The Core Neglected Tropical Diseases

s Community Ey Community 30 At a glance: the core e H e alt

Journal h Journal neglected tropical diseases (NTDs)

Trachoma Onchocerciasis Soil-transmitted Lymphatic Schistosomiasis | Vol helminths filariasis UM E 26 I E 26 CDC CDC CBM WHO SS U E 82 E 82 | 2013 Swiss Tropical Institute courtesy M Tanner Swiss Tropical

Trachomatous trichiasis A woman blinded by Adult female Ascaris lumbricoides Elephantiasis due to lymphatic Dipstick testing to detect onchocerciasis worm filariasis haematuria. The sample on the left is negative for haematuria – the other two are both positive

Where ••Africa ••Africa ••Worldwide ••Africa, ••Africa ••Latin America ••Latin America (see www.thiswormyworld.org) ••Asia ••Asia ••Yemen ••Yemen ••Latin America ••Latin America ••China ••Pacific Islands (see www.thiswormyworld.org) ••India (see www.thiswormyworld.org) ••Australia ••South-East Asia ••Pacific Islands (see www.trachomaatlas.org) How ••Discharge from ••Acquired by the bite of ••Eggs are passed out in ••Acquired by the bite of ••Acquired by contact infected eyes spreads an infected blackfly faeces and then infected mosquitoes with standing fresh via fingers, fomites (Simulium sp.) swallowed by another water (e.g. lakes) in and eye-seeking flies host (Ascaris, Trichuris) which there are (especially Musca or develop into infective infected snails sorbens) larvae and penetrate intact skin (hookworm)

Who ••Pre-school-age children ••People living near ••People living in ••Children aquire the ••Children and adults have the highest rivers where blackflies communities with infection, but who play, work or prevalence of active breed poor access to water sequelae tend to undertake chores on trachoma. The and sanitation occur in adults the edge of lakes prevalence of blindness ••People who walk from trachoma barefoot are at risk of increases with age hookworm infection What ••Inflammation of the ••Nodules under the ••Often asymptomatic ••Often asymptomatic ••Acute infection: conjunctiva (active skin ••May contribute to ••Enlargement of the fever, itchy rash trachoma) ••Pruritus anaemia leading to limbs, genitals or ••Chronic infection: ••Conjunctival scarring ••Thickening of skin or fatigue and lethargy breasts, with often asymptomatic; ••Trichiasis loss of skin pigment secondary skin haematuria, renal ••Corneal opacification ••Punctate keratitis changes failure, bladder cancer ••Sclerosing keratitis (urinary schistosomiasis); ••Uveitis liver failure (intestinal ••Chorioretinitis schistosomiasis) ••Optic atrophy Test ••Clinical diagnosis ••Skin snip ••Stool microscopy ••Examination of night ••Urine/stool ••Slitlamp examination for eggs blood smear for microscopy for eggs of eye microfilariae Treat Individual: Individual: Individual: Individual: Individual: ••Tetracycline eye ••Ivermectin 150µg/kg ••Single dose ••Albendazole 400mg ••Two doses of ointment twice daily once a month for albendazole 400mg for 21 days praziquantel 20mg/kg for 6 weeks, or single 3 months ••Washing of swollen taken 6 hours apart dose azithromycin, parts to reduce risk of after food 20mg/kg (maximum secondary infection 1g), for active trachoma and progression of ••Surgery for trichiasis elephantiasis Population: Population: Population: Population: Population: ••SAFE strategy ••Mass distribution of ••Mass distribution of ••Mass distribution of ••Mass distribution of ivermectin albendazole or DEC+albendazole, or praziquantel mebendazole. (if onchocerciasis ••Improved access to ••Improved access to co-endemic) safe methods for safe methods for disposal ivermectin+ disposal of human of human faeces albendazole faeces ••Education s

Trachoma Onchocerciasis Soil-transmitted Lymphatic Schistosomiasis helminths filariasis

Who ••Pre-school-age children ••People living near ••People living in ••Children aquire the ••Children and adults have the highest rivers where blackflies communities with infection, but who play, work or prevalence of active breed poor access to water sequelae tend to undertake chores on trachoma. The and sanitation occur in adults the edge of lakes prevalence of blindness ••People who walk from trachoma barefoot are at risk of increases with age hookworm infection What ••Inflammation of the ••Nodules under the ••Often asymptomatic ••Often asymptomatic ••Acute infection: conjunctiva (active skin ••May contribute to ••Enlargement of the fever, itchy rash trachoma) ••Pruritus anaemia leading to limbs, genitals or ••Chronic infection: ••Conjunctival scarring ••Thickening of skin or fatigue and lethargy breasts, with often asymptomatic; ••Trichiasis loss of skin pigment secondary skin haematuria, renal ••Corneal opacification ••Punctate keratitis changes failure, bladder cancer ••Sclerosing keratitis (urinary schistosomiasis); ••Uveitis liver failure (intestinal ••Chorioretinitis schistosomiasis) ••Optic atrophy Test ••Clinical diagnosis ••Skin snip ••Stool microscopy ••Examination of night ••Urine/stool ••Slitlamp examination for eggs blood smear for microscopy for eggs of eye microfilariae Community Ey Community Treat Individual: Individual: Individual: Individual: Individual: ••Tetracycline eye ••Ivermectin 150µg/kg ••Single dose ••Albendazole 400mg ••Two doses of ointment twice daily once a month for albendazole 400mg for 21 days praziquantel 20mg/kg

e H for 6 weeks, or single 3 months ••Washing of swollen taken 6 hours apart

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Journal h Journal 20mg/kg (maximum secondary infection 1g), for active trachoma and progression of ••Surgery for trichiasis elephantiasis | Vol Population: Population: Population: Population: Population: UM ••SAFE strategy ••Mass distribution of ••Mass distribution of ••Mass distribution of ••Mass distribution of E 25 I E 25 ivermectin albendazole or DEC+albendazole, or praziquantel

SS mebendazole. (if onchocerciasis ••Improved access to U ES 82 82 ES ••Improved access to co-endemic) safe methods for safe methods for disposal ivermectin+ disposal of human | 2013 31 2013 of human faeces albendazole faeces ••Education

Anthony Solomon Wellcome Trust Intermediate Clinical Fellow, Clinical Research Michael Marks Wellcome Trust Clinical Research Fellow, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK. Department, London School of Hygiene & Tropical Medicine, London, UK.