NEGLECTED TROPICAL DISEASES ANCIENT COMPANIONS OF POVERTY www.who.int/neglected_diseases Innovative and Intensified Disease Management focuses on diseases for which cost-effective control tools do not exist. These diseases include Buruli ulcer, Chagas disease, human African trypanosomiasis and leishmaniasis. Oman, 2009. Preventive Chemotherapy and Transmission Control uses safe and effective drugs to treat diseases through large-scale preventive chemotherapy. The diseases include lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma and STH. Rep. of Korea, 2008. Neglected Zoonotic Diseases are endemic in many developing countries. Common diseases are anthrax, bovine tuberculosis, brucellosis, cysticercosis, echinococcosis and rabies, and their control helps save lives and alleviate poverty in rural communities. Chile, 2007. Neglected tropical diseases debilitate, deform, blind and kill ... Neglected tropical diseases: ancient companions of poverty Neglected tropical diseases are a group of infectious diseases that thrive in impoverished settings, especially in the heat and humidity of tropical climates. Most are diverse parasitic diseases, spread by vectors ranging from mosquitoes to blackflies to snails, sandflies, tsetse flies, bugs and common house flies. Other diseases such as dracunculiasis, fascioliasis and helminthiases are spread by contaminated water and soil infested with the eggs of worms. Transmission cycles are perpetuated under conditions of environmental contamination and poor standards of living and hygiene. Once widely dispersed, these diseases are now concentrated in settings of extreme poverty in remote rural areas of Africa and Latin America, and also in urban slums or in conflict zones. Of the world’s poorest 2.7 billion people (defined as those who live on less than US$ 2.00 a day), more than 1 billion are affected by one or more neglected tropical disease. In many parts of the world, these diseases gradually disappeared as standards of living and hygiene improved. Cycle of suffering and disability Neglected tropical diseases are not highly visible. Except for dengue, they do not cause explosive outbreaks that attract media attention. They cause disabling infections that sometimes kill but more often disfigure. In most cases, individuals are affected simultaneously by 5–7 of these diseases. Some diseases diminish the economic productivity of young adults, impair childhood growth and development, cause adverse pregnancy outcomes and affect individuals in the prime of life. These diseases cause blindness, disability , deformities or otherwise maim those who are infected. The development of these diseases is insidious. Severe impairments often occur after years of silent infection so patients may have been unaware of the need to seek care. Other neglected tropical diseases, such as dengue and dengue haemorrhagic fever, human African trypanosomiasis and Buruli ulcer, and zoonoses such as rabies, anthrax and brucellosis, can kill within days, weeks or months once an advanced stage of disease is reached. Tool-ready and tool-deficient diseases: a new approach Since 2003, the World Health Organization (WHO) has moved away from using a disease-centred approach towards treating neglected tropical diseases as a group, based on disease biology and through the use of large-scale integrated programmes involving safe, inexpensive and effective medicines. The tool-ready diseases, which affect the largest number of people globally, are those for which powerful control strategies are available and for which well developed implementation strategies are immediately feasible. Through the use of preventive chemotherapy, single-dose oral medicines such as ivermectin are being used to simultaneously control and eliminate lymphatic filariasis and onchocerciasis. Other medicines such as albendazole, ivermectin and praziquantel make the prevention, control and possible elimination of worm infections more likely than ever before. Control strategies for diseases defined as tool-deficient rely on costly and difficult-to-manage tools. For most of these diseases, such as Buruli ulcer, Chagas disease, human African trypanosomiasis and leishmaniasis, early detection and treatment are vital to avoiding irreversible disability or death. Simple, safe and cost-effective tools and approaches must be developed, including pesticide products, and they must be made accessible. Neglected tropical diseases mainly: • affect people in remote rural areas or urban slums who have no political voice; • are linked to poverty and occur in areas where safe drinking-water is lacking; where education is poor; and where there is poor sanitation, substandard housing and reservoirs for insects and other vector-borne diseases; • affect low-income countries where people are simultaneously affected by several diseases; • are mostly disabling and disfiguring but also deadly; • have low priority in national health programmes, and data and statistics to help prepare control strategies are limited; • remain hidden, and cause social stigmatization and discrimination; • afflict people, particularly children and women, with lifelong consequences, including severe physical pain, irreversible disability and gross disfigurements. “Together, we are upholding a fundamental principle of health development: equity. Access to life-saving and health-promoting interventions should not be denied for unfair reasons, including an inability to pay ... These diseases have international importance in sectors well beyond health.” Dr Margaret Chan, WHO Director-General, in her address to the first WHO Global Partners Meeting, 19 April 2007 © Eric Lafforgue © Eric Lafforgue © Eric Lafforgue © Pierre Virot NEGLECTED TROPICAL DISEASES