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Geneva, Switzerland, WHO, Department of Control of Neglected Tropical Diseases, 2006.  p. (WHO/CDS/NTD/2006.2)Neglected tropical diseases affect an estimated 1 billion people, primarily poor populations living in tropical and subtropical climates. They frequently cluster geographically and overlap; individuals are often afflicted with more than one parasite or infection. 100% of low-income countries are affected by at least five neglected tropical diseases simultaneously. More than 70% of countries and territories that report the presence of neglected tropical disease are low-income and lower middle-income economies. Infections are attributable to unsafe water, poor housing conditions and poor sanitation. Children are most vulnerable to infections of most neglected tropical diseases. Neglected tropical diseases kill, impair or permanently disable millions of people every year, often resulting in life-long physical pain, social stigmatization and abuse. Many can be prevented, eliminated or even eradicated with improved access to existing safe and costeffective tools. (excerpt)
Global issues on the agenda at the World Health Assembly. Discussion of HIV / AIDS, leprosy, access to drugs.
JAMA. 2001 Jul 4; 286(1):29-30.During the World Health Assembly in May 2001, some of the high-priority issues are discussed including HIV/AIDS, the WHO policy on medicines, leprosy, and recommendations for infant and young child feeding. In particular, the worldwide HIV/AIDS pandemic and the Global Fund to fight specific diseases in developing countries were subjects of particular interest. In terms of policy on drugs, the main point under discussion was to ensure that public health issues are taken into account as countries develop patent legislation. The secondary issue was the revised drug strategy. A special briefing was also conducted, pointing to great progress in controlling leprosy. Moreover, the main issue in infant and young feeding tackled during the meeting is the promotion and support of breast-feeding.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES.. 1998; (874):v-vi, 1-43.This book provides an update on the global leprosy situation emphasizing the availability of technology for disease elimination, identification of obstacles, and development of appropriate recommendations for leprosy prevention. Section 1 presents the actions undertaken by the WHO in response to the increasing incidence of leprosy worldwide. Section 2 discusses the current status of leprosy through a presentation of estimated, registered and detected cases, as well as the success of multidrug therapy in disease elimination. Section 3 presents the definition, diagnosis, clinical manifestations, and other epidemiologic conditions affecting the disease. Section 4 reviews the current available drugs, which include dapsone, rifampicin, clofazimine, ofloxacin, minocycline, clarithromycin and their adverse reactions. Section 5 discusses management of reactions and neuritis, while section 6 presents the disabilities and rehabilitation associated with the disease. The rest of the chapters present a global strategy on leprosy elimination, monitoring, antiepilepsy activity integration, community action and participation, and research priorities. Based on the field trial and clinical study results, the Committee confirms the cost-efficacy and acceptability of a single dose combination of rifampicin, ofloxacin and minocycline as an alternative regimen. In conclusion, the need for improved reaction and neuritis management, prevention of leprosy-related disabilities and impairments and implementation of antileprosy activities as an integral part of the health services is highlighted.
Lancet. 1999 Sep 18; 354(9183):1010.HIV/AIDS, malaria, and tuberculosis are the most formidable challenges for Southeast Asia and account for more than 40% of the global communicable disease burden, according to WHO's 52nd Regional Committee Meeting in Dhaka, India, on September 6-11, 1999. Between July 1997 and March 1999 Southeast Asia reported a 40% increase in AIDS cases, with Thailand, Myanmar, and India accounting for more than 95% of cases. "It is estimated that less than 25% of the total AIDS cases have been reported," writes WHO regional director Uton Muchtar Rafei in his biennial report. Tuberculosis still has the highest mortality in the region. The annual number of new smear positive cases has increased from 18,000 to 70,000--a 2.5% increase. The region also accounts for 80% of global leprosy cases but is expected to achieve the target prevalence rate of <1/10,000 by 2002, albeit 2 years later than planned. (full text)
TDR NEWS. 1998 Feb; (55):4.The World Health Organization (WHO) is working to reduce the prevalence of leprosy to under 1 case/10,000 people in all endemic countries by 2000. Efforts are underway to eliminate leprosy rather than eradicate it because of the current lack of tools with which to eradicate leprosy. The major problem with existing skin test reagents to identify carriers of Mycobacterium leprae, the causative agent of leprosy, is their lack of specificity and tendency to cross-react. With a long-term view toward eradicating leprosy, the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) has been supporting the development of a skin test which will be specific for only leprosy. One immediate benefit of developing and using such a test would be the ability to immediately monitor the effect of multidrug therapy upon the circulation of M. leprae in given communities. A potential problem for the peptide-based skin tests being pursued is the genetic variation in antigen recognition which may exist in different human populations. Candidate peptides will be tested in different leprosy-endemic areas of Asia, Africa, and Latin America, with the skin test eventually either tailor-made for a given geographic area or containing a mix of several peptides representing all regional preferences.
TDR NEWS. 1996 Mar; (49):1-2.A UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) expert meeting has concluded that the means already exist with which to eliminate 4 of the 8 diseases which TDR originally identified as public health problems. Elimination in this case refers to reducing the number of cases of disease to a small and routinely manageable number. The diseases capable of being eliminated with existing tools are leprosy, onchocerciasis, lymphatic filariasis, and Chagas disease. Leprosy can be eliminated through the use of multidrug therapy, onchocerciasis through the administration of ivermectin, lymphatic filariasis through the use of DEC and ivermectin, and Chagas disease through the rational use of insecticides and the control of blood banks. Malaria, schistosomiasis, leishmaniasis, and African trypanosomiasis, however, must await better tools before their elimination can be attempted. TDR's role in identifying how to eliminate each of these diseases is described. Meeting attendees identified additional avenues of operational research upon which TDR should embark.
Geneva, Switzerland, WHO, Action Programme for the Elimination of Leprosy, 1997. , 27 p. (WHO/LEP/97.4)The World Health Organization's (WHO's) Action Program for the Elimination of Leprosy made considerable progress in 1997, largely as a result of the continued reliability of multidrug therapy (MDT). At the beginning of 1997, there were about 1,150,000 leprosy cases worldwide, 888,340 of which were registered for treatment. MDT has fully cured more than 8.4 million people of leprosy since its introduction in 1981 and the number of countries with prevalence rates above 1/10,000 population has declined from 122 in 1985 to 55 at the beginning of 1997. The target of eliminating leprosy as a public health problem by the year 2000 by reducing the prevalence to below 1/10,000 should be reached. However, the drive to distribute MDT must continue since there may be provinces, districts, or even a limited number of high-endemicity countries where prevalence exceeds this rate. The Seventh WHO Expert Meeting (1997) shortened the drug regimen for multibacillary leprosy from 24 to 12 months. In patients with paucibacillary leprosy with only one skin lesion, a single dose of three antileprosy drugs in combination was deemed sufficient to produce a cure. These chemotherapy simplifications are expected to ease the burden of both patients and health services. This 1997 status report updates the situation in terms of leprosy trends in the 28 endemic countries, progress with MDT coverage, chemotherapy, and monitoring and evaluation. An appendix presents statistics on registered cases, prevalence, case detection rates, MDT coverage, and cumulative number of cases cured in endemic countries.
Geneva, Switzerland, WHO, Action Programme for the Elimination of Leprosy, . vi, 106 p. (WHO/LEP/97.7)Elimination of leprosy by the year 2000--a goal set at the 1991 World Health Assembly--is a realistic possibility as a result of 10 years of successful experience with multidrug therapy. Almost all major endemic countries have implemented action programs to eliminate the disease. Key to leprosy elimination is making the World Health Organization (WHO)-recommended antileprosy drugs accessible to all patients, including those living in remote areas. This guide was prepared by WHO's Action Program for the Elimination of Leprosy to enable health workers in endemic countries (especially field workers) to contribute to this goal. It can be used for self-learning or for training courses. The pocket-sized guide includes information on the leprosy elimination strategy, diagnosis, classification of leprosy, organizing diagnostic services, treatment, management of complications, patient care and referral activities, and organizing multidrug therapy services.
In sickness or in health: TDR's parners. 7. Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
TDR NEWS. 1998 Feb; (55):8, 10.Mahidol University's Faculty of Tropical Medicine, Bangkok, Thailand, established in 1960, is one of 14 faculties, 5 institutions, 5 centers, and 2 colleges within Mahidol University. It consists of the following departments: Helminthology, Medical Entomology, Microbiology and Immunology, Protozoology, Social and Environmental Medicine, Tropical Hygiene, Tropical Medicine, Tropical Nutrition and Food Science, Tropical Pediatrics, Tropical Pathology, and Tropical Radioisotopes. The UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) has been associated with the Faculty since 1977, collaborating mainly upon malaria research, but also in filariasis, leprosy, and schistosomiasis research. Early TDR support was directed at research training and institutional strengthening, although by the early 1980s, the Faculty played an increasingly important role in TDR's research and development program. In recent years, the Faculty has focused upon researching malaria, parasitic and bacterial diseases, nutrition and food sciences, and environmental health. The Faculty's malaria-related research is described. The Faculty also conducts research in many other areas of tropical medicine outside of those of interest to TDR.
Lancet. 1995 Sep 9; 346(8976):675-7.WHO projections suggest that the annual number of tuberculosis (TB) cases worldwide will reach 10.2 million by the year 2000. HIV plays a dominant role in this increase in many resource-poor countries. The internationally recommended treatment regimens for TB combine some of the six major antituberculosis drugs: isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin, and thiacetazone. WHO treatment guidelines give priority to patients according to the nature of their disease and recommend two regimens of 6-8 months duration, the longer regimen incorporating thiacetazone. Recently, WHO has favored a 6-month treatment regimen given as directly observed therapy (DOT). The disadvantages of the standard approach are the heavy workload of smear examinations, the complexity of some drug regimens, and the low rates of therapy completion. With the increasing TB case load in areas of high HIV infection prevalence, laboratories cannot do initial as well as follow-up smear examinations. In Botswana the proportion of smear-positive TB cases declined to 40% in 1992, but the overall proportion of patients who had smears performed had declined (52% in 1992). The multiple regimens in use cause confusion and nonadherence to guidelines. Nonadherence is the major risk factor for the emergence of drug resistance, and low completion rates are the most obvious signs of inadequate control programs. Alternative approaches mean ensuring high completion rates and using the most effective drugs. Regarding diagnosis, research might show that the number of smears could be reduced depending on the initial reading. There is no reason why a rifampicin-based short-course regimen could not replace the multiple regimens now in use. Rifampicin-containing regimens of 62-78 doses given intermittently have been effective and are suitable for use within a DOT program. For prevention of drug resistance, only pills combining different drugs should be used and rifampicin should be limited to the treatment of TB and leprosy.
In: Tropical disease research: progress 1991-92. Eleventh programme report of the UNDP / World Bank / WHO Special Programme for Research and Training in Tropical Diseases (TDR). Geneva, Switzerland, World Health Organization [WHO], 1993. 1-14.1991 and 1992 were good years for the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR). Major advances were made in controlling leprosy, onchocerciasis, and Chagas disease, using TDR-supported products; significant advances were made in applied field research, operational research, and in the social sciences; arteether was brought into fully controlled clinical trials and a field trial of a malaria vaccine in African children was initiated; an initiative was launched to control malaria through the genetic engineering of the mosquito vector to interrupt transmission; TDR's research capability strengthening (RCS) component accelerated its move toward strengthening through research and increased its focus upon identifying individuals for training as a first step in the RCS process; and TDR increased the level of convergence among its internal components and between TDR and other health programs, and prepared to define its targets in terms of precise products and time frames.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1995; 73(1):1-6.The World Health Organization-recommended standard multidrug therapy (MDT) against leprosy was introduced in the 1980s and has since been extremely effective against the disease. The number of registered cases worldwide fell from 5.4 million in 1985 to 1.7 million in 1994, the global cumulative MDT coverage of registered patients was at 89%, and the cumulative relapse rates have been low at around 1%. Leprosy, however, remains an important problem in about 80 countries in Asia, Africa, and Latin America, with 2.4 million people estimated to be with the disease in 1994. 80% of the problem is confined to five countries and 92% to just 25 countries. The prevalence of leprosy is therefore far from evenly distributed. The largest numbers of registered cases are in India, Brazil, Indonesia, and Myanmar at 995,285, 223,539, 70,961, and 56,410, respectively. The highest prevalences per 10,000 population are in Brazil, Myanmar, Chad, and India at 14.30, 12.98, 12.43, and 11.34, respectively. Progress against leprosy prompted the World Health Assembly in 1991 to establish the goal of eliminating leprosy as a public health problem by the year 2000. Eliminated is defined as less than one case per 10,000 population. The strategy to that end envisages identifying and treating with MDT about five million cases of leprosy from 1994 to the year 2000 at an estimated cost of $420 million, including $150 million for the drugs.
WORLD HEALTH. 1994 Mar-Apr; 47(2):30-1.The chief of the World Health Organization (WHO) Leprosy Unit aims to eliminate leprosy as a public health problem by 2000. Multidrug therapy is needed to effect a considerable reduction in the leprosy prevalence within 6-7 years. WHO considers a leprosy prevalence in any community of less than 1 leprosy case/10,000 people to be no longer a public health problem. Multidrug therapy includes dapsone, rifampicin, and clofazimine. When these 3 drugs are used, the likelihood of the bacterium developing resistance is greatly reduced. Leprosy patients find multidrug therapy to be acceptable. Very high coverage (95%) of multidrug therapy, assuming high levels of patient compliance, should eliminate the pool of infectious sources and thereby transmission of Mycobacterium leprae. Even when leprosy is eliminated, physical rehabilitation will be needed, since leprosy's physical damage persists. Currently about 2.4 million leprosy cases live in 87 countries. 95% of these leprosy cases live in 25 countries. Brazil, India, Indonesia, Myanmar, and Nigeria house 81% of all leprosy cases. Around 650,000 new cases emerge each year, but this number is falling. As of late 1993, multidrug therapy has cured 5.6 million patients over the last 8 years. The cost to treat some 5 million patients between now and 2000 ranges from US$ 400-600 million, 25% going to drugs. Casual contact with a patient with leprosy does not transmit M. leprae. Persons at most risk of leprosy are those who live in close physical contact with someone with leprosy. The mean incubation period is 3-5 years but has been as long as 20 years. The long incubation period will account for new leprosy cases after 2000. The eastern Mediterranean region may reach elimination levels as early 1997. Countries must always monitor their progress. Governments, donor agencies, and WHO must be politically committed to leprosy elimination. The international health community should not become complacent.