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Eliminating Lymphatic Filariasis, Onchocerciasis, and Schistosomiasis from the Americas: Breaking a Historical Legacy of Slavery

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Eliminating Lymphatic Filariasis, Onchocerciasis, and Schistosomiasis from the Americas: Breaking a Historical Legacy of Slavery Historical Profiles and Perspectives Eliminating Lymphatic Filariasis, Onchocerciasis, and Schistosomiasis from the Americas: Breaking a Historical Legacy of Slavery Patrick J. Lammie1*, John F. Lindo2,3, W. Evan Secor1, Javier Vasquez2, Steven K. Ault2, Mark L. Eberhard1 1 Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 2 Pan American Health Organization/World Health Organization, Washington, D. C., United States of America, 3 The University of the West Indies, Kingston, Jamaica The 2007 bicentennial of the enactment velopment in the United States and in the pleting the interruption of transmission in of the bill to abolish the transatlantic slave Caribbean led to the spontaneous disap- the remaining active foci must now be trade in the British Empire has focused pearance of LF in some areas and sub- validated [10]. new attention on the historical legacy of stantial declines in the prevalence of 2007 also marks the centenary of the slavery and its human and social con- infection in others [7]. Ongoing trans- first description of Schistosoma mansoni, the sequences. Beyond the societal impact of mission in the Western Hemisphere, now causative agent of schistosomiasis in slavery, which continues to the present limited to four countries (Brazil, the the Americas. Schistosomiasis was once day, the transportation of millions of Dominican Republic, Haiti, and Guyana), widespread throughout the Caribbean and persons from sub-Saharan Africa to the is concentrated in impoverished settings South America and was a major cause of New World also resulted in the importa- and appears to be a growing problem in hepatic fibrosis and death. Through selec- tion of a number of parasitic diseases to urban slums. LF elimination programs tive and mass treatment campaigns, snail the Americas. Lymphatic filariasis (LF), based on the mass distribution of anti- control efforts, and improved sanitation, schistosomiasis, and onchocerciasis were filarial drugs have been developed in all the prevalence of schistosomiasis in the most likely imported to the Americas via four countries and have resulted in Americas has decreased and fatal infec- the slave trade; the presence of competent declines in the prevalence of filarial in- tions are now uncommon. However, the vectors (such as mosquitoes, black flies, fection ([8] and unpublished data). How- ‘‘subtle morbidities’’ of anemia and altered and snails) allowed transmission and ever, all four programs are resource growth and cognitive development in dispersal of the parasites [1–4]. Although challenged and none have achieved full children caused by schistosomiasis are parasitologists first speculated more than coverage of at-risk populations. increasingly recognized as public health a century ago that the slave trade was Onchocerciasis is well recognized as problems [11]. Millions of persons in responsible for introduction of these dis- a cause of blindness and skin disease due Brazil are still at risk of infection, but the eases to the New World [3], only recently to the pathology elicited by death of official status of schistosomiasis transmis- has convincing evidence supporting this microfilariae in the tissues. Transmission sion in a number of other former slave hypothesis been generated. Molecular of onchocerciasis in the Americas is now colonies with previously documented evaluation of Schistosoma mansoni and Onch- limited to 13 foci in six countries (Mexico, transmission, such as Suriname and Saint ocerca volvulus has demonstrated very limit- Guatemala, Columbia, Brazil, Venezuela Lucia, is not known [12]. The biological ed heterogeneity among New World and Ecuador) [9]. The Onchocerciasis and epidemiological characteristics of strains, which share a strong affinity with Elimination Program in the Americas is schistosomiasis make it much more chal- West African strains of these parasites coordinating twice-yearly mass treatment lenging to eliminate than lymphatic filari- [5,6]. Poverty and poor living conditions with ivermectin in these foci. Impressive asis or onchocerciasis. Because adult continue to put people at risk of LF, strides have been made in reducing the worms can live within hosts for years and schistosomiasis, and onchocerciasis. On prevalence of onchocercal disease, and in the diagnostic tests to detect active in- the 200th anniversary of the abolition of some foci interruption of transmission has fection and confirm successful cure are the slave trade, a fitting commemoration been achieved, leading to the decision to currently inadequate as public health would be a commitment to the regional halt mass treatment in one focus in tools, it is possible that an elimination eradication of these three diseases that Guatemala. End-game strategies for com- strategy based exclusively on drug treat- remain as a historical legacy of slavery. Lymphatic filariasis is a mosquito-trans- mitted infection that is associated with the Citation: Lammie PJ, Lindo JF, Secor WE, Vasquez J, Ault SK, et al. (2007) Eliminating Lymphatic Filariasis, Onchocerciasis, and Schistosomiasis from the Americas: Breaking a Historical Legacy of Slavery. PLoS Negl Trop development of debilitating lymphedema, Dis 1(2): e71. doi:10.1371/journal.pntd.0000071 elephantiasis, and hydrocele. The princi- pal mosquito vector in the Americas, Culex Editor: Charles H. King, Case Western Reserve University School of Medicine, United States of America quinquefasciatus, breeds in polluted water Published: November 7, 2007 and is adapted to urban environments. LF This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration once was widely distributed throughout which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. the region, particularly in areas where the local geography was amenable to planta- Funding: The authors received no specific funding for this article. tion-based agriculture and large numbers Competing Interests: The authors have declared that no competing interests exist. of slaves were imported. Economic de- *E-mail: [email protected] PLoS Neglected Tropical Diseases | www.plosntds.org 1 2007 | Volume 1 | Issue 2 | e71 Historical Profiles and Perspectives ment will not be successful. On the other guidelines that recognize the ‘‘right to the hand, provision of safe water and sanitary highest attainable standard of physical and improvements in the remaining endemic mental health,’’ which includes the pre- foci is a valid public health goal that will vention, treatment, and control of epidemic, yield important dividends beyond schisto- endemic, occupational, and other diseases somiasis control. Given the substantial [17,18]. Control and elimination of NTDs decline in infection prevalence that al- from endemic areas is central to ensuring the ready has occurred in the region, de- promotion and protection of human rights. velopment of the tools and strategies that We recognize that LF, onchocerciasis, will complete the task of elimination in this and schistosomiasis are not the only hemisphere deserves serious consideration. diseases to have been imported to the A new focus on neglected tropical Western Hemisphere through the slave diseases (NTDs), including LF, onchocer- trade. They are, however, diseases that still ciasis, and schistosomiasis, by the World cause substantial morbidity 200 years after Health Organization and the global health the end of the slave trade and are community holds the promise of delivering particularly attractive elimination targets. significant benefits to populations that In advocating for the elimination of NTDs suffer from these diseases [13]. However, in the Western Hemisphere, we are not little attention has been focused on the ignoring the greater burden of NTDs in Americas, in large part because of the sub-Saharan Africa. However, as noted by focal distribution of these infections and several recent reports from the Interna- the mistaken impression that the NTDs no tional Task Force for Disease Eradication, Figure 1. Example of a medallion de- signed by Josiah Wedgwood, circa 1787, longer represent a public health burden in eliminating these diseases in the Americas to raise public awareness of the suffer- the region. Recently, several authors have is now feasible, whereas the situation in ing brought about by the slave trade. drawn attention to the burden of NTDs in Africa is not so promising [15,19]. Recent Image used by permission of http://thepot- the Americas, and have recommended advocacy efforts for NTDs have made teries.org. potential solutions [14]. Equally important a strong case for the public health and doi:10.1371/journal.pntd.0000071.g001 is the recognition that these diseases in the economic value of these interventions and Americas, in contrast to the situation in the dramatic health benefits that integrat- opposition to achieve passage of the law Africa, can actually be eliminated with ed NTD programs can provide [13]. ending the British slave trade (trafficking) in proper efforts [15]. Although significant These efforts have led to significant new 1807. And he worked another 26 years progress has been made in reducing the financial commitments by the Bill&Me- until Parliament abolished slavery itself in prevalence of LF, onchocerciasis, and linda Gates Foundation and the United the British colonies. During those years,
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