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Perera DJ, Koger-Pease C, Paulini K, Daoudi M, Ndao M. Beyond schistosomiasis: unraveling co-infections and altered immunity. Clin Microbiol Rev 2024; 37:e0009823. [PMID: 38319102 PMCID: PMC10938899 DOI: 10.1128/cmr.00098-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Schistosomiasis is a neglected tropical disease caused by the helminth Schistosoma spp. and has the second highest global impact of all parasites. Schistosoma are transmitted through contact with contaminated fresh water predominantly in Africa, Asia, the Middle East, and South America. Due to the widespread prevalence of Schistosoma, co-infection with other infectious agents is common but often poorly described. Herein, we review recent literature describing the impact of Schistosoma co-infection between species and Schistosoma co-infection with blood-borne protozoa, soil-transmitted helminths, various intestinal protozoa, Mycobacterium, Salmonella, various urinary tract infection-causing agents, and viral pathogens. In each case, disease severity and, of particular interest, the immune landscape, are altered as a consequence of co-infection. Understanding the impact of schistosomiasis co-infections will be important when considering treatment strategies and vaccine development moving forward.
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Affiliation(s)
- Dilhan J. Perera
- Division of Experimental Medicine, McGill University, Montreal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Cal Koger-Pease
- Division of Experimental Medicine, McGill University, Montreal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Kayla Paulini
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
| | - Mohamed Daoudi
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
| | - Momar Ndao
- Division of Experimental Medicine, McGill University, Montreal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
- National Reference Centre for Parasitology, Research Institute of the McGill University Health Centre, Montreal, Canada
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Wasson MK, Whitson C, Miller B, Abebe W, Tessema B, Emerson LE, Anantharam P, Tesfaye AB, Fairley JK. Potential drivers of leprosy infection: A case–control study of parasitic coinfection and water, sanitation, and hygiene in North Gondar, Ethiopia. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.934030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite extensive control measures and a declining number of human reservoirs, the incidence of leprosy in excess of 200,000 new cases each year suggests that alternative pathways of transmission may play a role in continued endemicity. Parasitic coinfection and limited water, sanitation, and hygiene (WASH) have been suggested to predispose individuals to Mycobacterium leprae infection and were further explored in this study.MethodsLeprosy cases and uninfected controls were recruited from areas around North Gondar, Ethiopia throughout 2019. Participants completed dietary and WASH surveys in addition to providing stool for helminth microscopic diagnosis and urine for Schistosoma mansoni Point-of-care circulating cathodic antigen (POC-CCA)™ rapid diagnostic testing. A similar methodology was employed for a case–control study of leprosy previously conducted by our research team in North Gondar from May to October of 2018. To more comprehensively evaluate associations between the above exposures and leprosy, data from the present 2019 study and the previous 2018 study were combined in select multivariate logistic regression analyses.ResultsA total of 47 men (59%) and 33 women (41%) participated in this study with an average age of 40 (SD 15.0 years). Most leprosy cases were multibacillary (93%). There was a high prevalence of parasitic coinfection among both cases (71%) and controls (60%). WASH insecurities were also widespread. On multivariate analysis, lack of soap for handwashing [aOR= 2.53, 95% CI (1.17, 5.47)] and the lack of toilet facilities [Adjusted odds ratio (aOR)= 2.32, 95% CI (1.05, 5.12)] were significantly associated with leprosy. Positive directionality was identified for a number of other inputs, including helminth infection [aOR= 3.23, 95% CI (0.85, 12.35)].ConclusionsTaken together, these findings strengthen previous research conducted in 2018 implicating poor WASH conditions as a driver of leprosy infection. Leprosy remains the leading infectious cause of disability in the world. As such, future research should explore the above susceptibilities in more depth to curtail the global burden of disease.
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Deka MA. Predictive Risk Mapping of Schistosomiasis in Madagascar Using Ecological Niche Modeling and Precision Mapping. Trop Med Infect Dis 2022; 7:15. [PMID: 35202211 PMCID: PMC8876685 DOI: 10.3390/tropicalmed7020015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 01/27/2023] Open
Abstract
Schistosomiasis is a neglected tropical disease (NTD) found throughout tropical and subtropical Africa. In Madagascar, the condition is widespread and endemic in 74% of all administrative districts in the country. Despite the significant burden of the disease, high-resolution risk maps have yet to be produced to guide national control programs. This study used an ecological niche modeling (ENM) and precision mapping approach to estimate environmental suitability and disease transmission risk. The results show that suitability for schistosomiasis is widespread and covers 264,781 km2 (102,232 sq miles). Covariates of significance to the model were the accessibility to cities, distance to water, enhanced vegetation index (EVI), annual mean temperature, land surface temperature (LST), clay content, and annual precipitation. Disease transmission risk is greatest in the central highlands, tropical east coast, arid-southwest, and northwest. An estimated 14.9 million people could be at risk of schistosomiasis; 11.4 million reside in rural areas, while 3.5 million are in urban areas. This study provides valuable insight into the geography of schistosomiasis in Madagascar and its potential risk to human populations. Because of the focal nature of the disease, these maps can inform national surveillance programs while improving understanding of areas in need of medical interventions.
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Affiliation(s)
- Mark A Deka
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA 30341, USA
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Chen X, Shui TJ. The state of the leprosy epidemic in Yunnan, China 2011-2020: A spatial and spatiotemporal analysis, highlighting areas for intervention. PLoS Negl Trop Dis 2021; 15:e0009783. [PMID: 34613961 PMCID: PMC8494331 DOI: 10.1371/journal.pntd.0009783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite public health efforts to reduce the leprosy burden in Yunnan, China, leprosy remains an important public health problem in some specific areas. We analyzed the epidemiological characteristics and spatial distribution of leprosy in Yunnan, China, and provide data to guide disease prevention and control efforts. METHODOLOGY/PRINCIPAL FINDINGS The surveillance data of newly detected leprosy cases in Yunnan, China, during 2011-2020 were extracted from the LEPROSY MANAGEMANT INFORMATION SYSTEM IN CHINA (LEPMIS), and spatial distribution analysis, spatial autocorrelation analysis, and spatiotemporal scanning were performed with ArcGIS 10.6.1, GeoDa 1.8.8, and SaTScan 9.4.3 software, respectively. A total of 1907 newly detected leprosy cases were reported in Yunnan, China, during 2011-2020. The new case detection rate (NCDR) decreased from 0.62 in 2011 to 0.25 in 2020, with an annual incidence of 0.41/100,000 population. The proportions of multibacillary (MB) cases, cases in female patients, cases causing grade 2 physical disability (G2D), and cases in pediatric patients were 67.07%, 33.93%, 17.99%, and 2.83%, respectively. The number of counties with an incidence above 1/100,000 population decreased from 30 in 2011 to 8 in 2020. The Moran's I of leprosy in Yunnan, China, during 2011-2020 ranged from 0.076 to 0.260, indicating the presence of spatial clusters. Local spatial autocorrelation (LSA) analysis showed that high-high cluster areas (hot spots) were mainly distributed in the southeastern, northern, and northwestern regions. Spatiotemporal scanning showed three clusters with high NCDRs. The probably primary clusters, occurring during January 1, 2011-December 31, 2015, covered 11 counties in the southeastern region (RR = 5.046515, LRR = 271.749664, P = 0.000). CONCLUSION The number of leprosy cases in Yunnan decreased overall, although some high-NCDR regions remained. Geographic information system (GIS) analysis coupled with spatial analysis indicated regions with leprosy clusters. Continuous leprosy prevention and control strategies in Yunnan Province should be established, and interventions in high-risk regions should be prioritized and further strengthened.
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Affiliation(s)
- Xiaohua Chen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Tie-Jun Shui
- Yunnan Center for Disease Control and Prevention, Yunnan, China
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Dennison CL, de Oliveira LB, Fraga LADO, E Lima RS, Ferreira JA, Clennon JA, de Mondesert L, Stephens J, Magueta EB, Castelo Branco A, Rezende MDC, Negrão-Corrêa D, de Faria Grossi MA, Fairley JK. Mycobacterium leprae-helminth co-infections and vitamin D deficiency as potential risk factors for leprosy: A case-control study in south-eastern Brazil. Int J Infect Dis 2021; 105:261-266. [PMID: 33592342 DOI: 10.1016/j.ijid.2021.02.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence suggests that biological mechanisms involved in helminth infections and vitamin deficiencies increase susceptibility to other infections. The aim of this study was to investigate the associations of helminth co-infection and select micronutrient deficiencies with leprosy using a case-control design. METHODS From 2016 to 2018, individuals aged ≥3 years were recruited at clinics in and around Governador Valadares, Minas Gerais, Brazil in three groups: cases of leprosy, household contacts and community-matched (non-contact) controls. Helminths were diagnosed through stool Kato Katz examination and serum reactivity to anti-soluble adult worm antigen preparation IgG4. Serum ferritin, 25-OH vitamin D and retinol concentrations were measured. Multi-variate logistic regression was conducted to identify associations with active leprosy. RESULTS Seventy-nine cases of leprosy, 96 household contacts and 81 non-contact controls were recruited; 48.1% of participants were male with a median age of 40 years. Helminths were found in 7.1% of participants on Kato Katz test, all but one of which were Schistosoma mansoni, and 32.3% of participants were positive for S. mansoni serology. On multi-variate analysis, cases were more likely to be infected with helminths (diagnosed by stool) than household contacts [adjusted odds ratio (aOR) 8.69, 95% confidence interval (CI) 1.50-50.51]. Vitamin D deficiency was common, and was more likely in cases compared with non-contact controls (aOR 4.66, 95% CI 1.42,-15.33). Iron deficiency was not associated with leprosy, and vitamin A deficiency was not detected. CONCLUSION These associations suggest that the immune consequences of schistosomiasis and vitamin D deficiency may increase the risk of active leprosy. Comorbid conditions of poverty deserve further study as addressing co-infections and nutritional deficiencies could be incorporated into programmes to improve leprosy control.
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Affiliation(s)
- Cori L Dennison
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Lorena B de Oliveira
- Programa Multicêntrico de Bioquímica e Biologia Molecular, Universidade Federal de Juiz de Fora, Campus GV, Governador Valadares, Brazil
| | - Lucia A de O Fraga
- Programa Multicêntrico de Bioquímica e Biologia Molecular, Universidade Federal de Juiz de Fora, Campus GV, Governador Valadares, Brazil
| | | | | | | | - Laura de Mondesert
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Jessica Stephens
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Erica B Magueta
- Universidade Federal de Juiz de Fora, Campus GV, Governador Valadares, Brazil
| | - Alexandre Castelo Branco
- CREDENPES, Centro de Referencia em Doenças Endêmicas e Programas Especiais, Governador Valadares, Brazil
| | | | | | | | - Jessica K Fairley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 550 Peachtree Street, NE 7th Floor, Atlanta, GA, USA.
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De Carvalho AG, Guimarães Luz JG, Leite Dias JV, Tiwari A, Steinmann P, Ignotti E. Hyperendemicity, heterogeneity and spatial overlap of leprosy and cutaneous leishmaniasis in the southern Amazon region of Brazil. GEOSPATIAL HEALTH 2020; 15. [PMID: 33461274 DOI: 10.4081/gh.2020.892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/13/2020] [Indexed: 06/12/2023]
Abstract
Neglected tropical diseases characterized by skin lesions are highly endemic in the state of Mato Grosso, Brazil. We analyzed the spatial distribution of leprosy and Cutaneous Leishmaniasis (CL) and identified the degree of overlap in their distribution. All new cases of leprosy and CL reported between 2008 and 2017 through the national reporting system were included in the study. Scan statistics together with univariate Global and Local Moran's I were employed to identify clusters and spatial autocorrelation for each disease, with the spatial correlation between leprosy and CL measured by bivariate Global and Local Moran's I. Finally, we evaluated the demographic characteristics of the patients. The number of leprosy (N = 28,204) and CL (N = 24,771) cases in Mato Grosso and the highly smoothed detection coefficients indicated hyperendemicity and spatial distribution heterogeneity. Scan statistics demonstrated overlap of high-risk clusters for leprosy (RR = 2.0; P <0.001) and CL (RR = 4.0; P <0.001) in the North and Northeast mesoregions. Global Moran's I revealed a spatial autocorrelation for leprosy (0.228; P = 0.001) and CL (0.311; P = 0.001) and a correlation between them (0.164; P = 0.001). Both diseases were found to be concentrated in urban areas among men aged 31-60 years, of brown-skinned ethnicity and with a low educational level. Our findings indicate a need for developing integrated and spatially as well as socio-demographically targeted public health policies.
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Affiliation(s)
- Amanda Gabriela De Carvalho
- School of Medicine, Institute of Exact and Natural Sciences, Federal University of Rondonópolis, Rondonópolis; School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso.
| | - João Gabriel Guimarães Luz
- School of Medicine, Institute of Exact and Natural Sciences, Federal University of Rondonópolis, Rondonópolis, Brazil; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - João Victor Leite Dias
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teófilo Otoni, Minas Gerais, Brazil.
| | - Anuj Tiwari
- Department of Public Health, Erasmus University Medical Center, Rotterdam.
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel.
| | - Eliane Ignotti
- School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso; School of Health Sciences, Post-Graduation Program Environment Sciences, State University of Mato Grosso, Cáceres, Mato Grosso.
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Paz WSD, Gomes DS, Ramos RES, Cirilo TM, Santos IGA, Ribeiro CJN, Araújo KCGMD, Jesus AMRD, Santos ADD, Bezerra-Santos M. Spatiotemporal clusters of schistosomiasis mortality and association with social determinants of health in the Northeast region of Brazil (1980-2017). Acta Trop 2020; 212:105668. [PMID: 32805215 DOI: 10.1016/j.actatropica.2020.105668] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
The Northeast region of Brazil includes the states with the highest prevalence for schistosomiasis mansoni (SM). This study aimed to evaluate the spatiotemporal patterns of SM mortality and to analyze this association with social determinants in health. We conducted an ecological time series study (1980-2017), using spatial analysis tools. Time trend analysis was performed by joinpoint regression. Maps representing mortality rates for SM were constructed and Moran Index was calculated to analyze spatial autocorrelation. A total of 13,720 deaths from SM were reported in this period. The states of Pernambuco (PE) (50.62%) and Alagoas (AL) (22.09%) had the highest mortality percentages. The mortality rate decreased from 1.28 to 0.63 along the time. Although most states showed a stable trend, Sergipe (SE) and Bahia (BA) showed increasing trends in the latest years. Additionally, the spatial analysis showed the concentration of municipalities that presented high risk in the coastal region of the states of PE, AL, SE, and BA. Lastly, mortality rates were correlated with social and educational indicators and hospitalizations for diarrhea. Altogether, these results demonstrate that some states showed stable or increasing trends of SM mortality in the last period of the studied time interval.
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Affiliation(s)
- Wandklebson Silva da Paz
- Laboratório de Imunologia e Biologia Molecular, Departamento de Patologia, Universidade Federal de Sergipe, Aracaju, Sergipe, Brasil; Programa de Pós-Graduação em Biologia Parasitária, Universidade Federal de Sergipe (PROBP/UFS), São Cristóvão, Sergipe, Brasil.
| | - Dharliton Soares Gomes
- Programa de Pós-Graduação em Biologia Parasitária, Universidade Federal de Sergipe (PROBP/UFS), São Cristóvão, Sergipe, Brasil
| | - Rosália Elen S Ramos
- Programa de Pós-Graduação em Biologia Parasitária, Universidade Federal de Sergipe (PROBP/UFS), São Cristóvão, Sergipe, Brasil
| | - Tatyane Martins Cirilo
- Programa de Pós-Graduação em Biologia Parasitária, Universidade Federal de Sergipe (PROBP/UFS), São Cristóvão, Sergipe, Brasil
| | - Israel Gomes A Santos
- Departamento de Biologia, Universidade Estadual de Alagoas, Santana do Ipanema, Alagoas, Brasil
| | - Caíque Jordan N Ribeiro
- Instituto Federal de Educação, Ciência e Tecnologia de Sergipe (IFS), São Cristóvão, Sergipe, Brasil
| | - Karina Conceição Gomes M de Araújo
- Programa de Pós-Graduação em Biologia Parasitária, Universidade Federal de Sergipe (PROBP/UFS), São Cristóvão, Sergipe, Brasil; Departamento de Morfologia, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brasil
| | - Amélia Maria Ribeiro de Jesus
- Laboratório de Imunologia e Biologia Molecular, Departamento de Patologia, Universidade Federal de Sergipe, Aracaju, Sergipe, Brasil; Departamento de Medicina, Universidade Federal de Sergipe, Aracaju, Sergipe, Brasil
| | - Allan Dantas Dos Santos
- Programa de Pós-graduação em Enfermagem, Universidade Federal de Sergipe (PPGEN/UFS), São Cristóvão, Brasil
| | - Márcio Bezerra-Santos
- Laboratório de Imunologia e Biologia Molecular, Departamento de Patologia, Universidade Federal de Sergipe, Aracaju, Sergipe, Brasil; Programa de Pós-Graduação em Biologia Parasitária, Universidade Federal de Sergipe (PROBP/UFS), São Cristóvão, Sergipe, Brasil; Departamento de Morfologia, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brasil
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Emerson LE, Anantharam P, Yehuala FM, Bilcha KD, Tesfaye AB, Fairley JK. Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176061. [PMID: 32825398 PMCID: PMC7504265 DOI: 10.3390/ijerph17176061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/16/2022]
Abstract
Access to safe water, sanitation, and hygiene (WASH) is critical for preventing the spread of neglected tropical diseases (NTDs) including leprosy. WASH-related transmission factors remain largely unexplored in the leprosy transmission cycle. The aim of this project is to better understand WASH exposures among leprosy cases through a case-control study in North Gondar, Ethiopia. We hypothesized that leprosy cases were more likely to have inadequate WASH access and were more likely to have concurrent schistosomiasis, as schistosomiasis immune consequences may facilitate leprosy infection. Forty leprosy cases (forty-one controls) were enrolled, tested for Schistosomamansoni, administered a demographic and WASH survey, and assigned a WASH index score. WASH factors significantly associated with leprosy on adjusted analyses included open defecation (aOR = 19.9, 95% CI 2.2, 176.3) and lack of access to soap (aOR = 7.3, 95% CI 1.1, 49.9). S. mansoni was detected in 26% of participants and in stratified analysis those with leprosy had a 3.6 (95% CI (0.8, 15.9)) greater odds of schistosomiasis in districts bordering the lake, compared to 0.33 lower odds of schistosomiasis in districts not bordering the lake (95% CI (0.09, 1.2)). Overall, results suggest that leprosy transmission may be related to WASH adequacy and access as well as to schistosomiasis co-infection.
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Affiliation(s)
- Lisa E. Emerson
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (L.E.E.); (P.A.)
| | - Puneet Anantharam
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (L.E.E.); (P.A.)
| | - Feleke M. Yehuala
- College of Medicine and Health Sciences, University of Gondar, P.O. Box 196 Gondar, Ethiopia; (F.M.Y.); (A.B.T.)
| | | | - Annisa B. Tesfaye
- College of Medicine and Health Sciences, University of Gondar, P.O. Box 196 Gondar, Ethiopia; (F.M.Y.); (A.B.T.)
| | - Jessica K. Fairley
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (L.E.E.); (P.A.)
- School of Medicine, Emory University, Atlanta, GA 30322, USA;
- Correspondence:
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White C. 'Zero Leprosy' and other endgame strategies: Rhetoric vs. realism in public health campaigns. Glob Public Health 2020; 15:956-967. [PMID: 32202468 DOI: 10.1080/17441692.2020.1744681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
For over half a century, many public health campaigns related to infectious disease have focused on disease 'eradication,' rather than 'control' or 'management.' In this article, I will focus on the example of a recent global leprosy (Hansen's Disease) control campaign, Triple Zero. Drawing on examples from other public health initiatives, this article explores how the language of 'zero disease' or 'endgame strategies' is appealing to certain audiences but how it can also be misleading and have unexpected and unintended consequences. Depending on the specific characteristics of the disease, the disease vectors, and the circumstances of transmission, 'zero' disease is rarely an achievable goal. In addition, when a disease is said to reach 'zero,' it is important to consider the possible implications for people with social, physical, or emotional sequeläe from the disease and who still may require follow-up treatment and care.
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Affiliation(s)
- Cassandra White
- Department of Anthropology, Georgia State University, Atlanta, Georgia, United States
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10
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Standley C, Boyce MR, Klineberg A, Essix G, Katz R. Organization of oversight for integrated control of neglected tropical diseases within Ministries of Health. PLoS Negl Trop Dis 2018; 12:e0006929. [PMID: 30462639 PMCID: PMC6281257 DOI: 10.1371/journal.pntd.0006929] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/05/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are communicable diseases that impact approximately 1 billion people, but receive relatively little research, funding, and attention. Many NTDs have similar treatments, epidemiology, and geographic distribution, and as a result, the integration of control efforts can improve accountability, efficiency, and cost-effectiveness of programs. Here, we examine the landscape of efforts towards NTD integration across countries with the highest burden of disease, and review the administrative management of integration in order to identify approaches and pathways for integration. METHODOLOGY AND PRINCIPAL FINDINGS We utilized a standardized system to score countries for NTD endemnicity to create a list of 25 countries with the highest overall burden of NTDs. We then conducted a literature review to characterize the NTD control programs in the focus countries. Six countries were selected for key informant interviews to validate literature review results and gather additional data on opportunities and obstacles to NTD integration, from an administrative perspective. The majority of countries included in the study were located in Africa, with the remainder from Asia, North America, and South America. Multiple models and pathways were observed for the integration of NTD programs, in combination with other NTD programs, other diseases, or other health programs. Substantial heterogeneity existed with respect to the NTD control programs, and no country had integrated all of their NTD control efforts into a single program. NTDs that can be treated with preventative chemotherapy were frequently integrated into a single program. Leprosy control was also frequently integrated with those of other communicable diseases, and notably tuberculosis. Barriers to NTD integration may result from internal administrative obstacles or external obstacles. CONCLUSIONS Although many countries have begun to integrate NTD control efforts, additional work will be required to realize the full benefits of integration in most of the countries examined here. Moving forward, NTD integration efforts must ensure that administrative structures are designed to maximize the potential success of integrated programs and account for existing administrative processes.
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Affiliation(s)
- Claire Standley
- Georgetown University Medical Center, Center for Global Health Science and Security, Washington, District of Columbia, United States of America
| | - Matthew R. Boyce
- Georgetown University Medical Center, Center for Global Health Science and Security, Washington, District of Columbia, United States of America
| | - Anna Klineberg
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Houston, Texas, United States of America
| | - Gabrielle Essix
- Georgetown University Medical Center, Center for Global Health Science and Security, Washington, District of Columbia, United States of America
| | - Rebecca Katz
- Georgetown University Medical Center, Center for Global Health Science and Security, Washington, District of Columbia, United States of America
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11
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Geluk A. Correlates of immune exacerbations in leprosy. Semin Immunol 2018; 39:111-118. [PMID: 29950273 DOI: 10.1016/j.smim.2018.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 01/13/2023]
Abstract
Leprosy is still a considerable health threat in pockets of several low and middle income countries worldwide where intense transmission is witnessed, and often results in irreversible disabilities and deformities due to delayed- or misdiagnosis. Early detection of leprosy represents a substantial hurdle in present-day leprosy health care. The dearth of timely diagnosis has, however, particularly severe consequences in the case of inflammatory episodes, designated leprosy reactions, which represent the major cause of leprosy-associated irreversible neuropathy. There is currently no accurate, routine diagnostic test to reliably detect leprosy reactions, or to predict which patients will develop these immunological exacerbations. Identification of host biomarkers for leprosy reactions, particularly if correlating with early onset prior to development of clinical symptoms, will allow timely interventions that contribute to decreased morbidity. Development of a point-of-care (POC) test based on such correlates would be a definite game changer in leprosy health care. In this review, proteomic-, transcriptomic and metabolomic research strategies aiming at identification of host biomarker-based correlates of leprosy reactions are discussed, next to external factors associated with occurrence of these episodes. The vast diversity in research strategies combined with the variability in patient- and control cohorts argues for harmonisation of biomarker discovery studies with geographically overarching study sites. This will improve identification of specific correlates associated with risk of these damaging inflammatory episodes in leprosy and subsequent application to rapid field tests.
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Affiliation(s)
- Annemieke Geluk
- Dept. of Infectious Diseases, LUMC, PO Box 9600, 2300 RC Leiden, The Netherlands.
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