Neglected tropical diseases are a group of infections that are endemic in developing regions and cause significant disease burden. They include roundworm, hookworm, schistosomiasis, lymphatic filariasis, trachoma, sleeping sickness, and others. These diseases primarily affect poor populations in Africa, Asia, and Latin America. Integrated control programs involving mass drug administration, vaccination, sanitation efforts, and public-private partnerships can help eliminate neglected tropical diseases.

1. Neglected Diseases
Overview
By—Dr.Ashok Laddha—
Occupational Health Physician
Full Presentation in Process

2. BACKGROUND
 The neglected diseases are a group of tropical
infections which are especially endemic in low-income
populations in developing regions of Africa, Asia, and
the Americas. Different groups define the set of
diseases differently. Together, they cause an estimated
500,000 to 1 million deaths annually and cause a global
disease burden higher than that of HIV-AIDS.

3. List of Neglected diseases
 Neglected tropical diseases include in order of
decreasing prevalence: roundworm (ascariasis),
whipworm (trichuriasis), hookworm (necatoriasis,
ancylostomiasis), Snail Fever (schistosomiasis),
Elephantasis (lymphatic Filariasis), Tracheoma, Kala-
azar black fever , Chagas Disease , leprosy, Africal
sleeping sickness (African trypanosomiasis), Guinea
worm (dracunculiasis), and buruli ulcer.Yaws,Dengu
Fever,Rabies

4. Other Neglected diseases
 CSOM
 Snake bite
 Nodding syndrome
 Scabies
 Cysticercosis
 River Blindness
 Amebiasis
 Chiken gunia
 Japanese Encephalitis

5. neglected zoonotic diseases-OH
 Anthrax
 Brucellosis
 Bovine TB
 Cystecercosis and Neuro Cystecercosis
 hydatid disease
 RabIes
 HAT

6. CAUSES
 Bacteria
 Virus
 Protozoa
 Helminth

7. Reason For Neglect
 Prevalent in poor of developing countries hence
overlooked
 Major Resources Mobilized for 3 BiG Diseases
HIV/AIDS,MALARIA and Tuberculosis cause of their
higher mortality and public awareness
 MANY ARE ASYMPTOMATIC AND HAVE LONG
INCUBATION PERIOD
 “Neglected tropical diseases have traditionally ranked
low on national and international health agendas

8. Indian Scenario
 India is the epicenter for NTDs
 High Prevalence Rate
 India bears a disproportionately high burden of NTDs,
with over half of the 17 WHO classified NTDs at
endemic levels. It is estimated that more than 310
million people are infected, and that a significant
proportion of those afflicted, especially children, may
be simultaneously infected with more than one NTD.

9. Burden of Leading NTDs in India
 Ascariasis------------------17%
 Trichuriasis----------------12%
 Hookworm infection-----12%
 Lymphatic filariasis ------5%
 Tracoma--------------------1%
 Leprosy---------------------41%
 Rabies---------------------- 36%
 Japanese encephalitis,rabies and Visceral leishmaniasis
figures not determined

10. London Declaration on NTDs
 In January 2012, an international coalition of pharmaceutical
companies, non-governmental organisations (NGOs) and
governments pledged to control or eliminate 10 NTDs by 2020 in
line with targets set by the WHO. These commitments, captured
in the landmark London Declaration on Neglected Tropical
Diseases, represented the largest coordinated action to date to
address the burden of NTDs. Of the ten NTDs included in the
London Declaration, the diseases that are most prevalent in
India include lymphatic filariasis, soil transmitted helminthiases
(STH), trachoma, leprosy and visceral leishmaniasis. Other
NTDs not included in the London Declaration but of a high
burden in the country include dengue, rabies, cysticercosis and
Japanese encephalitis.

11. Vaccines for NTDs
 Vaccines are one of the most cost-effective preventive health interventions, yet
they are largely unavailable for the 17 NTDs. For example, both a pre-exposure
and post-exposure prophylaxis vaccine for rabies exists, although access and
affordability to these vaccines remains a challenge throughout India.
 A vaccine against dengue is rapidly becoming a reality and several companies
have dengue vaccine candidates under clinical development or are initiating
discovery programmes. Sanofi is anticipated to launch a vaccine in 2015, with
tiered pricing options for wealthy, middle- and lower-income countries.
 The
 Serum Institute of India, in collaboration with the University of Mahidol in
Thailand, recently announced a partnership to develop a dengue vaccine, and a
similar partnership has been announced by a Malaysian company to partner
with Russian institutes. Dengue, which primarily affects those in urban centres
in India, is on the radar of policy makers due to increased media attention and
awareness raising campaigns.
 Vaccine candidates for other NTDs are less advanced and have fewer players
involved.

12. soil-transmitted Helminths
 Ascariasis,
 Trichuriasis and
 Hookworm infections

13. Ascariasis
 Ascariasis is the most common helminthic infection,
with an estimated worldwide prevalence of 25% (0.8-
1.22 billion people)
 Symptomatic ascariasis may manifest as growth
retardation, pneumonitis, intestinal obstruction, or
hepatobiliary and pancreatic injury.
 The prevalence of ascariasis is highest in children aged
2-10 years, with the highest intensity of infection
occurring in children aged 5-15 years who have
simultaneous infections with other helminths

14. Trichuris trichiura
 Globally, Trichuris trichiura, or whipworm, is a very
common Intestinal H.Infection
 about one quarter of the world's population is thought
to carry the parasite. Principally a problem in tropical
Asia and, to a lesser degree, in Africa and South
America,
 Poor hygiene is associated with trichuriasis
transmission, and children are especially vulnerable
because of their high exposure risk.
 rarely fatal and is usually asymptomatic

15. Hookworm infections
 hookworm infections occur in an estimated 576 to 740
million people worldwide
 It mainly affects people in developing nations in the tropics
and subtropics due to poor sanitation.
 Hookworms are parasites –it affects lung and small
intestine
 can become infected with hookworms by coming into
contact with soil that contains their eggs or larvae. The
larvae enter your skin, travel through your bood stream,
and enter your lungs.
 Anemia, Nutritional deficiencies and ascites are the main
complications

16. Buruli Ulcer
 The risk of mortality is low
 Secondary infection is lethal
 High Morbidity— disability, S kin lesion, Disfigurement
 Caused by Bacteria
 Buruli ulcer, also known as Bairnsdale ulcer, Daintree ulcer,
Mossman ulcer, and Searl ulcer
 It is caused by a toxin-producing mycobacteria, Mycobacterium
ulcerans
 Buruli ulcer was first described by Sir Albert Cook in patients
from Buruli County in Uganda, and the causative organism was
isolated in 1948 by MacCallum in the Bairnsdale region of
Victoria, Australia
 Antibiotic treatment with cidal and static reduces the surgical
intervention

17. Nodding Syndrome
 Affects children
 Littile known disease detected in Sudan in 1960
 NAME GIVEN CAUSE OF ITS CHARACTERSTIC
PATHOLOGICAL NODDING SEIZURES
 The seizure starts when children begins eating or when they feel
cold
 Restricted to small region of sudan, tanzania and Uganda
 It is a mentally and physically disabling disease
 Possible cause--- infestations of the parasitic worm Oncocerca
volvulus
 Treatment--- symptomatic—anti-epileptic. Malaria drugs
,correction of anemia and malnutrition an nutritional
rehabilitation

18. River Blindness
 Caused by parasitic Worm Onchocerca volvulus ---lives 14
yrs in human body
 Transmitted to human by blackfly bite
 The flies breed in fast flowing streams of river
 Common in people who live near the river
 Death of Microfilaria librates the toxin which is very toxic
to eyes an skin
 Repeated exposure can result in ir-reversible blindness and
skin disfigurement----Lizard skin
 Treatment---Ivermectin single dose or in combination with
doxy

19. YAWS
 This disease is a bacterial infection that affects mainly the skin, bone
and cartilage.
 Within 90 days Mother nodule appears—which becomes warty in
appearance Nearby "daughter yaws" may also appear simultaneously
 3 Stages—1ry ,2 ndry and tertiary disease
 rarely fatal, yaws can lead to deformities and disability.
 It is not known how many people have the disease. However, tens of
thousands of cases have been reported in Ghana, Indonesia and Papua
New Guinea, with most occurring in children younger than 15.
 Yaws is spread by direct contact with the fluid from a lesion of an
infected person (skin to skin contact)
 Common in 14 tropical countries
 Treatment—Single dose of penicillin, or azithromycin

20. sleeping sickness
 sleeping sickness, also called African trypanosomiasis,
 transmitted by the tsetse fly
 caused by two germs (protozoa), Trypanosoma brucei
rhodesiense and Trypanosomoa brucei gambiense.
 Sleeping sickness is characterized by fever, inflammation
of the lymph nodes, and involvement of the brain and
spinal cord leading to profound lethargy, frequently ending
in death.
 The earlier sleeping sickness is diagnosed and treated, the
greater are the chances for recovery.
 Sixty million people who live mainly in rural parts of East,
West and Central Africa are at risk of contracting sleeping
sickness

21. sleeping sickness--Prevention
 isolation and proper treatment of all infected persons,
including large numbers of asymptomatic chronic carriers,
 protection of humans from bites of tsetse flies by the use
of insecticides and by maintaining extensive clearings
around villages and residence compounds,
 prophylactic doses of Suramin or of diamidine compounds
once every 60 to 90 days for persons who must enter the
jungle, so that they will not become infected from TSETSE
FLY bites, and
 occasional removal of entire villages from endemic to
disease-free zones. Some have suggested that entire
populations of wild animals be exterminated, since they
tend to become reservoirs of the disease.

22. Cysticercosis
 A tape worm infection
 Widely common
 The Clinical syndromes caused by T solium are categorized as either
neurocysticercosis (NCC) or extraneural cysticercosis (Intestinal)
 Neurocysticercosis is further divided into parenchymal and
extraparenchymal disease
 An estimated 50-100 million people are infected with cysticercosis
worldwide
 Areas of endemic disease include Central and South America, India,
China, Southeast Asia, and sub-Saharan Africa
 Seizures may be focal, focal with secondary generalization, or
generalized.
 Headaches—Migraine type--- nausea or vomiting, altered mental
status, dizziness, and decreased visual acuity
 Spinal cord involvement

23. Cysticercosis
 Taeniasis is acquired by humans through the
inadvertent ingestion of their cysticerci in
undercooked pork or beef.
 Medicines to kill the parasites (antiparasitic
treatments such as albendazole or
praziquantel)· Powerful anti-inflammatory
medications (steroids) to reduce swelling
 Prevention:Infections with T. saginata can be managed
through an individual clinical approach due to its low
pathogenicity (low ability to spread from host to host).

24. Chagas Disease
 Chagas disease is caused by a parasite. It is common in
Latin America but not in the United States. Infected blood-
sucking bugs, sometimes called kissing bugs, spread it.
When the bug bites you, usually on your face, it leaves
behind infected waste. You can get the infection if you rub
it in your eyes or nose, the bite wound or a cut. The disease
can also spread through contaminated food, a blood
transfusion, a donated organ or from mother to baby
during pregnancy.
 also known as American trypanosomiasis, is a potentially
life-threatening illness caused by the protozoan parasite,
Trypanosoma cruzi (T. cruzi).

25. Chagas Disease
 Acute Phase- lasts for the first few weeks or months of infection. It usually
occurs unnoticed because it is symptom free or exhibits only mild symptoms
and signs that are not unique to Chagas disease. The symptoms noted by the
patient can include fever, fatigue, body aches, headache, rash, loss of appetite,
diarrhea, and vomiting. The signs on physical examination can include mild
enlargement of the liver or spleen, swollen glands, and local swelling (a
chagoma) where the parasite entered the body. The most recognized marker of
acute Chagas disease is called Romaña's sign, which includes swelling of the
eyelids on the side of the face near the bite wound or where the bug feces were
deposited or accidentally rubbed into the eye
 Chronic Phase—Remain Silent for long period MAY develop following
complications
 Cardiac Complications
 Intestinal Complications

26. Transmission
 People also can become infected through:
 congenital transmission (from a pregnant woman to her
baby);
 blood transfusion;
 organ transplantation;
 consumption of uncooked food contaminated with feces
from infected bugs; and
 accidental laboratory exposure.
 Treatment: medications benznidazole (Rochagan, Ragonil)
and nifurtimox (Lampit) may eliminate or reduce the
number of parasites in the body.

27. Prevention
 Travelers who sleep indoors, in well-constructed facilities
(for example, air-conditioned or screened hotel rooms), are
at low risk for exposure to infected triatomine bugs, which
infest poor-quality dwellings and are most active at night.
 Preventive measures include spraying infested dwellings
with residual-action insecticides,
 using bed nets treated with long-lasting insecticides,
 wearing protective clothing, and
 applying insect repellent to exposed skin.
 In addition, travelers should be aware of other possible
routes of transmission, including bloodborne and
foodborne.

28. Preventive Measures--NTDs
 Specific prevention strategies vary from disease to disease
 Good Sanitation
 Provision of sources of safe drinking water
 Adequate housing
 Access to health care
 Pesticide spray
 Use of mosquito nets
 Use of boiling water
 Hand washing
 Availability of Drugs
 Vaccination-------? Should be cost effective

29. Four factor--Control
 neglected tropical disease control
 the commitment of pharmaceutical companies to
provide free drugs;
 the scale of programmes;
 the opportunities for synergizing delivery modes;
 and the often non-remunerated volunteer
contribution of communities and teachers

30. Control and elimination NTDs
 Prioritize an integrated approach targeting multiple
NTDs coupled with MDA,
 The global health community should increase
advocacy and funding for NTDs for public awareness
an policy makers
 Integrated control programs which involve NTDs and
other major disease control programs should be
encouraged where possible
 public-private partnership to combact NTDs

31. integrated efforts
 pharmaceutical companies
 multilateral and bilateral funding agencies
 National ministries of public health, education and
agriculture, civil society, and
 the affected communities themselves
 Corporate Sector----all working in collaboration on a
common effort
 Use of SAC Model

32. commitment
“NTDs can be eliminated. It
requires the will of the
government ,will of educated
partners, stake holders, and
helpers.”
corporate commitment

33. challenge
 The fact that NTDs are mainly diseases of the poorest
and most marginalised communities is a challenge in
itself

34. TAKE HOME MESSAGE
Health education and
awareness is mainstay for the
success
mass drug administration and
vaccination campaigns are
highly effective at reducing
NTDs