My Guest Lecture at Mahamicron 2014 - XX Maharashtra Chapter Conference of the Indian Association of Medical Microbiologists, Nagpur, 19/09/2014 to 21/09/2014. Dr Rajesh Karyakarte Delivered this Guest Lecture on 21/09/2014 at 9:30 AM.

1. Dr. Rajesh Karyakarte MD
Professor and Head,
Department of Microbiology,
Government Medical College, Akola,
Maharashtra, India
MAHAMICROCON 2014

2.  Neglected tropical diseases (NTDs) are caused by
diverse pathogens, majority being parasites
 Associated with:
 poverty and
 deprived environments in tropics
 NTDs also anchor large populations in poverty

3.  Most of the NTDs are ancient and have plagued
humanity for centuries
 NTDs disappear as living conditions and hygiene
improve
 NTDs affect an estimated 100 Crore people living in:
 Remote rural areas and
 Urban slums of tropical countries

4.  NTDs are found in places with low socio-economic
progress, where:
 Substandard housing,
 Lack of access to safe water and sanitation,
 Filthy environments, and
 Abundant insects and other vectors
contribute to efficient transmission of infection

5.  In 2007, WHO launched a “Global Plan to Combat
Neglected Tropical Diseases 2008–2015”
 In 2010, the first WHO report on neglected tropical
diseases, “Working to overcome the global impact
of neglected tropical diseases” was released
 In 2013, the second WHO report on neglected
tropical diseases, “Sustaining the drive to overcome
the global impact of neglected tropical diseases”
was released

6.  In all 17 NTDs have been profiled in the first WHO
report on neglected tropical diseases
 Some NTDs comprise separate infections and thus
separate diseases
 For example, soil-transmitted helminthiases
include:
 Ascariasis
 Trichuriasis
 Hookworm diseases

7.  NTDs are endemic in 149 out of 260 (57.30%)
countries and territories
 Of these,
 At least 100 countries are endemic for 2 or more
NTDs
 And 30 countries are endemic for 6 or more
NTDs

8. Parasitic
Chagas disease (American trypanosomiasis)
Cysticercosis
Dracunculiasis (guinea-wormdisease)
Echinococcosis
HumanAfrican trypanosomiasis (sleeping sickness)
Leishmaniasis
Lymphatic filariasis (elephantiasis)
Schistosomiasis (bilharziasis)
Onchocerciasis (river blindness)
Foodborne trematode infections
Soil-transmitted helminthiasis

9. Bacterial
Trachoma
Buruli ulcer (Mycobacterium ulcerans infection)
Leprosy (Hansen disease)
Endemic treponematoses
Viral
Dengue
Rabies

10.  Dengue
 Rabies
 Leprosy
 Trachoma
 Cysticercosis
 Echinococcosis
 Leishmaniasis
 Lymphatic Filariasis
 Soil transmitted helminthiasis
 Yaws and Guinea worm infection - eliminated

11.  Onchocerciasis and trachoma cause blindness
 Leprosy and lymphatic filariasis cause deformation
that hinder:
 Economic productivity and
 Normal social life
 Buruli ulcer maim patients when limbs have to be
amputated to save their life

12.  Human African trypanosomiasis (sleeping sickness)
severely debilitates before it kills, and mortality
approaches 100% in untreated cases
 Without post-exposure prophylaxis, rabies causes
acute encephalitis and is always fatal

13.  Leishmaniasis, in its various forms:
 Cause deep and permanent scars or
 Entirely destroys the mucous membranes of the
nose, mouth and throat
In its most severe form, it attacks the internal
organs and is rapidly fatal, if untreated

14.  Chagas disease damages heart of young adults,
reducing the labor force
 Severe schistosomiasis:
 Decreases school attendance,
 Contributes to malnutrition, and
 Impairs the cognitive development of children

15.  Guinea-worm disease debilitates the agricultural
work force, during peak season, due to
excruciating pain
 Dengue affects mostly poor, urban populations;
 it is also the leading cause of hospital admissions
in several countries

16.  The consequences of NTDs are very costly for
societies and for health care, for example:
 Intensive care is required for dengue hemorrhagic
fever and clinical rabies
 Surgery and prolonged hospital stays is necessary
for Chagas disease and Buruli ulcer

17.  The consequences of NTDs are very costly for
societies and for health care, for example:
 Rehabilitation for leprosy and lymphatic filariasis
 Cumbersome administration of toxic drugs for
sleeping sickness and leishmaniasis
 Expensive post-exposure immunization for Rabies
that is not affordable in many Asian and African
countries

18.  A proxy for poverty and disadvantage
 NTDs have an enormous impact on individuals, families
and communities in developing countries in terms of
▪ disease burden
▪ quality of life
▪ loss of productivity
▪ aggravation of poverty
▪ high cost of long-term care
 They constitute a serious obstacle to socioeconomic
development and quality of life at all levels

19.  Affect populations with low visibility and little
political voice
 NTDs affect low-income and politically
marginalized people living in rural and urban areas
 NTDs are concentrated in remote rural areas or
urban slums
 NTDs are linked to poverty hence offer little
incentive to industry to invest in developing new
or better products for a market that cannot pay

20.  Do not travel widely
 NTDs generally do not spread widely, and so
present little threat to the inhabitants of high-income
countries
 Distribution of NTDs is restricted by climate,
vectors and reservoir hosts to the tropics
 NTDs rarely affect travelers, exceptional example
being, outbreaks of dengue

21.  Cause stigma and discrimination, especially of
girls and women
 Many NTDs cause disfigurement and disability,
leading to stigma and social discrimination
 In some cases, their impact disproportionately
affects girls and women, whose marriage
prospects may diminish or who may be left
vulnerable to abuse and abandonment
 Some NTDs contribute to adverse pregnancy
outcomes

22.  Have an important impact on morbidity and
mortality
 A large body of evidence, published in peer-reviewed
medical and scientific journals, has
demonstrated that NTDs adversely affect
morbidity and mortality
 This refutes the once-widespread assumptions
held by the international community

23.  Are relatively neglected by research
 Research is needed to develop new diagnostics
and medicines, and to make accessible
interventions to prevent, cure and manage the
complications of all NTDs

24.  Can be controlled, prevented and possibly
eliminated using effective and feasible
solutions
 WHO’s Strategies:
1. Preventive chemotherapy;
2. Intensified case-management;
3. Vector control;
4. The provision of safe water, sanitation and hygiene; and
5. Veterinary public health using the one-health concept
 These strategies make control; prevention and even
elimination of several NTDs feasible at a low cost

25.  Mass distribution of seven broad-spectrum
anthelminthic medicines:
 Albendazole,
 Diethylcarbamazine,
 Ivermectin,
 Levamisole,
 Mebendazole,
 Praziquantel, and
 Pyrantel

26.  WHO recommends these medicines because of
their:
 Ease of administration and
 Efficacy
 Excellent safety profiles and
 Minimal side-effects

27.  Preventive chemotherapy is the main
intervention for controlling:
 Lymphatic filariasis,
 Onchocerciasis,
 Schistosomiasis, and
 Soil-transmitted helminthiases

28.  It is the principal strategy for controlling and
preventing those NTDs:
 Where no medicines are available for preventive
chemotherapy
 That are asymptomatic for long periods
 That require confirmation of diagnosis because of
the toxicity of medicines

29.  WHO recommends this intervention strategy for
prevention and control of:
 Buruli ulcer,
 Chagas disease,
 Human African trypanosomiasis,
 Leishmaniasis (in its cutaneous, mucocutaneous
and visceral forms),
 Leprosy, and
 Yaws

30.  Vector-borne diseases account for about 16% of
the estimated global burden of communicable
diseases
 The judicious use of pesticides is important for
the control of vector-borne diseases

31.  Most NTDs involve vector transmission:
 Insects:
▪ Dengue,
▪ Chagas disease,
▪ Human African trypanosomiasis,
▪ Leishmaniasis,
▪ Lymphatic filariasis and onchocerciasis;
 Snails:
▪ Foodborne trematodiasis, and
▪ Schistosomiasis;
 Crustaceans:
▪ Dracunculiasis, and
▪ Foodborne paragonimiasis

32.  Statistics compiled by the United Nations reveal
that:
 900 million people lack access to safe drinking-water,
and
 2500 million lack access to appropriate sanitation
 Until this situation improves, many NTDs and other
communicable diseases will not be eliminated, and
certainly not eradicated

33.  Veterinary public health is defined as the sum of all
contributions to the physical, mental and social
well-being of humans through an understanding
and application of veterinary sciences
 In 2008, a new concept, known as “one health”, was
defined as “the collaborative effort of multiple
disciplines to attain optimal health for humans,
animals, and our environment”.

34.  NTDs with a zoonotic component:
 Cysticercosis,
 Echinococcosis,
 Foodborne trematodiasis,
 Human African trypanosomiasis,
 Leishmaniasis, and
 Rabies

35.  DALYs: Disability-Adjusted Life Years
 Developed to assess:
 Quantitative and comparative burden of
individual diseases on human life
 DALYs give an estimate of the sum of years of
potential life lost due to:
 Premature mortality and
 The productive life lost

36. Neglected tropical
disease
DALYs (in
thousands)
Human African
trypanosomiasis
1673
Chagas disease 430
Schistosomiasis 1707
Leishmaniasis 1974
Lymphatic filariasis 5941
Onchocerciasis 389
Ascariasis 1851
Trichuriasis 1012
Hookworm disease 1092
The global burden of disease: 2004 update. Geneva, World Health Organization, 2008.

37.  WHO’s conservative assessment:
 Lymphatic filariasis causes a loss of almost US$ 1
billion a year in lost productivity
 The annual expenditure for rabies prevention and
control exceeds US$ 1 billion
 Cysticercosis: The estimated social monetary cost
in India: US$ 15.27 million
 Dengue fever: The average total economic burden
in India was estimated at US$29.3 million (Cost in
private health sector is 4 times this sum)

38.  How many DALYs can be averted by the
investment in control gives a proper cost benefit
ratio
 The cost of treating a patient with lymphatic
filariasis using ivermectin and albendazole (both
donated) ranges from US$ 0.05 to 0.10
 While the cost of the DALYs averted is reckoned to
be US$ 5.90

39. 1) Working to overcome the global impact of
Neglected Tropical Diseases: First WHO report on
Neglected Tropical Diseases
ISBN 978 92 4 156409 0 (NLM Classification: WC 680)
2) Sustaining the drive to overcome the global
impact of Neglected Tropical Diseases: Second
WHO report on Neglected Tropical Diseases
ISBN 978 92 4 156454 0 (NLM Classification: WC 680)