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Study supports single treatment for neglected diseases
Newsdesk
Infectious disease surveillance update For more information on visceral leishmaniasis in Somalia see PLoS Negl Trop Dis 2007; 1: e85; DOI:10.1371/ journal.pntd.0000085
Encephalitis in India More than 450 people have died from encephalitis this year in the Indian state of Uttar Pradesh. The worst affected regions are Gorakhpur, Khushi Nagar, and Mahrajganj. Local people first thought the disease was Japanese encephalitis (JE), which killed more than 1000 people in 2005. However, only 86 of more than 2000 cases have so-far been laboratory confirmed as being caused by JE virus and the other cases are of unknown origin; ten of these patients have subsequently died. In southeast Asia, cases of JE appear to have been increasing in recent years. The fatality rate for JE is generally high (5–30%) and approximately one-third of survivors have serious neurological sequelae. The outbreak in 2005 was followed by extensive immunisation in the region to prevent further spread, said health officials, and the JE vaccine was
considered effective in all areas where it had been given to children. Despite these vaccination programmes, however, “children with pre-existing antibodies or immunological failure and the presence of missing children are sufficient enough to cause an outbreak in these heavily populated regions”, T N Dhole (Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India) told TLID. “There is continued need for proper and meticulous completion of vaccination of all children below 15 years of age, vector control, segregation of piggeries from human colonies, and identification of the correct aetiological agent responsible for the cases of encephalitis”, he added.
Leishmaniasis in Somalia There has been a marked increase in the number of patients presenting with visceral leishmaniasis to clinics in war-
torn Somalia, according to researchers from Médecins Sans Frontières (MSF). Marie-Eve Raguenaud (MSF, Brussels, Belgium) and colleagues analysed data on 1671 patients with visceral leishmaniasis admitted to the Huddur treatment centre of Bakool Region, Somalia, over a 5-year period (2002–06). The number of patients admitted with the sandfly-transmitted disease increased seven-fold from a yearly average of 140 in 2002–05 to 1002 in 2006. “Although the reported number of patients treated gives an underestimate of the real prevalence, the trend in case detection clearly shows a sharp increase during the past 16-month period (Sep 05–Dec 06)”, the researchers said. “Vector control and other preventive measures have not been implemented but could improve control in this area”, they added.
Jennifer Horwood
Study supports single treatment for neglected diseases For more information on oral drug therapy for multiple neglected tropical diseases see JAMA 2007; 298: 1911–24; DOI:10.1001/jama.298.16.1911
770
Neglected tropical diseases are a group of 13 infectious diseases including elephantiasis, hookworm, and African sleeping sickness, which affect 1 billion people worldwide. According to a new study, many of these common conditions can be treated simultaneously with existing and inexpensive oral drugs. “Over the past couple of years there has been increasing awareness of these diseases”, said lead author Madhuri Reddy (Hebrew Rehabilitation Center, Boston, MA, USA). “They may not be attention grabbers because the death toll is not the most shocking, but the effects on disability and productivity are enormous.” Reddy and colleagues reviewed 29 randomised controlled trials, of which three targeted four diseases simultaneously, 20 targeted three diseases, and six targeted two diseases. Their analysis showed that existing
oral drugs were able to treat two or more of the most prevalent neglected tropical diseases simultaneously, while four of the seven most prevalent diseases can be treated with a single oral drug combination. “The medications are inexpensive and are mostly donated by the pharmaceutical companies”, commented Alan Fenwick (Imperial College, London, UK). “Getting them to the people just once a year is a question of organisation, logistics, and health education, and the cost is just 50 US cents per person per year.” “In the long term, we need clean water and sanitation on a large scale to prevent these diseases”, he added. “In the short term, effective drugs will reduce sickness, and give children both a healthy start to life and protection from future serious consequences.” Charles King (Case Western Reserve, Cleveland, OH, USA) points out
that neglected tropical diseases are basically diseases of rural poverty, whose day-to-day impact on health and performance status is not well understood by health experts from the developed world. “Neglected tropical diseases are so common and their health effects are so insidious that they do not command the attention of health providers, policymakers, or funding agencies, which tend to focus on more acutely disabling diseases”, he said. A change in approach is needed by the governments of countries most affected, explained Reddy. “They need to research the best strategies for dispensing the treatment and develop practical ways of coordinating services. Additionally, more work is needed to optimise drug doses and dosing schedules.”
Roxanne Nelson
http://infection.thelancet.com Vol 7 December 2007
Infectious disease surveillance update For more information on visceral leishmaniasis in Somalia see PLoS Negl Trop Dis 2007; 1: e85; DOI:10.1371/ journal.pntd.0000085
Encephalitis in India More than 450 people have died from encephalitis this year in the Indian state of Uttar Pradesh. The worst affected regions are Gorakhpur, Khushi Nagar, and Mahrajganj. Local people first thought the disease was Japanese encephalitis (JE), which killed more than 1000 people in 2005. However, only 86 of more than 2000 cases have so-far been laboratory confirmed as being caused by JE virus and the other cases are of unknown origin; ten of these patients have subsequently died. In southeast Asia, cases of JE appear to have been increasing in recent years. The fatality rate for JE is generally high (5–30%) and approximately one-third of survivors have serious neurological sequelae. The outbreak in 2005 was followed by extensive immunisation in the region to prevent further spread, said health officials, and the JE vaccine was
considered effective in all areas where it had been given to children. Despite these vaccination programmes, however, “children with pre-existing antibodies or immunological failure and the presence of missing children are sufficient enough to cause an outbreak in these heavily populated regions”, T N Dhole (Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India) told TLID. “There is continued need for proper and meticulous completion of vaccination of all children below 15 years of age, vector control, segregation of piggeries from human colonies, and identification of the correct aetiological agent responsible for the cases of encephalitis”, he added.
Leishmaniasis in Somalia There has been a marked increase in the number of patients presenting with visceral leishmaniasis to clinics in war-
torn Somalia, according to researchers from Médecins Sans Frontières (MSF). Marie-Eve Raguenaud (MSF, Brussels, Belgium) and colleagues analysed data on 1671 patients with visceral leishmaniasis admitted to the Huddur treatment centre of Bakool Region, Somalia, over a 5-year period (2002–06). The number of patients admitted with the sandfly-transmitted disease increased seven-fold from a yearly average of 140 in 2002–05 to 1002 in 2006. “Although the reported number of patients treated gives an underestimate of the real prevalence, the trend in case detection clearly shows a sharp increase during the past 16-month period (Sep 05–Dec 06)”, the researchers said. “Vector control and other preventive measures have not been implemented but could improve control in this area”, they added.
Jennifer Horwood
Study supports single treatment for neglected diseases For more information on oral drug therapy for multiple neglected tropical diseases see JAMA 2007; 298: 1911–24; DOI:10.1001/jama.298.16.1911
770
Neglected tropical diseases are a group of 13 infectious diseases including elephantiasis, hookworm, and African sleeping sickness, which affect 1 billion people worldwide. According to a new study, many of these common conditions can be treated simultaneously with existing and inexpensive oral drugs. “Over the past couple of years there has been increasing awareness of these diseases”, said lead author Madhuri Reddy (Hebrew Rehabilitation Center, Boston, MA, USA). “They may not be attention grabbers because the death toll is not the most shocking, but the effects on disability and productivity are enormous.” Reddy and colleagues reviewed 29 randomised controlled trials, of which three targeted four diseases simultaneously, 20 targeted three diseases, and six targeted two diseases. Their analysis showed that existing
oral drugs were able to treat two or more of the most prevalent neglected tropical diseases simultaneously, while four of the seven most prevalent diseases can be treated with a single oral drug combination. “The medications are inexpensive and are mostly donated by the pharmaceutical companies”, commented Alan Fenwick (Imperial College, London, UK). “Getting them to the people just once a year is a question of organisation, logistics, and health education, and the cost is just 50 US cents per person per year.” “In the long term, we need clean water and sanitation on a large scale to prevent these diseases”, he added. “In the short term, effective drugs will reduce sickness, and give children both a healthy start to life and protection from future serious consequences.” Charles King (Case Western Reserve, Cleveland, OH, USA) points out
that neglected tropical diseases are basically diseases of rural poverty, whose day-to-day impact on health and performance status is not well understood by health experts from the developed world. “Neglected tropical diseases are so common and their health effects are so insidious that they do not command the attention of health providers, policymakers, or funding agencies, which tend to focus on more acutely disabling diseases”, he said. A change in approach is needed by the governments of countries most affected, explained Reddy. “They need to research the best strategies for dispensing the treatment and develop practical ways of coordinating services. Additionally, more work is needed to optimise drug doses and dosing schedules.”
Roxanne Nelson
http://infection.thelancet.com Vol 7 December 2007