The Big Ten Tropical Diseases. Categorization and research strategic emphases

1. The Big Ten Tropical Diseases.Categorization and research strategic emphases Dr. Marcio Ulises Estrada Paneque. Dr. Genco Estrada Vinajera. Universidad Médica de Granma. Cuba.

2. Exchange Objectives: • To know a brief history, some facts, impact and current Tropical Diseases (TD) classification. • To approach the current research strategic emphases of those illnesses.

3. The Big Ten. Clasification. African Trypanosomiasis. Dengue. Category I Leishmaniasis. Malaria. Tuberculosis. Category II Schistosomiasis Onchocerciasis. Leprosy. Category III Chagas disease. Lymphatic filariasis

4. Classification due to… • Category I: Emerging or uncontrolled disease. • Category II: Control strategy available but disease burden persists. • Category III: Control strategy proven effective, disease burden falling, and elimination planned.

5. Categorization . Why? • New knowledge about the biological, social, economic, health system, and behavioral determinants, for effective control. • New tools for use in prevention and control, e.g. drugs, vaccines, diagnostics, epidemiological and environmental tools. • Interventions methods for applying existing and new tools at the clinical and community level. • Policies for large-scale implementation of existing and new disease prevention and control strategies.

6. 10 Big Tropical Diseases. Some questions. • What is the size and nature of the disease burden and what are the epidemiological trends? • What is the current disease control strategy? • What are the major problems and challenges for disease control? • What research is needed to address these problems /challenges? • What is currently being done in research and development? What research opportunities exist?

7. Tropical diseases impact. • Conditions that contribute to the risk for becoming infected with TD agent include biological factors related to population density, rural vs. urban living, nutritional status, climate and other environmental factors, as well as socioeconomic circumstances. At one time, many of today's tropical diseases also occurred in temperate regions, since many of the same risk factors were found there. • Illness and death due to infection remain all too frequent in the tropics. Every minute three children die of malaria alone. The burden imposed by these diseases, however, extends beyond the sad story of young lives being lost. They impede the capacity of children to grow and learn, and of young adults to work and raise a family. They stifle efforts for individual, community and national advancement. They sap resources which would otherwise be utilized for improving the human condition.

8. Health Research and Tropical Diseases • Setting priorities for the health research is a difficult task, especially for the neglected diseases of the poor. • A new approach to priority setting for tropical diseases research must be based on a comprehensive analysis of research needs and research opportunities for each of the ten major tropical diseases in its portfolio.

9. African trypanosomiasis • African trypanosomiasis, also known as Sleeping sickness, is a severe disease, which is fatal if left untreated. It is closely related to a widespread infection of cattle known as N’gana, which restricts cattle earing in many prime areas of Africa. • Sleeping sickness claims comparatively few lives annually, but the risk of major epidemics means that surveillance and ongoing control measures must be maintained.

10. Trypanosomiasis. Research emphases New basic knowledge: • Bioinformatics and applied genomics for identifying targets for drugs and diagnostics • Pathogenesis and host / pathogen interactions • Socioeconomic impact of human African trypanosomiasis and cost-benefit of control • Effect of health systems and policy changes on human African trypanosomiasis control, re-emergence, and epidemics • Factors influencing individual and community participation in control • Epidemiological significance of animal reservoirs for Trypanosoma gambiense • Tsetse genomics.

11. Dengue. • Dengue and dengue haemorrhagic fever have emerged as a major public health problem. • The primary vector mosquito has spread throughout the tropics and into susceptible human populations in urban areas. • The urbanization process, which has left many without adequate water, sewer systems or waste management, and created new breeding grounds for the vector, has hastened the spread of the disease. • Vector control has not halted the explosion in transmission of the disease.

12. Research strategic emphases for dengue. New knowledge: • Molecular tools for Aedes transformation; • Vectorial resistance to dengue; • Aedes population genetics and ecology; • Host-pathogen interactions in dengue, including pathogenesis, natural history, definition of high risk groups . • Dynamics of virus transmission, and population genetics (including modelling) • Social, economic, and biological factors related to promotion and support of community-based interventions; and release of transformed Aedes vectors

13. Leishmaniasis • Leishmania parasites are named after W.B. Leishman, who developed one of the earliest stains of Leishmania in 1901. Widespread in 22 countries in the New World and in 66 nations in Old World, leishmaniasis is not found in South-east Asia. • Human infections are found in 16 countries in Europe, including France, Italy Greece, Malta, Spain and Portugal. • Occurring in several forms, the disease is generally recognized for its cutaneous form which causes non-fatal, disfiguring lesions, although epidemics of the potentially Fatal visceral form cause thousands of deaths.

14. Leishmaniasis. Research emphases • New knowledge: a) Bioinformatics and applied genomics for identifying targets for drugs, vaccines, and diagnostics. b) Socioeconomic, environmental, and behavioral risk factors for infection and disease, especially in refugee populations in complex emergencies. New and improved tools: a) Development of Leishmania diagnostic tests. b) Development of vaccine candidates (new adjuvants for first generation vaccines; second generation vaccine).

15. Malaria • Malaria is the most important tropical disease, remaining widespread throughout the tropics, but also occurring in many temperate regions. • It exacts a heavy toll of illness and death - especially amongst children and pregnant women. It also poses a risk to travelers and immigrants, with imported cases increasing in non-endemic areas. • Treatment and control have become more difficult with the spread of drug-resistant strains of parasites and insecticide-resistant strains of mosquito vectors.

16. Malaria. Research emphases New basic knowledge: a) Anopheles genome sequencing and genetic manipulation for mosquito vector control. b) Bioinformatics and applied genomics for drugs, vaccines, and diagnostics. c) Development of an applied genomic database for the public domain d) Impact of health sector reform on malaria understanding mechanisms of resistance to drugs and insecticides. New tools: a) Discovery and development of new drugs, including combinations and drugs for use in pregnancy. c) Discovery of malaria vaccine candidate antigens. d) Development of vaccine candidates. e) Development of non-invasive approach to diagnostics for use close to the home

17. Tuberculosis • Tuberculosis threatens one-third of the world’s population. The World Health Organization declared tuberculosis a global health emergency since 1993. • The magnitude of the problem changed dramatically during the 1990s due to deteriorating control in some parts of the world (notably eastern Europe and the former Soviet Union), the spread of HIV, and population growth. • Without a coordinated control effort, tuberculosis will infect an estimated 1 billion more people by 2020, killing 70 million.

18. TB. Research Emphases. • New basic knowledge: Bioinformatics and applied genomics for identifying targets for drugs, vaccines, and diagnostics. Impact of health sector reform, globalization, and inequality of access. • New and improved tools: - Diagnostic test development; detection of disease, rifampicin resistance, latent infection. Discovery and development of new drugs.

19. Schistosomiasis • Schistosomiasis is also known as bilharzia after Theodor Bilharz, who first identified the parasite in Egypt in 1851. • Infection is widespread with a relatively low mortality rate, but a high morbidity rate, causing severe debilitating illness in millions of people. • The disease is often associated with water resource development projects, such as dams and irrigation schemes, where the snail intermediate hosts of the parasite breed.

20. Schistosomiasis. Research emphases. • New basic knowledge: a) Bioinformatics and applied genomics for identifying targets for drugs, vaccines, and diagnostics. b) Pathogenesis (host-pathogen interactions) focusing on reproductive health issues and immunological aspects of co-infection. c) Social economic impact and methodology for burden of disease assessment • New and improved tools: a) Discovery and development of new drugs. b) Evaluate safety and efficacy of existing drugs that are potentially anti- schistosomal. c) Review of vaccine research and development. d) Assess technical and use profiles of available diagnostics

21. Onchocerciasis • Onchocerciasis is the world’s second leading infectious cause of blindness. Rarely life-threatening, the disease causes chronic suffering and severe disability. • In Africa, it constitutes a serious obstacle to socioeconomic development. It is often called river blindness because of its most extreme manifestation and because the black flies that transmit the disease abound in riverside areas, where they breed in fast-flowing waters. • Fertile riverine areas are frequently abandoned for fear of the disease.

22. Onchocerciasis. Research… • New basic knowledge: Understanding ivermectin resistance mechanisms • New and improved tools: a) Discovery and development of macrofilaricidal drugs or drugs to permanently inhibit microfilariae production. b) Development of diagnostics for surveillance. c) Development of ivermectin resistance test.

23. Leprosy • Leprosy is occasionally known as Hansen’s disease, after Armauer Hansen, the Norwegian physician who first identified the microorganism which causes the disease. • Known and dreaded since biblical times because of the severe deformities that can occur, it was considered incurable until as recently as the 1940s.

24. Leprosy emphases New basic knowledge: a) Bioinformatics and applied genomics for identifying targets for diagnostics for infection with ML b) Pathogenesis of nerve reactions. c) Social and behavioral constraints for leprosy elimination. New tools: a) Rifampicin susceptibility test development. b) Development of a test for infection with Mycobacterium leprae. c) Development of tools for early diagnosis and treatment of leprosy reactions

25. Chagas disease Chagas disease is found only in Latin America. It is named after Carlos Chagas, a Brazilian doctor who first described the disease in 1909. He also described the life-cycle of the parasite, identified the insects that transmit the parasite, identified small mammals that act as reservoir hosts, and suggested means to help prevent its transmission.

26. Research emphases on Chagas disease. • New basic knowledge: a) Bioinformatics and applied genomics for identifying targets for drugs and elucidation of pathogenesis and risk factors. b ) Genetic and entomological studies on vectors (e.g. mechanisms of resistance, adaptation to ecological changes) • New tools: a) Development of candidate drugs. b) Clinical research on proposed prognostic markers of disease.

27. Lymphatic filariasis • Rarely life-threatening, lymphatic filariasis causes widespread and chronic suffering, disability, and social stigma. • It can lead to grotesquely swollen limbs a condition known as elephantiasis. • Lymphatic filariasis

28. Lymphatic filariasis emphases New basic knowledge: a) Bioinformatics and applied genomics for drugs. b) Progression / reversibility of disease manifestations after treatment, especially in children New tools: a) Discovery and development of macrofilaricidal drugs or drugs to permanently inhibit microfilariae production. b) Further development and evaluation of diagnostics for Brugia malayi.

29. Tropical Diseases. Hopes? To the fight against the HIV/AIDS, malaria, TB, others TD, infectious illnesses of the childhood, maternal and perinatal affections, micronutrients deficits and others, is necessary to add family planning, reproductive and derived gender health programs and other managed ones to the prevention and attention of the non transmitted diseases. The Third World is economically insolvent to achieve it without official financing for the development for the countries of high entrance.

30. Tropical Diseases. Hopes? • That is necessary for a true sustainable economic and social development, in a healthy world, it is many times more than what is affirmed. • To brake the monetary speculation and the career arms, it the only measures able to generate funds for the health and the world development. A better world is possible!