tropical health

1. Philadelphia, 6 December 2011
Mirta Roses, M.D., M.P.H.
Director
Pan American Health Organization
American Society for Tropical Medicine
and Hygiene
Freeing the Americas from NIDs:
Addressing the Unfinished Agenda

2. Neglected diseases, forgotten
diseases.
Forgotten populations.
What are these diseases, and where are they?
Who gets infected?
Do health workers really recognize
the NIDs?...

3. A Case of Forgotten People, Forgotten Diseases

4. Neglected infectious diseases affect the
most vulnerable people
Forgotten
diseases,
forgotten
populations

5. Key neglected infectious
diseases in LAC
• 12 diseases are targeted under
PAHO’s 2009 Resolution on NIDs:
– 10 targeted for elimination…
– 2 targeted for reducing disease burden…

6. 6
Ten diseases targeted for
elimination as a public health
problem
 Lymphatic Filariasis
 Onchocerciasis
 Blinding Trachoma
 Chagas disease (domestic
vectors, blood transfusion)
 Human Rabies
transmitted by Dogs
 Plague
 Leprosy/Hansen’s disease
 Malaria (where possible)
 Neonatal Tetanus
 Congenital Syphilis

7. 7
Two diseases targeted to reduce the burden of
disease, using available tools
• Schistosomiasis
(S. mansoni)
• Soil-transmitted
helminthiasis
– Ascaris, Trichuris,
human
hookworms
 Persistence in areas or
sites with a very high
prevalence
 Limited knowledge of the
epidemiological situation

8. Many of these diseases are overlapping:
affecting the same people within the same
geographical areas
6 NIDs mapped at the first
administrative level:
• Schistosomiasis
• Lymphatic filariasis
• Onchocerciasis
• Trachoma
• Human Rabies
transmitted by Dogs
• Soil-transmitted
Helminthiasis

9. What is the Burden of Disease in Latin
America and the Caribbean for NIDs?
Although disease burden in LAC is 8.8% of the global
burden:
• Soil-transmitted helminthiasis is widely
disseminated: 43 million children at risk
• Pockets of transmission of schistosomiasis in Brazil,
Saint Lucia, Suriname and Venezuela
• Lymphatic filariasis in Brazil, Guyana, Haiti and the
Dominican Republic
• Onchocerciasis in Brazil, Ecuador, Guatemala,
Mexico, and Venezuela
• Trachoma in Brazil, Colombia, Guatemala and
Mexico
5 million DALYs , higher than the burden of HIV disease in the Region

10. Other challenge: Antimicrobial
Resistance… NIDs NOT Exempt!
• Some examples
– Leprosy
– Leishmaniasis
– Mycosis
– Trachoma
• Special Risks of Resistance
– Chronically
immunocompromised
individuals

11. How do we reach
Elimination?
Think of vulnerable peoples.
Keep these diseases on the radar.
Diagnosis and treatment
are necessary but not
enough.

12. Reduce
suffering and
impairment of
vulnerable
populations due
to NIDs in LAC
Regional commitment (PAHO
Directing Council resolutions) and
advocacy
National commitment:
Formulate and finance
Integrated Plans of
Action (PoA) for NIDs
Implementation of PoA at
local level + Partnerships
Technical cooperation from
PAHO to countries to build
capacities
We can eliminate NIDs in LAC working first within the
health sector…by achieving universal coverage through
primary care

13. Addressing the
Social Determinants
of Health
Leadership of the
Health Sector
Improve health workers skills
Promote innovation for
diagnosis and treatment
Be People-centered and
geographically focused: mapping
NIDs for decision-making
Political Commitment for Intra-
and inter-sectoral integration:
increase capacity, efficiency of resources
Increase Access to health
services/primary care
Sensitize and Motivate: with help
of Local Leaders, find and reach people
at risk in rural areas & shantytowns
Increase Access to water and
sanitation, primary education,
improved housing
Use Poverty-Reduction
Strategies: to reduce inequities
and empower communities
Inter-programmatic and inter-sectoral Integration: the approach needed

14. Combating
over-the-
counter sales
Health
professional-
directed
treatment
schemes
Monitoring
systems
Rational use
of medicines
Protect the Medicines we have…
Prevention and Mitigation of Antimicrobial
Resistance – via Rational Use of Medicines

15. Although still “neglected”, we
have success stories to
share…
We need more stories, to reach
millions more

16. Onchocerciasis
Colombia has eliminated the disease: no more transmission,
blindness or other morbidity due to this disease
Ecuador, Guatemala and Mexico are close to elimination
Main challenge found in the Yanomami population on the
Brazil- Venezuela border

17. Chagas disease
Transmission by the primary vector has been
interrupted in 14 countries
20 countries doing blood-bank screening
Challenges: screening of pregnant women to prepare for
opportune treatment of infected newborns, and access to
drugs

18. Lymphatic filariasis (LF)
Three countries have been removed from the WHO
list of LF-endemic countries
LF Treatment has been integrated with treatment for
STH in 3 countries
Despite Haiti’s earthquake in 2010, four million people
were treated
Challenges: Nearly 100% of Haiti’s 10 million people
at risk, need to receive treatment once per year

19. Leprosy/Hansen’s disease
All countries except Brazil have eliminated leprosy as a
public health problem , measured as an overall national
average
When broken down further to the level of
province/state/department, 19 of 35 countries have
eliminated leprosy down to this level
Challenges: Elimination in Brazil and sustaining local
capacity once the national-level elimination goal is reached
(protecting our achievements)

20. Integrated Plans of Action (PoA) for NIDs
Use existing tools
Internal and external financing
Strategic alliances and partnerships
Monitoring and evaluation
Working in networks and with communities
Promotion of research and innovation
Training and formation of public health professionals
Key actions, innovation, collaboration

21. Thank you
Together we can see the END of the NIDs!
Together we can win the battle!
It’s an ethical and moral imperative!