and IRS - indoor spraying) (malaria control)

BUT does not help those with infections

So case management is needed

But the most effective treatment is regular washing with soap

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21
Q

Describe the issues with a lack of treatment of LF

A

This man’s hydrocele started 6 years ago – the operation costs $100 – and the queue in Niger alone is over 8,000 men waiting for the treatment

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22
Q

Describe the purpose of albendazole

A

To eliminate LF (used in combination with other medicines to prevent its transmission.)
To control STHs (one tablet can deworm a child).

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23
Q

Describe the consequences of Onchocerciasis

A

Adult worms live in nodules under the skin

Larvae cause the symptoms, itching and blindness

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24
Q

Describe The Onchocerciasis Life Cycle

A

Give birth to live larvae- ingested by fly- penetrate stomach wall of fly- travel to snout of fly- become infective- fly bites person- parasite penetrates skin- and grows in tissues under the skin.

25
Describe the use of Mectizan to treat Onchocerciasis
Mectizan sterilizes the adult worms Now less than 15 million infected Over 99% of those infected live in Africa
26
Describe blinding trachoma
Was the world’s leading cause of preventable blindness – in 2000 $2.9 billion lost in productivity annually 84 million infected 8 million have visual impairment Today less than 3.5 million infected
27
Which regions have the highest burden of Trachoma
Africa and the eastern Mediterranean region
28
How many trachoma endemic countries are there
51
29
Describe the issues with Guinea worm in Africa
In the year 2000, Guinea worm infected over 3 million individuals across Africa. Thanks to health education, filtering drinking water, and spraying to kill the crustacean host, only 30 cases were detected in the world in 2017 (in Ethiopia and in Chad) BUT 1,000 dogs have popped up with the worms (Chad
30
Describe the situation with schistosomiasis treatment in 2000
In 2000 no country in Sub Saharan Africa had a national schistosomiasis control programme and no treatments for STH
31
Describe the United Nations Millennium development goals
1.      Eradicate extreme poverty and hunger. 2.      Achieve universal primary education. 3.     Promote gender equality and empower women. 4.      Reduce child mortality. 5.      Improve maternal health. 6.      Combat HIV/AIDS, malaria and other diseases. 7.      Ensure environmental sustainability. 8.      Develop a global partnership for development
32
Describe the relative costs of treatments for NTDs
Low cost treatments
33
Describe the role of pharmaceutical companies in eliminating NTDs
o Pfizer donate Zithromax for Blinding Trachoma. (originally committed to provide doses of azithromycin for trachoma in 1999) o GSK donate Albendazole for Lymphatic Filariasis. o Novartis donate clofazimine and rifampicin (MDT) for Leprosy. o Merck donate Praziquantel for Shistosomiasis. o Merck and Co donate Mectizan for Onchocerciasis and LF. o Johnson-Johnson donate Mebendazole for intestinal worms. In October 2010, EISAI committed to provide 2 billion tablets of DEC for LF which is used with albendazole outside of Africa
34
Describe the structure in getting drugs delivered to countries
National Programmes make a joint request and report (along with an annual work plan) to WHO. This is processed by Joint Virtual Review panels (or regional review panels). WHO then orders pharmaceutical companies to deliver their drugs to national programmes. IVM and AZI ship the drugs MDP and ITI receive applications from national programmes.
35
What were the aims of the London Declaration in 2020
eradicate or prevent transmission for neglected tropical diseases.
36
Which organisers were involved in the London declaration
``` World Health Organisation World Bank OCP – APOC – ESPEN International Trachoma Initiative (ITI) Global Alliance for Elimination of Lymphatic Filariasis (GAELF) Global Schisto Alliance (GSA) Task Force for Global Health ```
37
Who are the implementers of the London declaration
``` Ministries of Health Supported by : RTI SCI Sightsavers Helen Keller CBM The ENDFUND Deworm the World Fred Hollows And ESPEN (a new WHO-AFRO initiative) ```
38
Which six countries were selected for SCI (Schistosomiasis control initiative) support in 2003
``` Niger Mali Burkina Faso Uganda Tanzania Zambia ```
39
Describe the ongoing expansion of SCI support
Ongoing SCI expansion into DRC, Ethiopia, Madagascar, Mauritania, Sudan, Senegal And Zimbabwe And Yemen With World Bank funds
40
Describe the financial support for SCI
With financial support from the Gates Foundation | USAID/NTD, Geneva Global, DFID, UK and private donations
41
Describe the financial aid for USAID
USAID made their first award against Neglected Tropical Diseases in 2006This award of $100 million over 5 years was to RTI A second award of $450 million was made in 2010 ($250m to “Envision” $200m through FHI)A top up award of $175 million was made in 2015Then in 2018 a new award (ASCEND) of $400 million was made to RTI and FHI
42
Describe the financial aid from the British government
Allocated £50 million over 5 years for NTD control announced in 2008A new £200 million 5 year commitment in January 2012 (shared between SCI, Liverpool School of Tropical Medicine, and Sightsavers) Currently a request for bids is on the table for £200 million
43
Describe other NTD donors
The Bill and Melinda Gates Foundation Started the NTD momentum in 2001 with the grants to SCI, GAELF, and ITI - more recently BMGF have invested in STH The World Bank Responds to country requests – Yemen has been one of the largest programmes Children’s Investment Fund Foundation (CIFF) UK based Foundation which concentrates on school based delivery of deworming and schistosomiasis treatments (Large investments initially in Kenya but now in India, Ethiopia and Nigeria) The END FUND
44
Describe the new wave of donors
Independent charity evaluators all recommend deworming as a cost effective intervention, and their followers donate to Sightsavers, The Endfund, Deworm the World and SCI in particular
45
As the drugs are donated, what is funding required for
``` Logistics Training Mapping, monitoring and evaluation Treatment Registration Social mobilisation Sensitisation Annual planning ```
46
Describe the changes in S. haematobium risk from 2011-2016 compared to 2000-2010
S. haematobium risk has declined by >60% comparing data from 2011-2016 with data from 2000-2010
47
What is limiting the progress of schistosomiasis
Coverage and research
48
Describe how NTDs relate to the SDG of reducing poverty
Neglected tropical diseases are inextricably linked to poverty Eliminating these infections may alleviate poverty
49
Describe how NTDs relate to the SDG of eliminating hunger
STH deprives people of nutrition: They feed on host tissues, including blood, leading to a loss of iron and protein  They increase malabsorption of nutrients They may cause a loss of appetite
50
Describe how NTDs relate to the SDG of improving health and well-being
Treating schistosomiasis and STH can reverse and/or prevent the damaging effects of infections: SDG 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and Neglected Tropical Diseases and combat hepatitis, water-borne diseases and other communicable diseases
51
Describe how NTDs relate to the SDG of quality education
Treating schistosomiasis and STH can increase school attendance by up to 25%
52
Describe how NTDs relate to the SDG of gender equality
With SCI-supported treatment programmes, there is equal access to treatment, regardless of gender*
53
Describe how NTDs relate to the SDG of clean water and sanitation
SCI works in partnership with WASH initiatives to have the greatest impact in eliminating schistosomiasis and STH SCI supports the Sustainable Development Goals. *On average, for DFID-funded programmes.
54
Describe how NTDs relate to the SDG of decent work and economic growth
Treating schistosomiasis and STH can increase future wage earnings by 40%
55
Describe how NTDs relate to the SDG of reducing inequalities
With SCI-supported treatment programmes, there is equal access to treatment, regardless of wealth status*
56
What does SCI collaborate with and support
SCI collaborates with multiple partners to ensure it achieves its goal of control and elimination of schistosomiasis and STH SCI supports the Sustainable Development Goals
57
Describe the total reduction in DALYs due to 7 NTDs
Total reduction in DALYs due to 7 NTDs over 10 years is 23%. LF has the biggest burden .
58
What diseases are targeted for elimination
``` Guinea worm Leprosy Schistosomiasis STHs Chagas Visceral Leishmaniasis River blindness LF Sleeping Sickness Blinding Trachoma ```

Epidemiology (18 decks)

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