China’s Hookworms Redux

My visits to Shanghai and the Chinese National Institute of Parasitic Diseases (IPD) began almost 20 years ago in the winter of 1994. I was eager to work at the IPD – then a component of the Chinese Academy of Preventive Medicine (CAPM) later the Chinese Center for Disease Control and Prevention (CCDC) –- following their publication of an extraordinary parasite epidemiology study of incredible magnitude that may never be repeated. Beginning late in the 1980s and into the early 1990s Chinese parasitologists conducted fecal examinations on almost 1.5 million people across all provinces. The study first published in the English biomedical literature in the Southeast Asian Journal of Tropical Medicine and Public Health found that hundreds of millions of Chinese were infected with soil-transmitted helminths (STHs), including 194 million people with hookworm infection (‘hookworm’). Most of these infections were south of the Yangtze River, cutting across all of the southern provinces from East to West, and I felt the IPD was an ideal institute to begin the co-development of a prototype human hookworm vaccine.

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Neglected Tropical Diseases of Oceania

Among Oceania’s population of 35 million people, the greatest number living in poverty currently live in Papua New Guinea (PNG), Fiji, Vanuatu, and the Solomon Islands. These impoverished populations are at high risk for selected NTDs, including Necator americanus hookworm infection, strongyloidiasis, lymphatic filariasis (LF), balantidiasis, yaws, trachoma, leprosy, and scabies, in addition to outbreaks of dengue and other arboviral infections including Japanese encephalitis virus infection. Through the Pacific Programme to Eliminate Lymphatic Filariasis, enormous strides have been made in eliminating LF in Oceania through programs of mass drug administration (MDA), although LF remains widespread in PNG. There are opportunities to scale up MDA for PNG’s major NTDs, which could be accomplished through an integrated package that combines albendazole, ivermectin, diethylcarbamazine, and azithromycin, in a program of national control. Australia’s Aboriginal population may benefit from appropriately integrated MDA into primary health care systems. Several emerging viral NTDs remain important threats to the region.

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Nigeria: “Ground Zero” for the High Prevalence Neglected Tropical Diseases

Nigeria has the greatest number of intestinal helminth infections, i.e., ascariasis, hookworm, and trichuriasis, among all African nations, ranking fourth or fifth globally behind only the much higher populated middle-income Asian nations, such as China, India, and Indonesia. Nigeria also has the greatest number of cases of schistosomiasis worldwide, with both intestinal schistosomiasis caused by Schistosoma mansoni and the urogenital schistosomiasis caused by Schistosoma haematobium endemic to that country. In terms of the high prevalence vector-borne NTDs, Nigeria has the greatest number of cases of LF and onchocerciasis in Africa, ranking globally third and first, respectively, and accounting for one-fourth or more of the global disease burden from these two NTDs.

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Saving 7 Million Pregnancies in Africa

Globally, an estimated 1,000 women die every day from pregnancy and childbirth complications — the majority of whom live in sub-Saharan Africa and South Asia. Both of these regions have a disproportionally high burden of diseases known as neglected tropical diseases (NTDs). While NTDs affect men, women, and children, one NTD in particular, hookworm, has devastating effects for pregnant women.

Hookworm is an intestinal parasitic infection causes severe blood loss, anemia, and malnutrition. These effects are particularly harmful to pregnant women and their unborn children: long-term blood loss from hookworms increases a mother’s risk of dying during childbirth. While hemorrhaging during pregnancy is not uncommon, African women are more likely to die from it because they are severely anemic even before they begin labor. Hemorrhage accounts for roughly one third of the pregnancy-related deaths in Africa.

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The Neglected Tropical Diseases and Their Devastating Health and Economic Impact on the Member Nations of the Organisation of the Islamic Conference

Founded in 1969, the Organisation of the Islamic Conference (OIC) is comprised of 57 nations that together represent the second largest international organization after the United Nations. According to their Web site, the OIC serves as the “collective voice of the Muslim world,” both protecting its interests and settling conflicts and disputes between member states. In addition to several important and prosperous oil- and gas-producing nations in the Middle East, the OIC nations also include some of the world’s poorest countries as well as large middle-income countries with regions of great poverty. In these geographic areas of poverty are also found some of the highest infection rates and endemicity of the neglected tropical diseases (NTDs).

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Neglected Tropical Diseases in Sub-Saharan Africa: Review of Their Prevalence, Distribution, and Disease Burden

The neglected tropical diseases (NTDs) are the most common conditions affecting the poorest 500 million people living in sub-Saharan Africa (SSA), and together produce a burden of disease that may be equivalent to up to one-half of SSA’s malaria disease burden and more than double that caused by tuberculosis. Approximately 85% of the NTD disease burden results from helminth infections. Hookworm infection occurs in almost half of SSA’s poorest people, including 40–50 million school-aged children and 7 million pregnant women in whom it is a leading cause of anemia. Schistosomiasis is the second most prevalent NTD after hookworm (192 million cases), accounting for 93% of the world’s number of cases and possibly associated with increased horizontal transmission of HIV/AIDS. Lymphatic filariasis (46–51 million cases) and onchocerciasis (37 million cases) are also widespread in SSA, each disease representing a significant cause of disability and reduction in the region’s agricultural productivity. There is a dearth of information on Africa’s non-helminth NTDs. The protozoan infections, human African trypanosomiasis and visceral leishmaniasis, affect almost 100,000 people, primarily in areas of conflict in SSA where they cause high mortality, and where trachoma is the most prevalent bacterial NTD (30 million cases). However, there are little or no data on some very important protozoan infections, e.g., amebiasis and toxoplasmosis; bacterial infections, e.g., typhoid fever and non-typhoidal salmonellosis, the tick-borne bacterial zoonoses, and non-tuberculosis mycobaterial infections; and arboviral infections. Thus, the overall burden of Africa’s NTDs may be severely underestimated. A full assessment is an important step for disease control priorities, particularly in Nigeria and the Democratic Republic of Congo, where the greatest number of NTDs may occur.

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