Headline

(EBBS 668) Infectious and Neglected

Tropical Diseases (LR8)

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 CLASS ASSIGNMENT TO BE USED IN CONTINOUS ASSESSMENT
Answer SIX of the following questions. This should include questions 9
& 10

1. About ‘Neglected Tropical Diseases’

a. Why are some diseases grouped together and labelled ‘Neglected
Tropical Diseases’?

According to the World Health Organization (WHO, 2022) criteria for classification, NTDs
are diseases, disorders, or conditions that are relatively neglected by scientific research and
public/private funding, compared to the magnitude of the health problem, disproportionately
affect poor and marginalized populations, causing important morbidity and mortality,
therefore justifying a global response; mainly affect, but are not limited to, communities
living in tropical and subtropical areas, especially those far from healthcare settings, can be
prevented and controlled by public health interventions.

b. What are the features of ‘Neglected Tropical Diseases’ that make their
grouping together appropriate and convenient?

i. NTDs represent the most common infections of people living in extreme poverty in sub-
Saharan Africa, Asia, and Latin America and the Caribbean.
ii. They disproportionately affect the “bottom billion,” which refers to the approximately 1.4
billion people who live below the World Bank poverty figure of US$1.25 per day.
iii. Among the bottom billion, the NTDs result in chronic infections lasting years or even
decades.
iv. The NTDs produce chronic disability that results in impaired child growth and intellectual
and cognitive development, impaired pregnancy outcomes, and decreased worker
productivity.

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 v. Through these mechanisms, the NTDs adversely affect not only health but also childhood
education and ultimately economic productivity; the NTDs represent an underlying reason
why the bottom billion cannot escape poverty.
vi. Many of the NTDs also cause blindness and disfigurement that are psychologically
devastating and result in social stigma.
vii. This high level of morbidity, economic impairment, and stigma does not necessarily translate
into large numbers of deaths; overall, the NTDs cause high-morbidity but low-mortality
conditions.
viii. In contrast to emerging infections such as SARS, and avian influenza, there is a
“nonemerging” character about the NTDs. Instead, the NTDs have afflicted humankind for
centuries and there are accurate descriptions of some of the NTDs in ancient texts.

2. Explain the ‘Kigali Declaration’ and the three pillars that underpin current
global efforts in combating NTDs. (https://unitingtocombatntds.org/kigali-
declaration/)

The Kigali Declaration on neglected tropical diseases (NTDs) is a high-level, political declaration which
aims to mobilize political will and secure commitments to achieve the Sustainable Development Goal 3
(SDG3) target on NTDs and to deliver the targets set out in the World Health Organization’s Neglected
Tropical Disease Roadmap (2021-2030).
The Declaration is a multi-year tool aiming to mobilize political will and secure commitments that will
help achieve global targets and goals from the World Health Organization’s Road maps on NTDs.

The three pillars underpinning efforts to eradicate NTDs include:

i. accelerate programmatic action
ii. intensify cross-cutting approaches
iii. change operating models and culture to facilitate country
ownership

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 3. Explain the following as applied in tuberculosis control

a. DOTS
The World Health Organization (WHO) and the International Union against TB and Lung Disease
(IUATLD) promote universal adoption of Directly Observed Treatment, Short-Course (DOTS) for TB
treatment as a means to improve TB treatment outcomes. The DOTS strategy focuses on five main
points of action. These include government commitment to control TB, diagnosis based on sputum-
smear microscopy tests done on patients who actively report TB symptoms, direct observation short-
course chemotherapy treatments, a definite supply of drugs, and standardized reporting and recording of
cases and treatment outcomes (Gautam, Karki, & Khanam, 2021).

b. Patient-centered care

Patient-centered care focuses on the patient and the individual's particular health care needs. The goal of
patient-centered health care is to empower TB patients to become active participants in their care.
The patient-centered approach of the WHO TB strategy consists of enabling patients to exercise their
rights and fulfill their responsibilities with transparency, respect and dignity, by giving due consideration
to their values and needs. A patient-centered approach to programmatic management of drug-resistant
TB may increase the chances of successful treatment outcomes, and improve wellbeing and financial risk
protection by improving adherence to treatment, benefiting patients and society as a whole This requires
that physicians, radiologic technologists, and other health care providers develop good communication
skills and address patient needs effectively. Patient-centered care also requires that the health care
provider become the TB patient advocate and strive to provide care that not only is effective but also safe
(Horter et al., 2021).

c. Elimination versus eradication

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 4. Elimination of disease: Reduction to zero of the incidence of a specified disease in a
defined geographical area as a result of deliberate efforts; continued intervention measures
are required. Example: neonatal tetanus.

5. Eradication: Permanent reduction to zero of the worldwide incidence of infection caused

by a specific agent as a result of deliberate efforts; intervention measures are no longer
needed. Example: smallpox.

The main difference between elimination and eradication is that elimination is the reduction
of the disease to zero new cases in a geographical area while eradication is the permeant
and complete worldwide reduction to zero new cases of the disease.

d. Relationship with HIV/AIDS

A latent TB infection is an infection that occurs when the amount of TB bacteria in the body is marginal
and inactive to cause any active disease or symptoms. Latent TB can last for years or even for an entire
lifetime, so long as the individual’s immunity is intact and the person involved is healthy. The
individual’s immune system keeps a latent TB infection under control and prevents it from ever causing
active disease or symptoms (Lebelonyane et al., 2021).

HIV weakens the immune system and can allow a latent TB infection to turn into an active disease or
infection. Additionally, the TB bacillus can progress at a relatively faster rate up the progression of an
HIV infection.

4. Explain the features of NTDs that make it possible for some to be targeted for
eradication while others can only be targeted for control or elimination.

a. Some NTDs have only human reservoir that make it easier to intervene
b.Some NTDs have vector reservoir making it difficult for elimination or eradication.
c. Some NTDs do not have readily available treatment, only preventable interventions are
available.

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 d.an effective intervention is available to interrupt transmission of the agent
e. Availability of practical diagnostic tools with sufficient sensitivity and specificity to
detect levels of infection that can lead to transmission
f. Humans are essential for the life-cycle of the agent, which has no other vertebrate
reservoir and does not amplify in the environment.

5. Use the use of the Akosombo Hydroelectric Project as example, to explain the epidemiological
relationship between schistosomiasis and onchocerciasis.

Schistosomiasis is a parasitic disease caused by infection with Schistosoma trematodes including S.

mansoni, S. japonicum, s. mekongi, S. guineensis and related S. intercalatum and S. haematobium.
There are two main types of the disease intestinal schistosomiasis and urogenital schistosomiasis (S.
haematobium only) (Casulli, 2021).

On the other hand, Onchocerciasis (river blindness) is also a parasitic disease caused by infection with
the worm Onchocerca volvulus. The disease causes severe itching, disfiguring skin conditions and visual
impairment and can result in permanent blindness. Human infection is transmitted through repeated bites
of infective Simulium blackflies, which breed mostly along fast-flowing water (Casulli, 2021).

The epidemiological difference in that Onchocerciasis is transmitted through repeated bites of infective
Simulium blackflies, which breed mostly along fast-flowing water. While Human transmission of
Schistosomiasis occurs through contact with slow-moving water or stagnant water (e.g. bathing,
swimming, washing clothes) infested with larval forms (cercariae) that develop in freshwater snails as an
intermediate host.
In the case of the Akosombo Hydroelectric Project, before the Volta river was dammed in the 1960s, the
river was fast flowing and therefore, people along its basin were at risk of being exposed by repeated
bites Simulium blackflies and getting Onchocerciasis (river blindness) which breed mostly along the fast-
flowing water. Moreover, after the damming of the river people along the river were now at risk of
getting Schistosomiasis due to the slowing down of the river, the proliferation of aquatic plants that can
harbor and provide feed for the intermediate host where infested larval forms (cercariae) develop.

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For all 20 NTDs construct the table as below and complete it.

Existence of Major mode(s) Main Keys issues in control,

animal of transmission interventions elimination and
NTD reservoir eradication
(Yes or
No)
1. Bilharzia Yes Parasites Treatment Target: elimination as
(schistosomiasis or Intermediate with a public health
snail fever) host snails in praziquantel problem.
fresh water Snail assessment of actions
releasing management required to meet 2030
infective Health sub-targets
larvae education for
Poor hygiene behavioural
and sanitation change
Human Hygiene and
behaviour sanitation
(water contact Clean water
and supply
defecating/urin Hospitalizatio
ating n of severe
in/near water) cases
2. Blinding trachoma No Bacteria SAFE Target: elimination as
Poor hygiene strategy: a public health
and sanitation Surgical case problem
Human management
behaviour (lack (S)
of facial Treatment

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 washing) with
azithromycin
(A)
Clean water
supply for
facial
washing (F)
Hygiene and
sanitation in
the
environment
(E)
Health
education for
behavioural
change
3. Buruli ulcer No The mode of Recommende Target: control
transmission is d treatment
not known and (combination
there is no oral antibiotic
known therapy):
prevention - rifampicin
against the and
disease clarithromycin
; or
- rifampicin
and
moxifloxacin
may also be
used
• Hygienic

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 wound care
4. Chagas disease No Transmission Two Target: elimination as
of infection is antiparasitic a public health
(i) vector-borne medicines problem
(through the (benznidazole
faeces and and
urine of nifurtimox)
triatomine can cure
bugs) in the infection
Americas and during the
(ii) acute or early
oral/foodborne, chronic phase,
(ii) congenital, or can
(iv) prevent or
transfusional curb
(through blood progression of
products), (v) the disease
organ • Life-long
transplantation medication or
and (vi) surgery may
laboratory be necessary
accidents for specific
everywhere. heart and/or
digestive
alterations
5. Dengue and No Medical care Transmitted to Target: control
Chikungunya by physicians people
and nurses for through bites
severe dengue of female
(prevention of Aedes aegypti
plasma leakage and Aedes

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 and organ albopictus
failure) mosquitoes.
• Maintenance
of volume of
body fluid and
platelet counts
6. Echinococcus Yes Infection is Triaging of Target: control
transmitted appropriate
through the case
faecal-oral management
route from the through
faeces of canid cyst staging
animals including:
(mainly dogs - “Watch and
for wait” strategy
CE, foxes and -
other canids for Anthelminthic
AE) to treatment with
intermediate albendazole or
hosts mebendazole
(livestock, - Percutaneous
mainly sheep methods +
for CE, small albendazole
rodents prophylaxis
for AE); (e.g. PAIR
humans are treatment:
accidental puncture,
intermediate aspiration,
hosts and do injection,
not transmit the re-aspiration)
infection - Surgery (cyst

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 further. removal) +
albendazole
prophylaxis
7. Elephantiasis – also Parasites Treatment Target: elimination as
known as lymphatic Mosquitoes with a public health
filariasis (transmitting albendazole problem
infective larvae plus
during blood ivermectin or
feeding) diethylcarbam
Poor sanitation azine
(mosquito Self-
breeding sites) protection
Human (bed net)
behaviour Health
(without self- education for
protection behavioural
change
Hygiene and
sanitation
Case
management
8. Foodborne Yes Infection is Anthelminthic Target: control
trematodiases transmitted medicines
through raw or (praziquantel,
undercooked triclabendazol
food e)
(freshwater • PAIR
fish, aquatic methods,
vegetables, surgery
crabs (including
and crayfish) partial

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 infected with hepatectomy)
larvae.
9. Guinea worm disease Yes Human Containment he Dracunculiasis is on
(dracunculiasis) infection is of human the verge of
usually cases eradication,e of
transmitted • Wound care eradication,
through including
drinking wound
stagnant water cleaning,
containing infection
parasite- prevention,
infected pain and
water fleas; inflammation
patients often reduction
immerse the
limb in water
to relieve
burning when
the worm is
emerging;
once in the
water, the
worm releases
larvae,
completing the
transmission
cycle.
10. Intestinal worms (soil- No Parasites Treatment Target: elimination as
transmitted helminths) Poor hygiene with a public health
and sanitation albendazole or problem
Human mebendazole

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 behaviour Health
(passing eggs education for
to the behavioural
environment in change
faeces, Hygiene and
barefoot, not sanitation
washing hands, Clean water
and so on supp
11. Leishmaniasis Yes is transmitted Treatment of Target: control
by the bite of leishmaniasis
female depends on
phlebotomine several factors
sandflies; only including type
10–25% of of disease,
those infected concomitant
by the pathologies,
Leishmania parasite
parasite will species and
develop the geographical
disease location.
Local
treatment
includes
pentavalent
antimonials,
paromomycin,
cryotherapy
and
thermotherapy
. Systemic
medicines

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 include
liposomal
amphotericin
B, pentavalent
antimonials
and
miltefosine.
12. Leprosy (Hansen’s No Infection is Early Target: elimination
disease) likely detection of (interruption of
transmitted by cases is transmission)
droplets from important to
the nose and contain the
mouth during spread of
prolonged infection and
close contact prevent
with untreated disabilities
leprosy patients • Multidrug
therapy
(MDT) lasting
6 to 12
months
combines
dapsone,
rifampicin and
clofazimine
• Periodic
monitoring,
detection and
treatment of
immunologica
l reactions

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 (Type 1 and 2)
and nerve
damage
• Management
of adverse
drug reactions
• Counselling
and
psychological
first aid
• Prevention
of disability,
wound care
and
management
of disability
including self-
care
•
Rehabilitation
to optimize
functioning of
the individual
in the
community
13. Mycetoma Yes CBM, PCM No “gold assessment of actions
and ST are standard” required to meet 2030
transmitted by treatment for sub-targets
traumatic CBM exists;
inoculation of treatment
relevant options

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 microorganism include
s through antifungals
broken skin. (itraconazole),
physical
therapies,
immune
adjuvants and
surgery for
minor lesions
• Itraconazole
is the
treatment of
choice for
PCM and ST
14. Rabies Yes The rabies Post-exposure Target: elimination as
virus is prophylaxis a public health
transmitted to (PEP) with the problem
humans mainly rabies vaccine
through the as well as
bites of rabies
domestic dogs immunoglobul
(up to 99%) but in for category
also by various III exposures
other mammals is needed
(such as bats). immediately
after exposure
to a
potentially
rabid animal
• Thorough
wound

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 washing is
essential
15. River blindness (also NO Parasites Treatment Control
known as Black flies with assessment of actions
onchocerciasis) (transmitting ivermectin required to meet 2030
infective larvae Health sub-targets
during blood education for
feeding) self-
Human protection
activities (near Case
black fly management
breeding sites)
16. Scabies No Human Topical Control
infection is scabicides Scabies: assessment of
transmitted such as actions required to
through close permethrin, meet 2030 sub-targets
contact with benzyl
the skin, which benzoate,
the female mite malathion and
burrows into sulfur
and lays eggs, ointment
triggering an • Oral
immune ivermectin
response that • Treatment of
causes intense all household
itching and contacts
rash. • Specialist
case
management
of crusted
scabies cases

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17. Sleeping sickness Yes transmitted Anthelminthic Target: elimination as
(human African through the bite medicines a public health
trypanosomiasis) of an infected (praziquantel, problem
tsetse fly of the triclabendazol
genus e)
Glossina; other • PAIR
modes methods,
of transmission surgery
include (including
mother-to- partial
child. hepatectomy)
18. Snakebite No Snakebite High-quality, Target: control
envenoming safe and
results from the effective
injection of a snake
complex antivenoms
mixture of that are
different toxins available in
(“venom”) rural health
following the posts and can
bite of a be delivered
venomous by qualified
snake or from health care
venom sprayed workers
into the eyes by • Ancillary
certain species treatments
of such as
snakes. mechanical
ventilation,
wound care,
infection

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 control,
surgery and
treatment of
shock
19. Taeniasis and Yes The tapeworm Taeniasis: Target: control
cysticercosis is acquired by single
ingesting administration
contaminated of
undercooked praziquantel
pork; NCC or
occurs after niclosamide,
ingestion of or 3-day
the parasite’s albendazole
eggs through •
the faecal-oral Neurocysticer
route, hand cosis: high
contamination doses and long
and courses of
contaminated praziquantel
food or water and/
or albendazole
and
supporting
therapy with
corticosteroids
and/or
antiepileptic
medicines;
possible
surgery
• Community

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 health
education on
WASH,
veterinary
20. Yaws No Human Azithromycin Target: eradication
transmission used as first-
occurs by skin- line treatment
to-skin contact •
through scrapes Intramuscular
or cuts. benzathine
benzylpenicilli
n used for
second-line
treatment and
for those with
proven
resistance to
azithromycin
• Patients
should be
examined
after 4 weeks;
in more than
95% cases are
completely
healed

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6. For each of the 20 NTDs complete the table below to indicate whether the indicated
intervention applies or not. Use √ to indicate applicable and X to indicate not-applicable.

Vecto Mass drug Water, Improvement in Health

control administration sanitation veterinary education
NTD
& hygiene public
health services
1. Bilharzia √ X √ √ √
(schistosomiasis or
snail fever)
2. Blinding trachoma √ √ √ X √
3. Buruli ulcer X X X X √
4. Chagas disease √ X √ X √
5. Dengue and √ X √ X √
Chikungunya
6. Echinococcus X X √ √ √
7. Elephantiasis – also √ √ √ X √
known as lymphatic
filariasis
8. Foodborne X √ √ √ √
trematodiases
9. Guinea worm disease √ X √ √ √
(dracunculiasis)
10. Intestinal worms (soil- X √ √ X √
transmitted helminths)
11. Leishmaniasis √ X X √ √
12. Leprosy (Hansen’s X √ √ X √
disease)
13. Mycetoma X X √ √ √
14. Rabies X X √ √ √
15. River blindness (also √ √ X X √

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 known as
onchocerciasis)
16. Scabies X √ √ X √
17. Sleeping √ X √ √ √
sickness
(human
African
trypanosomiasis)
18. Snakebite X X X X √
19. Taeniasis and X √ √ √ √
cysticercosis
20. Yaws X √ √ X √

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References

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Gautam, N., Karki, R. R., & Khanam, R. (2021). Knowledge on tuberculosis and utilization of DOTS
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Horter, S., Daftary, A., Keam, T., Bernays, S., Bhanushali, K., Chavan, D., Denholm, J., Furin, J.,
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Peterson, J. K., Bakuza, J., & Standley, C. J. (2020). One Health and Neglected Tropical Diseases-
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