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A Plan to Defeat NEGLECTED TROPICAL DISEASES the Poorest People Are Not Only Poor

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A Plan to Defeat NEGLECTED TROPICAL DISEASES the Poorest People Are Not Only Poor MEDICINE A Plan to Defeat NEGLECTED TROPICAL DISEASES The poorest people are not only poor. They are also chronically sick, making it harder for them to escape poverty. A new global initiative may break the vicious cycle BY PETER JAY HOTEZ n the north of Burkina Faso, not far to the east of one KEY CONCEPTS of the best-known backpacker destinations in West Af- ■ A group of seven tropical I rica, the Bandiagara Escarpment in Mali, lies the town diseases, mostly caused by of Koumbri. It was one of the places where the Burkina parasitic worms, affl ict a Ministry of Health began a mass campaign fi ve years ago billion impoverished people to treat parasitic worms. One of the benefi ciaries, Abou- worldwide. They seldom bacar, then an eight-year-old boy, told health workers he kill directly but cause life- felt perpetually tired and ill and had noticed blood in his long misery that stunts urine. After taking a few pills, he felt better, started to children’s growth, leaves adults unable to function to play soccer again, and began focusing on his schoolwork their fullest, and heightens and doing better academically. the risk of other diseases. The Burkina Faso program, which treated more than two million children, was both a success story and an em- ■ Fortunately, they can be blem of the tragedy of disease in the developing world. For easily treated, often with a single pill. Various agen- want of very simple treatments, a billion people in the cies and foundations are world wake up every day of their lives feeling sick. As a collaborating to deliver result they cannot learn in school or work effectively. these drugs, although they Most people in richer countries equate tropical disease have reached only about with the big three—HIV/AIDS, tuberculosis and malar- 10 percent of the popula- ia—and funding agencies allocate aid accordingly. Yet a tion so far. group of conditions known collectively as neglected tropi- ■ The U.S. has its own ne- cal diseases (N T Ds) has an even more widespread impact . glected parasitic diseases They may not often kill, but they debilitate by causing se- Getty Images ONE TABLET of ivermectin per year that affect millions of rural vere anemia, malnutrition, delays in intellectual and cog- / AFP is enough to protect against river and urban poor. nitive development, and blindness. They can lead to hor- blindness. Health workers in the —The Editors rifi c limb and genital disfi gurement and skin deformities Ivory Coast have been battling and increase the risk of acquiring HIV/AIDS and suffer- SANGOISSOUF a resurgence of the disease. 90 SCIENTIFIC AMERICAN January 2010 LYMPHATIC FILARIASIS www.ScientificAmerican.com SCIENTIFIC AMERICAN 91 [DISEASE STATS] THE GRISLY SEVEN The neglected tropical diseases comprise seven parasitic or bacterial infections that are common in impoverished areas. DISEASE CASES CAUSE TRANSMISSION EFFECTS Roundworm 800 million 5- to 14-inch-long Ascaris Soil ■ Malnutrition and intestinal obstruction in young children (Ascariasis) worms that live in the small ■ Child stunting intestine (shown actual size) ■ Impaired cognition Whipworm 600 million 1- to 2-inch-long Trichuris Soil ■ Colitis and infl ammatory bowel disease (Trichuriasis) worms that live in the colon ■ Child stunting and impaired cognition (large intestine) Hookworm 600 million 0.5-inch-long Necator Soil ■ Severe iron defi ciency anemia and protein malnutrition worms that live in the ■ “Yellow disease”(anemia) small intestine ■ Child stunting and impaired intellectual and cognitive development ■ Maternal morbidity and mortality in pregnancy Schistosomiasis 200 million 0.5- to 1-inch-long blood Freshwater ■ Spiny eggs that damage the bladder, intestine or liver and cause infl ammation fl ukes that live in veins of ■ Chronic pain, anemia, malnutrition and stunting the bladder or intestines ■ Liver and intestinal fi brosis (for Schistosoma mansoni and S. japonicum) ■ Blood in urine, kidney disease, female genital schistosomiasis (for S. haematobium) Lymphatic 120 million 2- to 4-inch-long Wuchereria Mosquitoes ■ Leg swelling fi lariasis (LF) worms that live in the limbs, ■ Scrotum enlargement (elephantiasis) breasts and genitals ■ Disfi gurement Onchocerciasis 30–40 1- to 20-inch-long Black fl ies ■ Microfi lariae (larvae) in the skin and eyes million Onchocerca worms living ■ Onchocerca skin disease in nodules under the skin ■ Blindness Trachoma 60–80 Chlamydia intracellular Poor hygiene, ■ Blindness million bacteria house fl ies [THE AUTHOR] ing complications during pregnancy. They not more coordinated and systematic way. Over the only result from poverty but also help to perpet- past half a decade the Bill & Melinda Gates Peter Jay Hotez became interested uate it. Children cannot develop to their full po- Foundation, the Dubai-based sustainable devel- in medicine as child when he read Paul De Kruif’s classic book Microbe tential, and adult workers are not as productive opment fund Legatum, and the U.S. and British Hunters and asked his parents for as they could be. governments have committed serious money, ); a microscope. He went on to obtain Such diseases are not confi ned to developing while major pharmaceutical companies have ) worms both a Ph.D. and an M.D., specializ- nations. I estimate that millions of Americans donated urgently needed NTD drugs. But the ing in parasitology. He now chairs living in poverty also suffer from NTD-like in- battle has only begun. the department of microbiology, woman crying woman ( immunology and tropical medicine fections. Parasitic diseases such as cysticercosis, WILSON CAT ); ( Chagas disease, trichomoniasis and toxocaria- Like Leeches in Your Gut at George Washington University. Hotez Hotez is president of the Sabin sis occur with high frequency in our inner cities, The scale and extent of the global NTD problem Vaccine Institute, a member of the post-Katrina Louisiana, other parts of the Mis- are hard to take in. Almost every destitute per- Pictures Redux Institute of Medicine of the Nation- sissippi Delta, the border region with Mexico, son living in sub-Saharan Africa, Southeast Asia al Academies of Science, and co-founder of the Global Network and Appalachia [see box on page 94]. and Latin America is infected with one or more for Neglected Tropical Diseases. NTDs have plagued humankind for thou- of these diseases. The illnesses last years, decades ); MARIELLA ); FURRER sands of years. Historians have found accurate and often even a lifetime. The seven most com- descriptions of many of them in ancient texts as mon NTDs have the most devastating impact. diverse as the Bible, the Talmud, the Vedas, the Three of them are caused by parasitic worms, woman and child writings of Hippocrates, and Egyptian papyri. also known as helminths, that live in the intes- ( What is new, however, is that donors, drugmak- tines. The large common roundworm, which re- ers, health ministries in low- and middle-in- sults in ascariasis, affl icts 800 million people Redux Pictures Redux come countries, the World Health Organization and the whipworm, which results in trichuriasis, (WHO), and public-private partnerships are 600 million people. These helminths rob chil- ERIK S. LESSER linking their efforts to combat the NTDs in a dren of nutrients, stunting their growth. Even COURTESY OF GW MEDICAL CENTER MARKETING AND COMMUNICATIONS ( 92 SCIENTIFIC AMERICAN January 2010 learning in school. More than 40 million preg- nant women are also infected with hookworm, rendering them vulnerable to malaria or addi- tional blood losses in childbirth. Their babies ENDEMIC AREAS TREATMENT MAJOR CONTROL PROGRAMS are born with low birth weights [see “Hook- Asia, Africa, Americas Albendazole, mebendazole WHO, Children Without Worms, worm Infection,” by Peter J. Hotez and David I. Deworm the World Pritchard; Scientific American, June 1995]. Schistosomiasis is the next most common NTD. It is caused by parasitic worms known as schistosomes that live in the veins draining the Asia, Africa, Americas Albendazole, mebendazole WHO, Children Without Worms, intestines or bladder. More than 90 percent of Deworm the World the 200 million cases occur in sub-Saharan Af- rica, with another few million cases in Brazil Asia, Africa, Americas Albendazole, mebendazole WHO, Children Without Worms, and several other countries. Female schisto- Deworm the World, Sabin Vaccine Institute somes release eggs equipped with tiny spears that invade and damage organs, including the Mostly in Africa; Praziquantel Schistosomiasis Control Initiative intestine and liver or the bladder and kidneys, remainder in Brazil, depending on the species. Roughly 100 million East Asia, Middle East school-aged children and young adults pass blood in their urine or feces every day as a re- Asia, Africa, Ivermectin or diethylcarbamazine Global Program to Eliminate Lymphatic Americas and albendazole Filariasis, Lymphatic Filariasis Support sult. The infl ammation produces pain, malnu- Center, Carter Center trition, growth stunting and anemia. In women, schistosomes deposit eggs in the cervix and va- Mostly in Africa, Ivermectin African Program for Onchocerciasis gina, causing disabling pain during sexual in- some in Latin America Control, Carter Center, Mectizan Donation Program tercourse and tripling the risk of acquiring HIV/ AIDS [see “Fighting Killer Worms,” by Patrick Skelly; Scientific American, May 2008]. Two other important helminth infections are Africa, Asia, Azithromycin; SAFE strategy: simple International Trachoma Initiative, Americas surgery, antibiotics, face washing, Carter Center, Helen Keller International, lymphatic fi lariasis (LF) and onchocerciasis. The environment (such as sanitation) Sight Savers, Christian Blind Mission worms that cause LF live in the limbs, breasts and genitals of 120 million people in Asia, Afri- worse are hookworms, which are found in 600 ca and Haiti. They lead to elephantiasis, a gross- million people. These half-inch-long worms at- tach to the inside of the small intestine and suck blood, like an internal leech. Over a period of ELEPHANTIASIS (below, in Haiti) months or years they produce severe iron-defi - and blindness (right, in Ethiopia) ciency anemia and protein malnutrition.
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