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Home , Filariasis, Lymphatic filariasis, Schistosomiasis

Historical Profiles and Perspectives Eliminating Lymphatic , , and 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, 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 in of the bill to abolish the transatlantic slave 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- in others [7]. Ongoing trans- first description of 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, , and ), widespread throughout the Caribbean and persons from sub-Saharan to the is concentrated in impoverished settings and was a major cause of New World also resulted in the importa- and appears to be a growing problem in hepatic and death. Through selec- tion of a number of parasitic diseases to urban slums. LF elimination programs tive and mass treatment campaigns, the Americas. (LF), based on the mass distribution of anti- control efforts, and improved , 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 However, the vectors (such as mosquitoes, black , fection ([8] and unpublished data). How- ‘‘subtle morbidities’’ of and altered and ) 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 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 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 and Onch- limited to 13 foci in six countries (Mexico, transmission, such as 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]. and poor living conditions with 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 -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 , Dis 1(2): e71. doi:10.1371/journal.pntd.0000071 , and . 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 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 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 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, the schistosomiasis in the Americas, these Kingdom and United States governments anti-slavery proponents carried medallions diseases continue to represent a threat to and to new discussions with the Global similar to the ribbons and bracelets com- millions of persons, particularly in eco- Fund to Fight AIDS, and monly worn today to signify support for nomically marginalized communities. about linking NTD programs to various causes or diseases. On these medal- Slaveryandtheslavetradehavebeen those targeting HIV, malaria, and tuber- lions was printed ‘‘Am I not a man and prohibited in all their forms by international culosis [20]. Efforts to eradicate LF, a brother?’’ (Figure 1). Elimination of LF, human rights declarations and treaties that onchocerciasis, and schistosomiasis in the onchocerciasis, and schistosomiasis in the also protect the life, well being, personal Americas will provide critical operational Americas is a worthy goal for public health freedom, and the physical and mental experience with strategies to interrupt and for the enjoyment of physical and integrity of human beings [16]. In recent transmission in residual foci and low- mental health as a basic human right, years, the topic of reparations for slavery has prevalence settings. They will also be a learning tool for NTD control in more been a contentious political topic. One of the instructive in the development of tools to challenging settings, and a continuation of major difficulties with this concept is that conduct surveillance following the cessation the efforts and struggles for justice of those neither the perpetrators nor direct victims of of mass treatment. This experience will who suffered the inhumanity of slavery and the slave trade are available to make or benefit the African programs and galvanize of those who worked to halt the slave trade receive restitution. On the other hand, the increased support for the elimination of 200 years ago. Now is the time to continue elimination of diseases that are a conse- NTDs in Africa by demonstrating ap- this pioneering work to eliminate three of quence of this trade would represent proaches that make this an achievable goal. the lasting legacies of slavery. a tangible contribution to the health and Nevertheless, the global experience with well being of people and communities who, guinea worm eradication portends that Acknowledgments arguably, still suffer from the residual affects these efforts will not be easy. But the effort of slavery. What is needed now is renewal of to eradicate slavery was not easy either. We thank our colleagues for their helpful comments. The views of the authors are their political will and a dedication of new Slave revolts and rebellions occurred own and do not necessarily represent those of financial and technical resources to a co- throughout the period of slavery with great the Centers for Disease Control and Prevention, ordinated elimination effort consistent with loss of life on both sides. William Wilber- the Pan American Health Organization, or the international human rights treaties and force worked for 20 years against great World Health Organization.

References 1. Laurence BR (1989) ‘‘Barbadoes leg’’: Filariasis 2. Grove DI (1990) A history of human helminthol- 3. Manson P (1902) Report of a case of in Barbados, 1625–1900. Med Hist 33: ogy. Wallingford (United Kingdom): CAB In- Bilharzia from the West Indies. Brit Med J ii: 480–488. ternational. 848 p. 1894–1895.

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4. Ruiz-Reyes F (1952) [Historical data on the origin 10. Boatin BA, Richards FO Jr (2006) Control of Available: http://www.ohchr.org/english/law/ of onchocerciasis in America.] [Article in Span- onchocerciasis. Adv Parasitol 61: 349–394. ccpr.htm. Accessed 5 September 2007. ish.] Rev Med (Mex) 32: 49–56. 11. King CH, Dickman K, Tisch DJ (2005) Reassess- 17. United Nations General Assembly (1966) In- 5. Morgan JAT, Dejong RJ, Adeoye GO, ment of the cost of chronic helmintic infection: A ternational Covenant on Economic, Social and Ansa EDO, Barbosa CS, et al. (2005) Origin meta-analysis of disability-related outcomes in Cultural Rights. Article 12. A.G. res. 2200A and diversification of the Schisto- endemic schistosomiasis. Lancet 365: 1561–1569. (XXI), 21 ONU GAOR Sup. (No. 16) 49, U.N. soma mansoni. Mol Ecol 14: 3889–3902. 12. Chitsulo L, Engels D, Montresor A, Savioli L doc. A/6316. Available: http://www.unhchr.ch/ 6. Zimmerman PA, Katholi CR, Wooten MC, (2000) The global status of schistosomiasis html/menu3/b/a_cescr.htm. Accessed 5 Lang-Unnasch N, Unnasch TR (1994) Recent control. Acta Trop 77: 41–51. September 2007. evolutionary history of American Onchocerca volvu- 13. Molyneux DH, Hotez PJ, Fenwick A (2005) 18. Committee on Economic, Social and Cultural lus, based on analysis of a tandemly repeated ‘‘Rapid-impact interventions’’: How a policy of Rights, United Nations (2000) General Comment DNA sequence family. Mol Biol Evol 11: integrated control for Africa’s neglected tropical 14: The right to the enjoyment of the highest 384–392. diseases could benefit the poor. PLoS Med 11: attainable standard of health. (Article 12 of the 7. Chernin E (1987) The disappearance of bancrof- e336, doi:10.1371/journal.pmed.0020336. International Covenant on Economic, Social, and Cultural Rights). 22nd Period of Sessions, 2000, tian filariasis from Charleston, South Carolina. 14. Holveck JC, Ehrenberg JP, Ault SK, Rojas R, U.N. Doc. E/C.12/2000/4. Available: http:// Am J Trop Med Hyg 37: 111–114. Vasquez J, et al. (2007) Prevention, control and www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12. 8. Beau de Rochars M, Kanjilal S, Direny AD, elimination of neglected diseases in the Americas: 2000.4.En. Accessed 5 September 2007. Radday J, Lafontant JG, et al. (2005) The Pathways to integrated, inter-programmatic, in- 19. World Health Organization (2007) Meeting of the Leogane, Haiti demonstration project: Decreased ter-sectoral action for health and development. International Task Force for Disease Eradica- microfilaremia and program costs after three BMC Public Health 7: 6. tion—12 May 2006. Wkly Epidemiol Rec 82: years of mass drug administration. Am J Trop 15. Dadzie Y, Neira M, Hopkins D (2003) Final 25–32. Med Hyg 73: 888–894. report on the eradicability on Onchocerciasis. 20. Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, 9. World Health Organization (2005) Onchocercia- Filaria J 2: 2. Ehrlich Sachs S, et al. (2006) Incorporating sis (river blindness). Report from the fourteenth 16. United Nations General Assembly (1966) In- a rapid-impact package for neglected tropical InterAmerican conference on Onchocerciasis, ternational Covenant on Civil and Political diseases with programs for HIV/AIDS, tuber- Atlanta, Georgia, United States. Wkly Epidemiol Rights. Article 8. A.G. Res. 2200, 21 U.N. culosis, and malaria. PLoS Med 3: e102, Rec 80: 257–260. GAOR Sup. (No.16) 52, U.N. doc. A/6316. doi:10.1371/journal.pmed.0030102.

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