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Infectious Diseases in the South-East Asia Region Infectious Diseases in the South-East Asia Region 2021 Infectious Diseases in the South-East Asia Region Nimalan Arinaminpathy1 , Abhinav Sinha2 , Anupkumar R. Anvikar2 , Arjun K. Joseph3 , Gagandeep Kang3 , Isabel Frost1,4,5 , Jyoti Joshi4,5 , Chand Wattal6, Neeraj Goel6 , Anita Kotwani7 , Subhash Hira8,9,10 , Shivangi Pawar11 and Ramanan Laxminarayan4 © Center for Disease Dynamics, Economics & Policy (CDDEP), 2021. 1. Imperial College London, UK Template design by Tolpa Studios, www.tolpa.com. 2. ICMR - National Institute of Malaria Research, Department of Health Research, MoHFW, Government of India, New Delhi e ndings and conclusions contained within are those of the authors and do not necessarily reect positions or policies 3. Translational Health Science and Technology Institute, India of CDDEP. 4. Center for Disease Dynamics Economics & Policy, New Delhi, India Related research and additional information on access to antibiotics and antibiotic use and resistance is available at 5. Amity University, Noida, India www.cddep.org. 6. Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India Our work is available for sharing and adaptation under an Attribution 4.0 International (CC BY 4.0) license. You can 7. Department of Pharmacology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, copy and redistribute our material in any medium or format India and remix, transform, and build upon the material for any purpose, even commercially. You must give appropriate credit, provide a link to the license, and indicate if changes 8. University of Washington, Seattle, USA were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. 9. Levy Mwanawasa Medical University, Lusaka For more information, visit https://creativecommons.org/ licenses/by-nc-nd/4.0/ 10. ISRN, New Delhi, India OFFICERS Suggested Citation: 11. Foster Homeopathic Medical College, Aurangabad, India Director, Ramanan Laxminarayan Nimalan Arinaminpathy, Abhinav Sinha, Anupkumar R. Associate Director for Finance and Anvikar, Arjun K. Joseph, Gagandeep Kang, Isabel Frost, Administration, Priscilla Michell Jyoti Joshi, Chand Wattal, Neeraj Goel, Anita Kotwani, Subhash Hira, Shivangi Pawar and Ramanan Laxminarayan, "Infectious Diseases in the South-East Asia Region", BOARD OF DIRECTORS CDDEP, 2021. Anil Deolalikar (Chair) Keshav Desiraju CENTER FOR DISEASE DYNAMICS, ECONOMICS Ramanan Laxminarayan & POLICY Didier Pittet 5636 Connecticut Ave NW PO Box 42735, Washington DC Stephen Tollman 20015, USA Mary E. Wilson Infectious Diseases in the South-East Asia Region | 2021 Infectious Diseases in the South-East Asia Region Nimalan Arinaminpathy1 , Abhinav Sinha2 , Anupkumar R. Anvikar2 , Arjun K. Joseph3 , Gagandeep Kang3 , Isabel Frost1,4,5 , Jyoti Joshi4,5 , Chand Wattal6, Neeraj Goel6 , Anita Kotwani7 , Subhash Hira8,9,10 , Shivangi Pawar11 and Ramanan Laxminarayan4 © Center for Disease Dynamics, Economics & Policy (CDDEP), 2021. 1. Imperial College London, UK Template design by Tolpa Studios, www.tolpa.com. 2. ICMR - National Institute of Malaria Research, Department of Health Research, MoHFW, Government of India, New Delhi e ndings and conclusions contained within are those of the authors and do not necessarily reect positions or policies 3. Translational Health Science and Technology Institute, India of CDDEP. 4. Center for Disease Dynamics Economics & Policy, New Delhi, India Related research and additional information on access to antibiotics and antibiotic use and resistance is available at 5. Amity University, Noida, India www.cddep.org. 6. Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India Our work is available for sharing and adaptation under an Attribution 4.0 International (CC BY 4.0) license. You can 7. Department of Pharmacology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, copy and redistribute our material in any medium or format India and remix, transform, and build upon the material for any purpose, even commercially. You must give appropriate credit, provide a link to the license, and indicate if changes 8. University of Washington, Seattle, USA were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. 9. Levy Mwanawasa Medical University, Lusaka For more information, visit https://creativecommons.org/ licenses/by-nc-nd/4.0/ 10. ISRN, New Delhi, India OFFICERS Suggested Citation: 11. Foster Homeopathic Medical College, Aurangabad, India Director, Ramanan Laxminarayan Nimalan Arinaminpathy, Abhinav Sinha, Anupkumar R. Associate Director for Finance and Anvikar, Arjun K. Joseph, Gagandeep Kang, Isabel Frost, Administration, Priscilla Michell Jyoti Joshi, Chand Wattal, Neeraj Goel, Anita Kotwani, Subhash Hira, Shivangi Pawar and Ramanan Laxminarayan, "Infectious Diseases in the South-East Asia Region", BOARD OF DIRECTORS CDDEP, 2021. Anil Deolalikar (Chair) Keshav Desiraju CENTER FOR DISEASE DYNAMICS, ECONOMICS Ramanan Laxminarayan & POLICY Didier Pittet 5636 Connecticut Ave NW PO Box 42735, Washington DC Stephen Tollman 20015, USA Mary E. Wilson Infectious Diseases in the South-East Asia Region | 2021 Table of Contents Foreword 1 Overview 3 Tuberculosis 7 Background 8 Tuberculosis in the South-East Asian Region 10 Assessing priorities for TB control in the SEA region 13 Addressing gaps: new and emerging strategies for TB control 16 Conclusion 22 References 23 Malaria 29 Background 27 Malaria in the South-East Asia region 31 Priorities for malaria control 34 Population-based interventions 35 Funding for diagnosis and treatment 38 Costs and benets of interventions 39 Research and development agenda 41 Social, policy, and advocacy issues 43 Conclusion 44 References 45 Enteric pathogens and typhoid 53 Background 51 Control of enteric pathogens and typhoid 60 Healthcare management 66 Cost-effectiveness of prevention and treatment 67 Implementation of control strategies 72 Research agenda 74 Conclusion 76 References 77 Infectious Diseases in the South-East Asia Region | 2021 iv Table of Contents Foreword 1 Overview 3 Tuberculosis 7 Background 8 Tuberculosis in the South-East Asian Region 10 Assessing priorities for TB control in the SEA region 13 Addressing gaps: new and emerging strategies for TB control 16 Conclusion 22 References 23 Malaria 29 Background 27 Malaria in the South-East Asia region 31 Priorities for malaria control 34 Population-based interventions 35 Funding for diagnosis and treatment 38 Costs and benets of interventions 39 Research and development agenda 41 Social, policy, and advocacy issues 43 Conclusion 44 References 45 Enteric pathogens and typhoid 53 Background 51 Control of enteric pathogens and typhoid 60 Healthcare management 66 Cost-effectiveness of prevention and treatment 67 Implementation of control strategies 72 Research agenda 74 Conclusion 76 References 77 Infectious Diseases in the South-East Asia Region | 2021 iv Antimicrobial resistance and hospital-acquired infections 53 Background 84 Foreword Prevalence and epidemiology of drug resistance in South-East Asia 85 Risk factors and interventions 89 e emergence and spread of COVID-19 is yet another reminder of the vast social and economic impact Research and development agenda 96 communicable diseases can have. roughout history communicable diseases such as HIV/AIDS, 99 tuberculosis, malaria, neglected tropical diseases (NTDs) and enteric pathogens have taken hundreds of Addressing gaps millions of lives, deepened poverty and inequality, reduced productivity and stymied economic growth. ey Conclusion 102 have impeded sustainable development and been a barrier to the right of all to good health and well-being. References 103 ough communicable diseases continue to burden countries in the WHO South-East Asia Region, progress against them has in recent years been strong. Between 2010 and 2018 the Region reduced the HIV/AIDS and sexually transmitted infections 111 number of new HIV infections by an estimated 33% and the number of HIV-related deaths by 27%. Achieving the 90-90-90 targets remains a core priority, with community engagement and outreach, Background 110 especially among key populations, central to the Region’s strategy. Priorities for HIV/AIDS and STI control 115 Momentum to tackle TB is unprecedented. Between 2015 and 2018, treatment coverage increased by Cost-effectiveness of interventions 117 around 20%. Average national investments in TB have more than doubled. Accelerating efforts to End TB by 2030 is one of the Region’s eight Flagship Priorities. All countries are working to achieve the time- Research agenda 120 bound targets of the UN General Assembly’s High-level Political Declaration on the Fight against TB. Roadmap to 2040 121 Our progress against malaria continues. In 2018 the South-East Asia Region had an estimated 8 million 124 Conclusion cases and 11 600 malaria deaths – 69% and 70% fewer compared with 2010. is is the largest decline of all References 125 six WHO Regions. Countries in the Greater Mekong Sub-region continue to make strong gains, recording a 76% reduction in malaria cases and a 95% drop in deaths between 2010 and 2018. e battle against NTDs is ongoing. ree NTDs – lymphatic lariasis, yaws and trachoma – have been eliminated from one or more countries in the Region. More are set to follow, as countries strive to achieve a set of new time-bound targets. Across the Region, lifting the NTD burden has become a measure
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