* Includes the impact of recent research findings on control strategy
* Discusses the health policy implications of these findings and the importance of evaluation and monitoring
* Highlights the lessons learned and the interactions between control programs and health systems
Control of parasitic infections of humans has progressed rapidly over the last three decades. Such advances have resulted from focal disease control efforts based on historically effective interventions to new approaches to control following intensive research and pilot programs. Control of Human Parasitic Diseases focuses on the present state of control of the significant human parasitic infectious diseases. Includes the impact of recent research findings on control strategy Discusses the health policy implications of these findings and the importance of evaluation and monitoring Highlights the lessons learned and the interactions between control programs and health systems
Cover 1
Contributors to Volume 61 6
Foreword 10
Preface 12
Contents 14
Control of Human Parasitic Diseases: Context and Overview 20
Control of Parasitic Diseases 22
Concepts of Control, Elimination and Eradication 22
Examples of Parasite Elimination and Vector ‘‘Eradication’’ 24
Components of Control 26
The Range of Interventions 26
Control of Animal Reservoir Hosts 26
Community Participation in Parasitic Disease Control 27
Steps in a Control Programme 30
Scaling up Control Programmes 36
Strengthening the Evidence Base 37
The Health Policy Environment 37
Health Financing and Sector-Wide Approaches 38
Public-Private Partnerships 40
The Global Burden of Parasitic Diseases 41
‘‘Neglected’’ Tropical Disease Initiatives and the Integration of Control 42
Integrated Control 42
Evidence for the Value of Integrated Control 45
The Cost-Effectiveness of Parasite Control 46
Scaling Up Integrated Control 47
Defining End Points for Integrated Control 48
Parasitic Diseases: New and Old Challenges 48
Emerging Diseases 48
Climate Change 49
Epidemics of Parasitic Diseases 50
Conclusions 56
References 57
Useful Websites: 64
Malaria Chemotherapy 66
The Pharmacology and Therapeutics of Antimalarials 67
The 4-Aminoquinolines 67
Summary 67
Mode of Action 68
Mechanisms of Resistance 68
Clinical Pharmacokinetics 69
Therapeutic Use 70
Adverse Effects and Adverse Interactions 70
Antifolate Drugs and Combinations 71
Summary 71
Mode of Action 71
Mechanisms of Resistance 72
Clinical Pharmacokinetics 73
Therapeutic Use 73
Adverse Effects and Drug Interactions 74
Quinine and Congeners 74
Summary 74
Mode of Action 75
Clinical Pharmacokinetics 75
Therapeutic Use 75
Adverse Effects and Drug Interactions 76
The Artemisinin Group 76
Summary 76
Mode of Action 77
Clinical Pharmacokinetics 77
Therapeutic Use 77
Adverse Effects 77
A Summary of Other Drugs Used for Malaria 78
Mefloquine 78
Atovaquone– Proguanil 79
Halofantrine 80
Antibiotics 80
Primaquine 80
Developing New Antimalarial Drugs 81
The Use of Antimalarial Drugs 82
Chemoprophylaxis 82
Intermittent Presumptive Treatment (for Pregnant Women and infants) 83
Case Management of Uncomplicated Malaria 84
Background 84
Lumefantrine– artemether (Coartem) 86
Chlorproguanil– Dapsone– Artesunate (CDA) 86
Dihydroartemisinin– Piperaquine (DHA–PQ) 86
Other Management 87
Case Management of Severe P. falciparum Malaria 87
Management of Malaria Outside the Formal Sector 90
Conclusions 90
References 92
Useful Websites: 95
Insecticide-Treated Nets 96
Introduction 97
Efficacy Studies 98
The Impact of ITNs on Malaria Morbidity 98
Children and Adults 98
Pregnant Women 99
ITNs in Combination with Other Malaria Control Interventions 102
Untreated Nets 104
The Impact of ITNs on Childhood Mortality 105
Protective Efficacy and Lives Saved 105
Mass Effect versus Individual Barrier Protection 105
The Impact of ITNs on Other Diseases and Nuisance Insects 108
Acquisition of Malarial Immunity 109
Effectiveness and Cost-Effectiveness Studies 111
Effectiveness of ITNs 111
ITNs Alone 111
ITNS as Part of National Malaria Control Programmes 115
Cost-Effectiveness of ITNs 115
Risk Assessment 117
Monitoring and Impact of Insecticide Resistance 118
Technological Advances 120
Evolution of ITN Policy 123
Equity versus Sustainability 123
Role of the Commercial Sector 124
Who Should Pay? 125
Role of ITNs Relative to IRS 126
Evolution of ITN Delivery Strategies 128
National Level 128
Projects 128
Subsidized Sales 128
Free Goods, Including Vouchers 130
Total Market Approach 131
Unsubsidized Commercial Sales 131
Moving from Projects to Programmes: Going to Full Scale 131
Current ITN Coverage 132
Regional Level 133
Conclusions and Needs 135
References 136
Control of Chagas Disease 148
Introduction 149
The Southern Cone Initiative 151
Technology and Strategy Development 151
Cost-Effectiveness 152
Organization 153
Regional Coordination 154
The Central American Initiative 155
History and Political Framework 156
Chagas Disease Vectors 158
Control of Rhodnius prolixus 162
Control of Triatoma dimidiata 164
Organization and Management 167
Challenges in Central America 170
Efficient Geographic Coverage of Triatoma dimidiata Control 170
Sustainable Vector Control via Integration of the Maintenance Phase 173
Chagas Disease Control Initiatives in Other Regions 175
Andean Region 175
Amazon Region 176
Mexico 176
Conclusion 177
Acknowledgements 178
References 178
Human African Trypanosomiasis: Epidemiology and Control 186
Introduction 187
Disease Burden and Distribution 189
The Vector—Tsetse Flies 191
Trypanosomiasis in Animals 193
Species Other than Trypanosoma brucei 193
Hosts and Reservoirs of Trypanosoma brucei 193
Wild Hosts 193
Domestic hosts 195
Diagnosis 197
Microscopy 197
CATT 198
Other Field Serological Tests for T. b. gambiense 199
ELISA 199
PCR 199
T. b. rhodesiense 200
T. b. gambiense 200
New Technology in Diagnostics 201
Field Diagnostics: Realistic and Appropriate Technologies 201
Treatment 202
Control 204
Historical Paradigms for Control: Biology and Necessity 204
Approaches Adopted in West Africa 206
Approaches Adopted in East Africa 207
Overlap of T. b. gambiense and T. b. rhodesiense: Policy Implications 208
Modern Paradigms for Control: Options for Policy 209
Choice 1: Human Treatments 209
Choice 2: Vector Control 210
Choice 3: Animal Treatments for Human Health Benefit 213
Responsibility for Control 216
Government 216
Community Control 217
Third Parties 218
Conclusions 219
Acknowledgements 221
References 221
Chemotherapy in the Treatment and Control of Leishmaniasis 242
Introduction 243
The Current Epidemiologic Situation and Requirements for New Control Strategies 244
Epidemiology 244
HIV–Leishmania co-infection 248
Canine Leishmaniasis 249
Control Components: Epidemiological Information, Diagnosis, Treatment and Prevention 250
Current Drugs used for the Treatment of Leishmaniasis 259
Treatments for VL 259
Pentavalent Antimonials 259
Amphotericin B 263
Miltefosine 264
Paromomycin 265
Other Treatments for VL 266
Treatments for CL 266
Pentavalent Antimonials 267
Amphotericin B 267
Miltefosine 268
Paromomycin 268
Other Treatments for CL 268
Treatment of Complicated Forms 269
Leishmania– HIV Co-infections and Secondary Prophylaxis 269
Recidivans Cutaneous Leishmaniasis 271
Diffuse Cutaneous Leishmaniasis 271
Mucocutaneous Leishmaniasis 271
PKDL 272
Pregnancy 272
Controlof Leishmaniasis—Needs 273
Visceral Leishmaniasis 273
Cutaneous Leishmaniasis 273
Test of Cure 274
A Policy for Drug Resistance 275
Elimination Programme 278
Conclusions 279
Disclaimer 280
Acknowledgement 280
References 280
Dracunculiasis (Guinea Worm Disease) Eradication 294
Introduction 295
Life Cycle 296
Dracunculiasis 298
Clinical Impact 298
Treatment 301
Epidemiology 301
Where, Why, When, and Whom 301
Socio-Economic Impact 305
Eradication Campaign 305
Genesis and Initial Efforts to Gain Traction on Eradicating the Disease 305
Workshop on Opportunities to Control Dracunculiasis: 1982 307
The WHO Collaborating Center for Research, Training, and Eradication of Dracunculiasis at the CDC 308
The First African Regional Conference on Dracunculiasis Eradication and First World Health Assembly Resolution 308
The Carter Center 309
Other Resolutions 310
Strategy for Eradication 310
Interventions against Disease Transmission 311
Progress towards Eradication 320
Reductions in Cases of Dracunculiasis 320
Reductions in Endemic Villages 325
Reductions in Endemic Countries 325
Finishing the Job 325
References 326
Intervention for the Control of Soil-Transmitted Helminthiasis in the Community 330
Population-Based Interventions to Control Soil-Transmitted Helminthiasis 331
Intervention Package 333
Regular Anthelminthic Treatment 334
Health Education 337
Sanitation 338
Groups at Risk 340
Preschool Children 340
School-Age Children 340
Women of Childbearing Age 341
Frequency of Treatment 341
Targets 342
Delivering the Intervention 344
Helminth Control through Schools 344
Helminth Control through Community-Based Intervention 345
Impact on Morbidity 346
Preschool Children 346
School-Age Children 347
Pregnant Women 348
Adults 349
Cost of the Intervention 349
Regular Chemotherapy 350
Health Education 351
Sanitation 352
New Technology for Sustaining Deworming 353
Scaling up Deworming for School-age Children 355
Questions Needing Answers 356
References 358
Control of Onchocerciasis 368
Introduction 370
The Parasite Life Cycle and Human Disease 371
Onchocerca volvulus 371
Life Cycle and Transmission 371
The Vector 372
The Disease 372
Clinical Manifestations 372
Geographical Distribution and Epidemiological Patterns 373
Distribution in Africa 373
Distribution in the Americas 373
Diagnosis and Treatment 375
Diagnosis 375
Parasitological Diagnosis 375
Immunodiagnosis 376
DNA Probes 377
The DEC Patch Test 377
Treatment 377
Suramin and Diethylcarbamazine 377
Ivermectin 378
Impact of Ivermectin on Adult O. volvulus Parasites 379
Doxycycline and Wolbachia 380
Moxidectin 380
Vector Control Approaches to Onchocerciasis 381
The Onchocerciasis Control Programme in West Africa 381
Vector Elimination/Eradication 384
Control Through Ivermectin Administration 385
The Scale of Ivermectin Treatment 385
APOC and OEPA 386
Targeting of Distribution 388
Coverage 388
Passive Distribution 389
Challenges of Community-Directed Treatment with Ivermectin 389
CDTI 389
Impact of Ivermectin on the Eye and Skin Lesions 390
Impact on Transmission 391
Duration of Treatment with Ivermectin 392
Ivermectin ‘‘Resistance’’ 392
Surveillance 393
Entomological Surveillance 393
Epidemiological Surveillance 395
Cost of the Disease and Costs of the Programmes 396
Social and Economic Costs of the Disease 396
Costs of the Programmes 397
Future Challenges 398
Ivermectin Treatment of Onchocerciasis in Areas that are Co-Endemic for Loa loa 399
Ivermectin Distribution in Hypoendemic Areas 400
Sustainability 401
Detection of Ivermectin Resistance 401
Cessation of Ivermectin Distribution 402
Macrofilaricides and Other Drugs 403
Managerial Challenges 403
References 404
Lymphatic Filariasis: Treatment, Control and Elimination 414
Setting the Stage for the Elimination of Lymphatic Filariasis 415
Recognizing the Barriers/Challenges to LF Elimination 415
Biological Barriers Imposed by the Parasite 415
Social and Political Barriers to LF Elimination 418
Reasons for Optimism about the Feasibility of Eliminating LF 419
Biological Features of LF that Favour its Elimination 419
Social (Historical) Considerations 420
Technical Considerations: The Availability of Effective Tools (for Treatment, for Diagnosis) 421
A Promising Strategy to Eliminate LF 424
Turning Potential into Reality: The Global Programme to Eliminate LF 429
’Drivers’ of the Programme 429
Scientific Underpinning 429
Resources 431
Political Will and Partnership 432
Management 434
Achievements of the Global Programme: 1999–2005 435
Scope of Programme Implementation 435
Impact on LF Transmission and Disease 437
Ancillary Health Benefits 443
Integrated Management of Public Health Programmes 444
Raising Awareness of Global Health Issues and their Solutions 445
Principal Challenges Now Facing the Global Programme to Eliminate LF 446
Treating Individuals with LF 448
Treating LF Infection in Individuals 448
Treating the Disease in Individuals with LF 451
The Future 452
References 453
Control of Cystic Echinococcosis/Hydatidosis: 1863-2002 462
Introduction 464
Life Cycle Biology of Echinococcus. granulosus 465
Medical Importance 467
Epidemiology of E. granulosus Transmission 467
Hydatid Control Programmes Leading to Elimination or Near Elimination of E. granulosus 469
Iceland (1863–1960) 469
New Zealand (1938–2002) 473
Tasmania (1964–1996) 475
Falkland Islands (1965–1997) 478
Cyprus (1971–1985) 479
Lessons Learned from Island Hydatid Control Programmes 481
Slow-Track versus Fast-Track 482
Options and Phases for Control of Cystic Hydatidosis 485
Continental Hydatid Control Programmes with Variable Success—South America 487
Epidemiology of Cystic Echinococcosis in South America 487
Hydatid Control Programmes in South America 489
Hydatid Control in Chile, Regions XI (1982–1997) and XII (1979–1997)—Evidence of Success 490
Hydatid Control in Argentina, Provinces of Neuquén (1970–1988) and Rio Negro (1980–1997)—Evidence of Success but Continued Transmission 493
Hydatid Control in Uruguay (1965–2002)—Initial Failure followed by Evidence of Success 496
Other Hydatid Control Programmes with No or Limited Success—Wales, Kenya, Sardinia 497
Mid-Wales, UK (1983–1989) 498
Northwest Turkana, Kenya (1983–2000) 500
Sardinia (1960–1997) 502
Current Options and Tools for Hydatid Control 504
Epidemiological Modelling 504
Surveillance Tools 506
Ovine Hydatidosis 506
Canine Echinococcosis 508
Human Cystic Echinococcosis 510
Vaccination against Echinococcus granulosus 511
Options for Control of Echinococcus multilocularis 513
Concluding Remarks 514
Acknowledgements 514
References 515
Control of Taenia solium Cysticercosis/Taeniosis 528
Introduction 529
Disease Distribution and Burden 532
Occurrence 532
Disease Burden 534
Diagnosis 538
Taeniosis 538
Questioning and Self-Detection 538
Stool Microscopy 539
Peri-Anal Egg Detection 540
Copro-Antigen Detection ELISA 540
Copro-DNA Assays 541
Serology 542
Human Cysticercosis 543
Biopsy of Subcutaneous Nodules 543
Imaging 544
Immunodiagnosis 544
Porcine Cysticercosis 547
Lingual Examination 547
Pig Carcass Inspection 548
Immunodiagnosis 549
Treatment 550
Taeniosis 550
Cysticercosis 550
Human Cysticercosis 550
Porcine Cysticercosis 552
Vaccination 553
Surveillance and Reporting 556
Prevention and Control 557
Conclusions 565
Acknowledgements 566
References 566
Implementation of Human Schistosomiasis Control: Challenges and Prospects 586
Introduction 588
Life History and Transmission—Breaking the Life Cycle 588
Historical Perspective—Successes and Failures 590
Epidemiology 598
Epidemiology and Distribution, GIS and Disease Prediction 598
Water-Resource Developments 600
Infection, Re-infection and Genetic Factors 603
Control 605
Current Control Objectives and Strategies—Global Persuasion 605
Current Strategies to Reduce and Reverse Morbidity using Praziquantel 606
Other Drugs 609
Health Education 609
Vaccines 610
Schistosomiasis Control Initiative 611
Overview and Progress 611
Political Commitment 616
Procurement of Praziquantel and Albendazole 617
Future Strategies 618
Low Transmission Areas 618
Towards Elimination of the Disease 618
Integration and Sustainability 622
Integration with other Health Programmes 622
The First Steps Towards Integration of Activities 626
Achieving Sustainability 627
Acknowledgements 628
References 629
Index 642
Contents of Volumes in This Series 674
Colour Plate Section 682
Control of Human Parasitic Diseases: Context and Overview
David H. Molyneux Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
Abstract 1
1. Control of Parasitic Diseases 3
1.1. Concepts of Control, Elimination and Eradication 3
1.2. Examples of Parasite Elimination and Vector “Eradication” 5
1.4. Scaling up Control Programmes 17
1.5. Strengthening the Evidence Base 18
2. The Health Policy Environment 18
2.1. Health Financing and Sector-Wide Approaches 19
2.2. Public–Private Partnerships 21
2.3. The Global Burden of Parasitic Diseases 22
2.4. “Neglected” Tropical Disease Initiatives and the Integration of Control 23
3. Parasitic Diseases: New and Old Challenges 29
3.3. Epidemics of Parasitic Diseases 31
References 38
ABSTRACT
The control of parasitic diseases of humans has been undertaken since the aetiology and natural history of the infections was recognized and the deleterious effects on human health and well-being appreciated by policy makers, medical practitioners and public health specialists. However, while some parasitic infections such as malaria have proved difficult to control, as defined by a sustained reduction in incidence, others, particularly helminth infections can be effectively controlled. The different approaches to control from diagnosis, to treatment and cure of the clinically sick patient, to control the transmission within the community by preventative chemotherapy and vector control are outlined. The concepts of eradication, elimination and control are defined and examples of success summarized. Overviews of the health policy and financing environment in which programmes to control or eliminate parasitic diseases are positioned and the development of public–private partnerships as vehicles for product development or access to drugs for parasite disease control are discussed. Failure to sustain control of parasites may be due to development of drug resistance or the failure to implement proven strategies as a result of decreased resources within the health system, decentralization of health management through health-sector reform and the lack of financial and human resources in settings where per capita government expenditure on health may be less than $US 5 per year. However, success has been achieved in several large-scale programmes through sustained national government investment and/or committed donor support. It is also widely accepted that the level of investment in drug development for the parasitic diseases of poor populations is an unattractive option for pharmaceutical companies. The development of partnerships to specifically address this need provides some hope that the intractable problems of the treatment regimens for the trypanosomiases and leishmaniases can be solved in the not too distant future. However, it will be difficult to implement and sustain such interventions in fragile health services often in settings where resources are limited but also in unstable, conflict-affected or post-conflict countries. Emphasis is placed on the importance of co-endemicity and polyparasitism and the opportunity to control parasites susceptible to cost-effective and proven chemotherapeutic interventions for a package of diseases which can be implemented at low cost and which would benefit the poorest and most marginalized groups. The ecology of parasitic diseases is discussed in the context of changing ecology, environment, sociopolitical developments and climate change. These drivers of global change will affect the epidemiology of parasites over the coming decades, while in many of the most endemic and impoverished countries parasitic infections will be accorded lower priority as resourced stressed health systems cope with the burden of the higher-profile killing diseases viz., HIV/AIDS, TB and malaria. There is a need for more holistic thinking about the interactions between parasites and other infections. It is clear that as the prevalence and awareness of HIV has increased, there is a growing recognition of a host of complex interactions that determine disease outcome in individual patients. The competition for resources in the health as well as other social sectors will be a continuing challenge; effective parasite control will be dependent on how such resources are accessed and deployed to effectively address well-defined problems some of which are readily amenable to successful interventions with proven methods. In the health sector, the problems of the HIV/AIDS and TB pandemics and the problem of the emerging burden of chronic non-communicable diseases will be significant competitors for these limited resources as parasitic infections aside from malaria tend to be chronic disabling problems of the poorest who have limited access to scarce health services and are representative of the poorest quintile. Prioritization and advocacy for parasite control in the national and international political environments is the challenge.
1 CONTROL OF PARASITIC DISEASES
1.1 Concepts of Control, Elimination and Eradication
A distinction must be made between the terms ‘control’, ‘elimination’ and ‘eradication’; the latter term is often used inappropriately and it should be employed with caution. The International Task Force for Disease Eradication (ITFDE) was established in 1988 to evaluate systematically the potential for eradication of candidate diseases and to identify specific barriers to eradication. The criteria used to assess the feasibility of eradication are provided in Table 1. The Task Force was reconstituted in 2001 to evaluate the current situation. The ITFDE defined eradication as ‘reduction of the world-wide incidence of a disease to zero as a result of deliberate efforts obviating the necessity for further control measures’. The original ITFDE reviewed more than 90 diseases, 30 of them in depth, and concluded that dracunculiasis, rubella, poliomyelitis, mumps, lymphatic filariasis and cysticercosis could probably be eradicated using existing technology. The term ‘elimination’ is increasingly being used to replace the term ‘eradication’, which should be only used in Global terms. The Dahlem conference held in Berlin in 1997 (Dowdle and Hopkins, 1998) also considered these issues in some detail and introduced the term extinction to classify an organism that did not exist on the planet contrasting with smallpox, which had been eradicated as a cause of disease but stocks had been retained in secure laboratories. The use of the term elimination is now regarded as referring to the removal of the organism from a defined geographical region (“local eradication”), which creates problems for quantification of achievement towards the goal. The accepted position being that the disease is not eradicated but no longer requires ongoing investment in control and is maintained at a level when the problem is no longer a significant health burden. A new concept has also been introduced through World Assembly Resolutions of the “Elimination of a disease as a Public Health problem”. The definitions which will be used in this chapter are from Dowdle and Hopkins (1998), WHO (1998) and Molyneux et al. (2004):
Table 1
Criteria for assessing eradicability of diseases or conditions (Dowdle and Hopkins, 1998)
Scientific feasibility
Epidemiologic vulnerability (e.g. absence of non-human reservoir; ease of spread; natural cyclical decline in prevalence; naturally induced immunity; ease of diagnosis; and duration of any relapse potential)
Effective, practical intervention available (e.g. vaccine or other primary preventive, curative treatment, and means of eliminating vector). Ideally, intervention should be effective, safe, inexpensive, long lasting and easily deployed
Demonstrated feasibility of elimination (e.g. documented elimination from island or other geographic unit)
Political will/popular support
Perceived burden of the disease (e.g. extent, deaths, other effects; true burden may not be perceived; the reverse of benefits expected to accrue from eradication; relevance to rich and poor countries)
Expected cost of elimination or eradication (especially in relation to perceived burden from the...
| Erscheint lt. Verlag | 23.3.2007 |
|---|---|
| Sprache | englisch |
| Themenwelt | Sachbuch/Ratgeber |
| Medizin / Pharmazie ► Allgemeines / Lexika | |
| Medizin / Pharmazie ► Gesundheitsfachberufe | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Mikrobiologie / Infektologie / Reisemedizin | |
| Studium ► Querschnittsbereiche ► Epidemiologie / Med. Biometrie | |
| Studium ► Querschnittsbereiche ► Infektiologie / Immunologie | |
| Naturwissenschaften ► Biologie | |
| Technik | |
| ISBN-10 | 0-08-046294-4 / 0080462944 |
| ISBN-13 | 978-0-08-046294-3 / 9780080462943 |
| Haben Sie eine Frage zum Produkt? |
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