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Emergency initiative to reduce leishmaniasis in Afghanistan
Newsdesk Emergency initiative to reduce leishmaniasis in Afghanistan The WHO has launched an emergency initiative in Kabul, Afghanistan, together with its partners, the Massoud Foundation and HealthNet International (HNI), to dramatically reduce the incidence of cutaneous leishmaniasis (CL) in less than 2 years. A high level of stigma is attached to the disease in Afghanistan and other Asian countries, particularly among women and children, explains Mark Rowland (London School of Hygiene and Tropical Medicine, London, UK). “It can affect a woman’s marital prospects and cause social exclusion within a family”. There are an estimated 67 500 cases in Kabul, making Afghanistan’s capital the largest centre of CL in the world. The initiative is the first stage of a national leishmaniasis control programme that, if successful, will be replicated in other parts of Afghanistan. The WHO has secured US$ 250 000 from the Belgian government to purchase and distribute first-line drugs, pentostam or glucantime, and insecticide-treated bednets (ITNs) to provide protection against the disease. Rowland
told TLID, “Following ITN trials in Afghanistan in 1996–1997, there is very sound evidence for the effectiveness of this type of intervention.” Although two essential parts of the disease control programme, Annick Lenglet, HNI’s malaria and leishmaniasis control programme manager in Kabul, insists these strategies are not new. “HNI has been implementing these and additional measures, including health education, capacity building for health professionals, and quality control, for many years now in Afghanistan,” says Lenglet. The Afghan health-care infrastructure has suffered greatly through the years with the Soviet occupation, civil war, and the fall of the Taliban, allowing neglected diseases such as CL to take hold. But the situation is improving. The Ministry of Health, with international aid and funding, is implementing the so-called “Basic Package of Health Services”, which aims to deliver a standardised package of health services to each Afghan, explains Lenglet. “It is obviously a slow
process in a country which up until recently had no system of standardised healthcare.” An added problem facing the prolonged CL epidemic is the return of non-immune refugees from Pakistan, explains Philippe Desjeux, in charge of the CL control programme at the WHO. “Returning refugees who have no immunity to the disease are settling in suburbs of Kabul where the sanitary conditions are poor, providing a breeding site for the vector,” Desjeux adds. For the intervention to be sustainable, it needs to be underpinned by education, Desjeux told TLID. “People need to understand how they become infected, how to be cured, and that they should look for treatment as soon as possible”. In addition, key affected regions need to be identified. Lenglet told TLID, “HNI will be conducting a national malaria and leishmaniasis prevalence survey in the coming year, which will allow us to plot a risk map for Afghanistan.” Josephine Querido
For around US$125, people will be able to find out if they’ve been infected with a virus that might make them fat. An obesity researcher has launched a new biotech company that plans to offer an antibody test for adenovirus-36 (Ad36), the suspect pathogen. The test comes from several years of work on a possible connection between Ad-36 and obesity by Nikhil Dhurandhar (Wayne State University, Detroit, MI, USA) and his collaborator Richard Atkinson (Obetech, Richmond, VA, USA). Atkinson, who founded the test company, Obetech, was formerly at the University of Wisconsin, and is a founder of the American Obesity Association, and an editor of the association’s flagship journal. The idea that obesity can be an infectious disease may be unconventional, but Dhurandhar and Atkinson have received a mostly respectful response from peers. “Their work on obesity-related viruses has a
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Wishing away obesity: the result of infection?
strong experimental base in animal models and their descriptive epidemiological data appears sound. Whether or not their hypothesis holds up in appropriately designed prospective human studies remains to be answered as far as I know”, says Steven Heymsfield (Columbia University College of Physicians and Surgeons, New York, NY, USA). But Heymsfield also questions the utility of offering a test for the virus,
Infectious Diseases Vol 4 October 2004
http://infection.thelancet.com
Gusto/Science Photo Library
Is obesity an infectious disease? since there is no treatment for Ad-36 infection. Atkinson declares, “If skinny people get this assay and it’s positive, they’ll know they’re at risk and should adopt a different lifestyle”. Atkinson says he is hoping that everybody, not just fat people, will view Ad-36 testing as similar to a cholesterol test, identifying a risk factor for disease. The researchers have reported that chickens, mice, rhesus monkeys, and marmosets infected with Ad-36 tend to be fatter than those not infected. In a study of 500 people, the researchers found that about 30% of the obese, but only 11% of the non-obese, possessed Ad-36 antibodies. Among 26 twin pairs discordant for Ad-36 antibodies, the antibody-positive twins were heavier than the antibody-negative twins. In vitro experiments suggest that Ad-36 might trigger obesity by enhancing differentiation of the infant fat cells known as preadipocytes. Tabitha M Powledge
599
For personal use. Only reproduce with permission from Elsevier Ltd.
told TLID, “Following ITN trials in Afghanistan in 1996–1997, there is very sound evidence for the effectiveness of this type of intervention.” Although two essential parts of the disease control programme, Annick Lenglet, HNI’s malaria and leishmaniasis control programme manager in Kabul, insists these strategies are not new. “HNI has been implementing these and additional measures, including health education, capacity building for health professionals, and quality control, for many years now in Afghanistan,” says Lenglet. The Afghan health-care infrastructure has suffered greatly through the years with the Soviet occupation, civil war, and the fall of the Taliban, allowing neglected diseases such as CL to take hold. But the situation is improving. The Ministry of Health, with international aid and funding, is implementing the so-called “Basic Package of Health Services”, which aims to deliver a standardised package of health services to each Afghan, explains Lenglet. “It is obviously a slow
process in a country which up until recently had no system of standardised healthcare.” An added problem facing the prolonged CL epidemic is the return of non-immune refugees from Pakistan, explains Philippe Desjeux, in charge of the CL control programme at the WHO. “Returning refugees who have no immunity to the disease are settling in suburbs of Kabul where the sanitary conditions are poor, providing a breeding site for the vector,” Desjeux adds. For the intervention to be sustainable, it needs to be underpinned by education, Desjeux told TLID. “People need to understand how they become infected, how to be cured, and that they should look for treatment as soon as possible”. In addition, key affected regions need to be identified. Lenglet told TLID, “HNI will be conducting a national malaria and leishmaniasis prevalence survey in the coming year, which will allow us to plot a risk map for Afghanistan.” Josephine Querido
For around US$125, people will be able to find out if they’ve been infected with a virus that might make them fat. An obesity researcher has launched a new biotech company that plans to offer an antibody test for adenovirus-36 (Ad36), the suspect pathogen. The test comes from several years of work on a possible connection between Ad-36 and obesity by Nikhil Dhurandhar (Wayne State University, Detroit, MI, USA) and his collaborator Richard Atkinson (Obetech, Richmond, VA, USA). Atkinson, who founded the test company, Obetech, was formerly at the University of Wisconsin, and is a founder of the American Obesity Association, and an editor of the association’s flagship journal. The idea that obesity can be an infectious disease may be unconventional, but Dhurandhar and Atkinson have received a mostly respectful response from peers. “Their work on obesity-related viruses has a
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Wishing away obesity: the result of infection?
strong experimental base in animal models and their descriptive epidemiological data appears sound. Whether or not their hypothesis holds up in appropriately designed prospective human studies remains to be answered as far as I know”, says Steven Heymsfield (Columbia University College of Physicians and Surgeons, New York, NY, USA). But Heymsfield also questions the utility of offering a test for the virus,
Infectious Diseases Vol 4 October 2004
http://infection.thelancet.com
Gusto/Science Photo Library
Is obesity an infectious disease? since there is no treatment for Ad-36 infection. Atkinson declares, “If skinny people get this assay and it’s positive, they’ll know they’re at risk and should adopt a different lifestyle”. Atkinson says he is hoping that everybody, not just fat people, will view Ad-36 testing as similar to a cholesterol test, identifying a risk factor for disease. The researchers have reported that chickens, mice, rhesus monkeys, and marmosets infected with Ad-36 tend to be fatter than those not infected. In a study of 500 people, the researchers found that about 30% of the obese, but only 11% of the non-obese, possessed Ad-36 antibodies. Among 26 twin pairs discordant for Ad-36 antibodies, the antibody-positive twins were heavier than the antibody-negative twins. In vitro experiments suggest that Ad-36 might trigger obesity by enhancing differentiation of the infant fat cells known as preadipocytes. Tabitha M Powledge
599
For personal use. Only reproduce with permission from Elsevier Ltd.