The planet’s children and their neglected tropical diseases
Most children who currently live in extreme poverty in Africa, Asia and the Americas suffer from chronic and debilitating parasitic infections. Together, with ancient bacterial and viral infections such as trachoma, leprosy, Buruli ulcer, yaws and rabies, this group of 17 afflictions are collectively designated as neglected tropical diseases.
The latest information released in April by WHO conveys some chilling statistics about neglected tropical diseases (NTDs) affecting children living in poverty. Today, an estimated 876 million children require regular and periodic deworming medicines to treat their intestinal helminth infections — ascariasis, trichuriasis and hookworm infection. Another 276 million people, both children and adults, require treatment for schistosomiasis, while 1.23 billion require treatment for lymphatic filariasis (LF elephantiasis).
These numbers essentially indicate that all of the world’s children living below the World Bank poverty line of $1.25 per day require NTD treatments.
The reason we need to care so much about NTDs is not so much because they are fatal diseases, even though more than 10,000 children die annually from these conditions. Instead, their greater public health impact is the ability of NTDs to interfere with child growth, physical fitness and cognition and intellect. Through these mechanisms, NTDs also trap children in a perpetual cycle of poverty.
In response, the Global Network for Neglected Tropical Diseases, an initiative of the Sabin Vaccine Institute, was created to raise awareness about seven of the most common NTDs (through its END7 campaign) and to work with governments to promote the concept of delivering a low-cost package of treatments for NTDs. In most instances, the packages can be delivered for around 50 cents per person annually. The U.S. Agency for International Development’s NTD Program supports mass treatment programs in 25 low-income countries. In addition, the United Kingdom’s Department for International Development provides vital support. Through such approaches, at least two important NTDs — LF elephantiasis and trachoma — are being eliminated as public health problems.
However, we also feel that the disease-endemic countries themselves have a key role in shaping and envisioning a future in which children can live without NTDs. India and Nigeria, in particular, account for approximately one-third of the world’s children who suffer from intestinal worms and half of the planet’s population who require treatment for LF elephantiasis. Moreover, Nigeria alone accounts for one-quarter of the cases of schistosomiasis.
Efforts in India
The government of India is now aggressively pursuing a campaign to eliminate LF elephantiasis. Traditionally, India has been “ground zero” for this horrific condition, which distorts the limbs, breasts, and genitals of tens of millions of people. India has recently launched one of its largest public health campaigns known as “Hathipaon Mukt Bharat” (Filaria Free India) by treating more than 400 million people in 17 endemic states with an annual dose of the anti-filarial drug Hetrazan (diethylcarbamazine citrate, Lederle). Since it is typically co-administered with Albenza (albendazole, Amedra Pharmaceuticals), diethylcarbamazine citrate is believed to also have a significant impact on reducing the number of India’s children who simultaneously have intestinal helminths.
To achieve its goals, the Indian Ministry of Health and Family Welfare worked with the Global Network to launch a series of public service announcements (PSAs) to draw attention to the large-scale mass drug administration and the importance of taking preventive medicine. India has a great track record of eradicating smallpox and defeating polio. However, drug treatment compliance remains a major challenge, and educating and informing the population through PSAs will be a key advocacy tool. Ultimately, we believe that through the simple solution of taking one dose of free, safe pills given to affected communities, LF elephantiasis will be the next big disease domino to fall!
Goals in Nigeria
The government of Nigeria also has some heavy lifting to do in terms of controlling or eliminating its major NTDs, which like India, includes intestinal helminths and LF elephantiasis, but also includes schistosomiasis and onchocerciasis (river blindness). In all, Nigeria has the greatest number of people at risk for NTDs in Africa. According to WHO, of the 180 million people living in Nigeria, approximately 114 million require treatment for LF elephantiasis, 62 million need treatment for schistosomiasis, and 70 million children remain in need of deworming for their intestinal helminths. In many instances, the same individual will simultaneously suffer from all three of these NTDs, and require treatment with albendazole, Biltricide (praziquantel, Bayer Healthcare) and ivermectin simultaneously.
The goal is to reproduce Nigeria’s success in eradicating guinea worm by scaling up NTD treatments and packages in a multiyear national plan that currently extends to 2017 and then to 2020. The current plan is to provide treatments for more than 60 million people annually, but even this large-scale program only targets 20% of the population at risk for LF elephantiasis and will need to be expanded. For example, an additional 30 million children will require deworming annually to target their intestinal helminth infections.
Our hope is that by taking on India and Nigeria, two of the largest NTD-affected countries, their successes could set an example for the rest of the world. Mass treatments are not the only solution — we are also working to develop new generation vaccines for the NTDs — but through these extremely low-cost treatment interventions we can go a long way toward freeing a generation from debilitating and disfiguring NTDs. At the same time, such interventions are key cost-saving measures because they lift people out of poverty by allowing them to work and ensuring that children achieve their full physical growth and intellectual potential.
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Peter Hotez, MD, PhD, is Texas Children’s Hospital Endowed Chair of Tropical Pediatrics and president of the Sabin Vaccine Institute; he is also the dean of the National School of Tropical Medicine at Baylor College of Medicine.
Neeraj Mistry, MD, MPH, is the managing director of the Global Network for Neglected Tropical Diseases, an initiative of the Sabin Vaccine Institute.
Disclosures: Hotez and Mistry report no relevant financial disclosures.