FamiliesUSA

The Neglected Tropical Diseases

Peter Hotez MD PhD FAAP

The George Washington UniversitySabin Vaccine Institute

The Millennium Development Goals (MDGs) 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.

The 2000 Millennium Declaration

The Neglected Tropical Diseases“Ancient Afflictions of Stigma and Poverty”

Core Group of 13

• Protozoan Infections– African

Trypanosomiasis– Chagas Disease– Leishmaniasis

• Bacterial Infections– Buruli Ulcer– Leprosy– Trachoma

• Helminth Infections– Ascariasis– Hookworm Infection– Trichuriasis– Schistosomiasis – Lymphatic Filariasis– Onchocerciasis– Dracunculiasis

Disease Number of Cases Population at-risk

Ascariasis 807 million 4.2 billion

Trichuriasis 604 million 3.2 billion

Hookworm 576 million 3.2 billion

Schistosomiasis 200 million 0.6 billion

Lymphatic Filariasis 120 million 1.0 billion

Trachoma 84 million 0.5 billion

Onchocerciasis 18-37 million 0.1 billion

Leishmaniasis 12 million 0.4 billion

Chagas Disease 8-9 million 0.025 billion

Leprosy 0.4 million ND

Trypanosomiasis 0.3 million ND

Dracunculiasis 0.01 million ND

The Most Common Infections of Poor People

Neglected Tropical DiseasesCOMMON FEATURES

• The Most Prevalent Infections of Poor People– Up to half of the 2.7 billion people who live on less than $2 per

day– Rural areas (slums and poor urban areas) of low-income

countries

• Non-Emerging Ancient Conditions • Indigenous Populations• Chronic Conditions Disabling Conditions

– Growth Delays– Blindness– Disfigurement– Stigma

• Poverty Promoting Conditions– Child development and education– Pregnancy outcome– Productive capacity

Buruli Ulcer Onchocerciasis

Leishmaniasis

“It’s quite a problem for me when I have to stand at work for long periods.”

“I am a fisherman. I can’t work

continuously. I am ill every other week

with renewed pain.”

“My parents brought me two suitors but neither decided to marry me.”

Lymphatic Filariasis in Sri Lanka

Ranking of Communicable Diseases By DALYs

Disease Condition Disease Burden

HIV-AIDS 84.5 million

Neglected Tropical Diseases 56.6 million

Malaria 46.5 million

Tuberculosis 34.7 million

Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, Ehrlich Sachs S, Sachs JDPLoS Medicine 2006; 3: e102

Version 2.0: Integrating Neglected Tropical Disease Control

Low Cost of Interventions

0 200 400 600 800 1000

Cost per patient treatment per year (US dollars)

'Rapid Impact'Package

Malaria

TB

HIV/ AIDS

Range of treatment costs per person per year

<$0.50 for packaged intervention – delivery

costs for donated drugs

Global Network for Neglected Tropical Diseaseshttp://www.GNNTDC.org

• Schistosomiasis Control Initiative • International Trachoma Initiative• Helen Keller International• Liverpool School - GAELF• Human Hookworm Vaccine Initiative• Earth Institute at Columbia Univ.• Task Force for Child Survival

– Mectizan Donation Program– Albendazole Donation Program– Mebendazole Donation Program

8 / 56 Countries

Geneva GlobalBurundiRwanda

Exxon MobilEquatorial Guinea

USAIDBurkina FasoGhanaMaliNiger Uganda

New NTD Control ProjectsThe Global Network for Neglected Tropical Disease Control

The Buzz on NTDs

“The world is now paying attention to these [neglected] diseases and making progress in unprecedented ways, with ambitious goals, excellent interventions, and growing evidence of multiple benefits for health. The attention to long-neglected diseases is a positive sign that health is a responsibility shared by the international community.” -Dr. Margaret Chan, Director-General of the World Health Organization

“Comprehensive, Africa-wide control of malaria and NTDs together would probably cost no more than $3 billion a year, or just two days of Pentagon spending. If each of the billion people in the rich world devoted the equivalent of one $3 coffee a year to the cause, several million children every year would be spared of death and debility, and world would be spared the grave risks when disease and despair run unchecked. A new Global Network for Neglected Tropical Disease Control is helping make this opportunity a reality.” - Jeffrey Sachs, Director of the Earth Institute, Scientific American January 2007

“It quickly became clear that this story is not just about the staggering numbers of the world’s citizens overwhelmed by HIV, AIDS, TB, and malaria. And it’s not just the story about one billion people who are afflicted with disabling, oftentimes stigmatizing, neglected tropical diseases, such as human hookworm infection and elephantiasis… it’s all about the faces of dying children and sick mothers who haunt those who have seen them...What struck me, and what I think struck us all…that these challenges are all interconnected.” - Clinton Global Initiative, Closing Remarks

VERSION 3.0: NEW TOOLS FOR DISEASE CONTROL

Days Since Treatment20 40 60 80 100 120 140 160 180

Days Since Treatment20 40 60 80 100 120 140 160 180

Ho

okw

orm

Bu

rden

Village A

Village BZanzibar, Tanzania

•Low efficacy of Mebendazole•Re-infection within 4-12 mos•Diminishing efficacy

Hookworm Re-Infection

Product Development Partnership

Sabin Vaccine InstituteGeorge Washington UniversityFIOCRUZInstituto ButantanLondon School Hyg. Trop. Med.Queensland Inst. Med. Res