A Research and Development Agenda for the Control and Elimination of Human Helminthiases
Identifieur interne : 002887 ( Pmc/Corpus ); précédent : 002886; suivant : 002888A Research and Development Agenda for the Control and Elimination of Human Helminthiases
Auteurs : Jürg UtzingerSource :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2012.
Url:
DOI: 10.1371/journal.pntd.0001646
PubMed: 22545174
PubMed Central: 3335882
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PMC:3335882Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A Research and Development Agenda for the Control and Elimination of Human Helminthiases</title><author><name sortKey="Utzinger, Jurg" sort="Utzinger, Jurg" uniqKey="Utzinger J" first="Jürg" last="Utzinger">Jürg Utzinger</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="aff2"><addr-line>University of Basel, Basel, Switzerland</addr-line></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22545174</idno><idno type="pmc">3335882</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335882</idno><idno type="RBID">PMC:3335882</idno><idno type="doi">10.1371/journal.pntd.0001646</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">002887</idno><idno 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article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosntds</journal-id><journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title></journal-title-group><issn pub-type="ppub">1935-2727</issn><issn pub-type="epub">1935-2735</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22545174</article-id><article-id pub-id-type="pmc">3335882</article-id><article-id pub-id-type="publisher-id">PNTD-D-12-00362</article-id><article-id pub-id-type="doi">10.1371/journal.pntd.0001646</article-id><article-categories><subj-group subj-group-type="heading"><subject>Editorial</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Parasitic Diseases</subject><subj-group><subject>Helminth Infection</subject></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>A Research and Development Agenda for the Control and Elimination of Human Helminthiases</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Utzinger</surname><given-names>Jürg</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland</addr-line></aff><aff id="aff2"><label>2</label><addr-line>University of Basel, Basel, Switzerland</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>juerg.utzinger@unibas.ch</email></corresp></author-notes><pub-date pub-type="collection"><month>4</month><year>2012</year></pub-date><pub-date pub-type="epub"><day>24</day><month>4</month><year>2012</year></pub-date><volume>6</volume><issue>4</issue><elocation-id>e1646</elocation-id><permissions><copyright-statement>Jürg Utzinger.</copyright-statement><copyright-year>2012</copyright-year><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.</license-p></license></permissions><counts><page-count count="7"></page-count></counts></article-meta></front><body><p>In this issue of <italic>PLoS Neglected Tropical Diseases</italic>, the Disease Reference Group on Helminth Infections (DRG4) has put forward a collection of eight reviews that, taken together, outline a compelling research and development agenda for the control and elimination of helminth diseases of humans (<ext-link ext-link-type="uri" xlink:href="http://www.ploscollections.org/helminths">http://www.ploscollections.org/helminths</ext-link><xref rid="pntd.0001646-Lustigman1" ref-type="bibr">[1]</xref>–<xref rid="pntd.0001646-OseiAtweneboana1" ref-type="bibr">[8]</xref>). Emphasis is placed on six major helminth infections: (i) soil-transmitted helminthiasis; (ii) schistosomiasis; (iii) lymphatic filariasis; (iv) onchocerciasis; (v) food-borne trematodiasis; and (vi) cysticercosis/taeniasis. Selection of these helminthiases is justified on multiple grounds. Firstly, as shown in <xref ref-type="table" rid="pntd-0001646-t001">Table 1</xref>, more than half of the world's population is at risk of one or several of these helminthiases, and hundreds of millions of people are currently infected. Secondly, consequences of the mainly long-term chronic infection include suffering, stigmatisation, subtle and gross morbidity (e.g., anaemia, limb deformations and blindness), and premature death, hence causing an intolerable global burden <xref rid="pntd.0001646-Little1" ref-type="bibr">[9]</xref>–<xref rid="pntd.0001646-Pullan1" ref-type="bibr">[17]</xref>. These features, in turn, exacerbate poverty <xref rid="pntd.0001646-Hotez1" ref-type="bibr">[18]</xref>–<xref rid="pntd.0001646-King1" ref-type="bibr">[20]</xref>. Thirdly, there is growing commitment at all levels—from local communities to politicians, philanthropic organisations, and civil society—to control and eventually eliminate/eradicate the major human helminthiases.</p><table-wrap id="pntd-0001646-t001" position="float"><object-id pub-id-type="doi">10.1371/journal.pntd.0001646.t001</object-id><label>Table 1</label><caption><title>Helminth Infections Emphasised by DRG4 for Development of a Research Agenda for Control and Elimination.</title></caption><alternatives><graphic id="pntd-0001646-t001-1" xlink:href="pntd.0001646.t001"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col></colgroup><thead><tr><td align="left" rowspan="1" colspan="1">Helminth Infection</td><td align="left" rowspan="1" colspan="1">Causative Agent(s)</td><td align="left" rowspan="1" colspan="1">At-Risk Population (Millions)</td><td align="left" rowspan="1" colspan="1">No. of People Infected (Millions)</td><td align="left" rowspan="1" colspan="1">No. of People with Morbidity (Millions)</td><td align="left" rowspan="1" colspan="1">No. of Deaths per Year (Thousands)</td><td align="left" rowspan="1" colspan="1">Global Burden (Thousand DALYs)</td><td align="left" rowspan="1" colspan="1">Reference(s)</td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Soil-transmitted helminthiasis</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Ascariasis</td><td align="left" rowspan="1" colspan="1"><italic>Ascaris lumbricoides</italic></td><td align="left" rowspan="1" colspan="1">5,416</td><td align="left" rowspan="1" colspan="1">807–1,221</td><td align="left" rowspan="1" colspan="1">350</td><td align="left" rowspan="1" colspan="1">3–60</td><td align="left" rowspan="1" colspan="1">1,817–10,500</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Bethony1" ref-type="bibr">[10]</xref>, <xref rid="pntd.0001646-Lammie1" ref-type="bibr">[11]</xref>, <xref rid="pntd.0001646-Pullan1" ref-type="bibr">[17]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Trichuriasis</td><td align="left" rowspan="1" colspan="1"><italic>Trichuris trichiura</italic></td><td align="left" rowspan="1" colspan="1">5,307</td><td align="left" rowspan="1" colspan="1">604–795</td><td align="left" rowspan="1" colspan="1">220</td><td align="left" rowspan="1" colspan="1">3–10</td><td align="left" rowspan="1" colspan="1">1,006–6,400</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Bethony1" ref-type="bibr">[10]</xref>, <xref rid="pntd.0001646-Lammie1" ref-type="bibr">[11]</xref>, <xref rid="pntd.0001646-Pullan1" ref-type="bibr">[17]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Hookworm infection</td><td align="left" rowspan="1" colspan="1"><italic>Ancylostoma duodenale</italic> and <italic>Necator americanus</italic></td><td align="left" rowspan="1" colspan="1">5,346</td><td align="left" rowspan="1" colspan="1">576–740</td><td align="left" rowspan="1" colspan="1">150</td><td align="left" rowspan="1" colspan="1">3–65</td><td align="left" rowspan="1" colspan="1">59–22,100</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Bethony1" ref-type="bibr">[10]</xref>, <xref rid="pntd.0001646-Lammie1" ref-type="bibr">[11]</xref>, <xref rid="pntd.0001646-Pullan1" ref-type="bibr">[17]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Strongyloidiasis</td><td align="left" rowspan="1" colspan="1"><italic>Strongyloides stercoralis</italic></td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1">30–100</td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Bethony1" ref-type="bibr">[10]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Lymphatic filariasis</td><td align="left" rowspan="1" colspan="1"><italic>Wuchereria bancrofti</italic>, <italic>Brugia malayi</italic>, and <italic>B. timori</italic></td><td align="left" rowspan="1" colspan="1">>1,000</td><td align="left" rowspan="1" colspan="1">120</td><td align="left" rowspan="1" colspan="1">43</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">5,777</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Lammie1" ref-type="bibr">[11]</xref>, <xref rid="pntd.0001646-Taylor1" ref-type="bibr">[14]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Schistosomiasis<xref ref-type="table-fn" rid="nt101">a</xref></td><td align="left" rowspan="1" colspan="1"><italic>Schistosoma haematobium</italic>, <italic>S. japonicum</italic>, and <italic>S. mansoni</italic></td><td align="left" rowspan="1" colspan="1">779</td><td align="left" rowspan="1" colspan="1">207</td><td align="left" rowspan="1" colspan="1">120</td><td align="left" rowspan="1" colspan="1">15–280</td><td align="left" rowspan="1" colspan="1">1,702–4,500</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Lammie1" ref-type="bibr">[11]</xref>, <xref rid="pntd.0001646-Steinmann1" ref-type="bibr">[12]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Food-borne trematodiasis</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Clonorchiasis</td><td align="left" rowspan="1" colspan="1"><italic>Clonorchis sinensis</italic></td><td align="left" rowspan="1" colspan="1">601</td><td align="left" rowspan="1" colspan="1">15.3</td><td align="left" rowspan="1" colspan="1">1.1</td><td align="left" rowspan="1" colspan="1">5.6</td><td align="left" rowspan="1" colspan="1">275</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Keiser1" ref-type="bibr">[13]</xref>, <xref rid="pntd.0001646-Frst1" ref-type="bibr">[16]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Paragonimiasis</td><td align="left" rowspan="1" colspan="1"><italic>Paragonimus</italic> spp.</td><td align="left" rowspan="1" colspan="1">292</td><td align="left" rowspan="1" colspan="1">23.2</td><td align="left" rowspan="1" colspan="1">5.3</td><td align="left" rowspan="1" colspan="1">0.2</td><td align="left" rowspan="1" colspan="1">197</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Keiser1" ref-type="bibr">[13]</xref>, <xref rid="pntd.0001646-Frst1" ref-type="bibr">[16]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Fascioliasis</td><td align="left" rowspan="1" colspan="1"><italic>Fasciola gigantica</italic> and <italic>F. hepatica</italic></td><td align="left" rowspan="1" colspan="1">91</td><td align="left" rowspan="1" colspan="1">2.6</td><td align="left" rowspan="1" colspan="1">0.3</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">35</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Keiser1" ref-type="bibr">[13]</xref>, <xref rid="pntd.0001646-Frst1" ref-type="bibr">[16]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Opisthorchiasis</td><td align="left" rowspan="1" colspan="1"><italic>Opisthorchis felineus</italic> and <italic>O. viverrini</italic></td><td align="left" rowspan="1" colspan="1">80</td><td align="left" rowspan="1" colspan="1">8.4</td><td align="left" rowspan="1" colspan="1">0.3</td><td align="left" rowspan="1" colspan="1">1.3</td><td align="left" rowspan="1" colspan="1">74</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Keiser1" ref-type="bibr">[13]</xref>, <xref rid="pntd.0001646-Frst1" ref-type="bibr">[16]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Intestinal fluke infections</td><td align="left" rowspan="1" colspan="1"><italic>Echinostoma</italic> spp., <italic>Fasciolopsis buski</italic>, <italic>Metagonimus</italic> spp., and <italic>Heterophyidae</italic></td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1">6.7</td><td align="left" rowspan="1" colspan="1">0.9</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">84</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Keiser1" ref-type="bibr">[13]</xref>, <xref rid="pntd.0001646-Frst1" ref-type="bibr">[16]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Onchocerciasis</td><td align="left" rowspan="1" colspan="1"><italic>Onchocerca volvulus</italic></td><td align="left" rowspan="1" colspan="1">120</td><td align="left" rowspan="1" colspan="1">37</td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1">0.05 (in the OCP area)</td><td align="left" rowspan="1" colspan="1">484</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Little1" ref-type="bibr">[9]</xref>, <xref rid="pntd.0001646-Taylor1" ref-type="bibr">[14]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Cysticercosis/taeniasis</td><td align="left" rowspan="1" colspan="1"><italic>Taenia solium</italic> and <italic>T. saginata</italic></td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1">n.d.</td><td align="left" rowspan="1" colspan="1">>2,000</td><td align="left" rowspan="1" colspan="1"><xref rid="pntd.0001646-Torgerson1" ref-type="bibr">[15]</xref></td></tr></tbody></table></alternatives><table-wrap-foot><fn id="nt101"><label>a</label><p>Listed are the three main schistosome species parasitising humans; of lesser importance are <italic>S. guineenisis</italic> and <italic>S. intercalatum</italic> (both restricted to West and Central Africa) and <italic>S. mekongi</italic> (restricted to Cambodia and Lao PDR).</p></fn><fn id="nt102"><label></label><p>DALY, disability-adjusted life year; n.d., not determined; OCP, Onchocerciasis Control Programme.</p></fn></table-wrap-foot></table-wrap><p><xref ref-type="fig" rid="pntd-0001646-g001">Figure 1</xref> shows that the six helminthiases are at distinctively different stages of control and elimination with geographical idiosyncrasies for some of them <xref rid="pntd.0001646-WHO1" ref-type="bibr">[21]</xref>. Several helminthiases have been targeted for elimination (e.g., lymphatic filariasis and onchocerciasis in the Americas), and progress made thus far gives hope that this goal can indeed be achieved by 2015 or 2020 if certain conditions are met <xref rid="pntd.0001646-Taylor1" ref-type="bibr">[14]</xref>, <xref rid="pntd.0001646-WHO1" ref-type="bibr">[21]</xref>. For schistosomiasis and soil-transmitted helminthiasis, discussions are escalating to shift the focus from control to elimination <xref rid="pntd.0001646-Knopp1" ref-type="bibr">[22]</xref>, <xref rid="pntd.0001646-Spear1" ref-type="bibr">[23]</xref>, and in Africa, the African Programme for Onchocerciasis Control (APOC) is also moving towards this goal <xref rid="pntd.0001646-WHOAPOC1" ref-type="bibr">[24]</xref>. The pivotal role of research, coupled with teaching and training of strong cadres of researchers from endemic settings as essential backbones and platforms to design, implement, and adapt the control and elimination agenda for major helminthiases as well as other tropical diseases, cannot be emphasised enough <xref rid="pntd.0001646-Colley1" ref-type="bibr">[25]</xref>–<xref rid="pntd.0001646-Alonso1" ref-type="bibr">[27]</xref>.</p><fig id="pntd-0001646-g001" position="float"><object-id pub-id-type="doi">10.1371/journal.pntd.0001646.g001</object-id><label>Figure 1</label><caption><title>Stages of control/elimination of the six helminthiases emphasised by DRG4.</title><p>The schematic representation shows the different stages of a control programme (from morbidity to transmission control), including the extreme ends (i.e., no control, extent of the problem yet to be determined on the far left; and elimination on the far right). Colour codes of horizontal lines: black, global; blue, Latin America and Caribbean; red, sub-Saharan Africa; brown, Middle East and North Africa; green, Asia. Dashed lines indicate that, in some counties within a sub-region (or globally), the control/elimination is less or more advanced than in the sub-region (or globally) overall.</p></caption><graphic xlink:href="pntd.0001646.g001"></graphic></fig><p>In 2007/2008, the Special Programme for Research and Training in Tropical Diseases (TDR), based at and executed by the World Health Organization (WHO), and co-sponsored by the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and WHO, initiated a network of disease-specific and thematic reference groups (DRGs/TRGs). DRG4 was particularly prolific, as witnessed in the collection of authoritative reviews presented here. This accompanying editorial summarises the goal, objectives and expected outcomes of the DRGs/TRGs global research “think tank”. Next, light is shed on the composition of DRG4, its mode of operation and its first outputs. It is then argued that <italic>PLoS Neglected Tropical Diseases</italic> is an appropriate outlet for the studies reviewed and synthesised by DRG4. Indeed, open access to the identified and ranked research priorities by all stakeholders is a major asset and is likely to reinforce the control and elimination agenda of the major helminthiases.</p><sec id="s2"><title>A Global Research “Think Tank”</title><p>The idea to create a global network of DRGs and TRGs as a major international research “think tank” stems from the fourth external review of TDR that took place between February 2005 and May 2006 <xref rid="pntd.0001646-Daar1" ref-type="bibr">[28]</xref>. The role and operation of this “think tank” were incorporated into the 10-year strategic plan of TDR, which is endorsed by WHO. A key recommendation of the aforementioned external review was that TDR should shift its emphasis from pursuing a model of disease portfolio (“neglected diseases”) <xref rid="pntd.0001646-Remme1" ref-type="bibr">[29]</xref> to infectious diseases of poverty-related research needs (“needy populations”). As a result of this thinking, the 10-year strategy and underlying business plan of TDR recommended two strong pillars to position and further enhance the organisation's strategic advantages in a rapidly changing global landscape of funding, research and development: (i) knowledge management that should lead to the concept of stewardship, and (ii) capacity building that should foster empowerment <xref rid="pntd.0001646-Ridley1" ref-type="bibr">[30]</xref>.</p><p>Conceptualised in 2007/2008, a total of 10 reference groups, six of them with a disease-specific focus, and the remaining four with a thematic and cross-cutting emphasis, were initiated <xref rid="pntd.0001646-Boatin1" ref-type="bibr">[2]</xref> (<xref ref-type="table" rid="pntd-0001646-t002">Table 2</xref>; see also Table S1 in <xref rid="pntd.0001646-Boatin1" ref-type="bibr">[2]</xref>). Each reference group comprises 10–14 international experts. Groups are chaired and co-chaired by renowned scientists, at least one of whom is based in a developing country. A competitively selected young career research fellow is offered the opportunity to be part of the group, primarily pursuing research within the realm of the group, but also charged with some limited operational and managerial tasks to ascertain smooth operation of the groups. The reference groups are hosted by WHO country offices in Africa, Asia, and Latin America.</p><table-wrap id="pntd-0001646-t002" position="float"><object-id pub-id-type="doi">10.1371/journal.pntd.0001646.t002</object-id><label>Table 2</label><caption><title>Global Network of Disease-Specific Reference Groups (DRGs) and Thematic Reference Groups (TRGs).</title></caption><alternatives><graphic id="pntd-0001646-t002-2" xlink:href="pntd.0001646.t002"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col></colgroup><thead><tr><td align="left" rowspan="1" colspan="1">DRG and TRG</td><td align="left" rowspan="1" colspan="1">Disease(s) or Thematic Focus</td><td align="left" rowspan="1" colspan="1">Hosting Institution(s) and Country(ies)</td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">DRG1</td><td align="left" rowspan="1" colspan="1">Malaria</td><td align="left" rowspan="1" colspan="1">WHO Regional Office for Africa (AFRO), Republic of the Congo</td></tr><tr><td align="left" rowspan="1" colspan="1">DRG2</td><td align="left" rowspan="1" colspan="1">Tuberculosis, leprosy, and Buruli ulcer</td><td align="left" rowspan="1" colspan="1">WHO Country Office for the Philippines</td></tr><tr><td align="left" rowspan="1" colspan="1">DRG3</td><td align="left" rowspan="1" colspan="1">Chagas disease, human African trypanosomiasis, and leishmaniasis</td><td align="left" rowspan="1" colspan="1">WHO Country Offices for Sudan and Brazil</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>DRG4</bold></td><td align="left" rowspan="1" colspan="1"><bold>Helminthiases</bold></td><td align="left" rowspan="1" colspan="1"><bold>African Programme for Onchocerciasis Control (APOC), Burkina Faso</bold></td></tr><tr><td align="left" rowspan="1" colspan="1">DRG5</td><td align="left" rowspan="1" colspan="1">Dengue and emerging viral diseases</td><td align="left" rowspan="1" colspan="1">WHO Country Office for Cuba</td></tr><tr><td align="left" rowspan="1" colspan="1">DRG6</td><td align="left" rowspan="1" colspan="1">Zoonosis and marginalised infectious diseases</td><td align="left" rowspan="1" colspan="1">WHO Regional Office for Easter and Mediterranean (EMRO), in collaboration with WHO Country Office for Egypt</td></tr><tr><td align="left" rowspan="1" colspan="1">TRG1</td><td align="left" rowspan="1" colspan="1">Social science and gender</td><td align="left" rowspan="1" colspan="1">WHO Country Office for Ghana</td></tr><tr><td align="left" rowspan="1" colspan="1">TRG2</td><td align="left" rowspan="1" colspan="1">Innovation and biotechnology platforms</td><td align="left" rowspan="1" colspan="1">WHO Country Office for Thailand</td></tr><tr><td align="left" rowspan="1" colspan="1">TRG3</td><td align="left" rowspan="1" colspan="1">Implementation and health systems research</td><td align="left" rowspan="1" colspan="1">WHO Country Office for Nigeria</td></tr><tr><td align="left" rowspan="1" colspan="1">TRG4</td><td align="left" rowspan="1" colspan="1">Environment, agriculture and human health</td><td align="left" rowspan="1" colspan="1">WHO Country Office for the People's Republic of China</td></tr></tbody></table></alternatives><table-wrap-foot><fn id="nt103"><label></label><p>In 2007/2008, the Special Programme for Research and Training in Tropical Diseases (TDR) set up a global network of DRGs and TRGs as an independent “think tank” of international experts. The groups met regularly to review, debate, and synthesise existing information, including stakeholder consultation. The ultimate aim was to establish and strengthen an evidence base on infectious diseases of poverty and cross-cutting themes, including identifying knowledge gaps and current research priorities.</p></fn></table-wrap-foot></table-wrap><p>As per TDR's latest 10-year strategy and vision, the global network of DRGs and TRGs operate within the guiding principles of knowledge management and capacity building, thus emphasising stewardship and empowerment. The specific objectives are to systematically review, debate, and synthesise available information and to define and rate research priorities. This is facilitated by regular meetings (it was initially planned that the groups would meet once a year for 3–5 days), usually in the hosting country of a specific group. Broad stakeholder consultation, usually at the outset of the meetings, was adopted as an integral part of the <italic>modus operandi</italic> of the groups.</p></sec><sec id="s3"><title>The Disease Reference Group on Helminth Infections (DRG4)</title><p>DRG4 initially comprised 14 individuals. The group is chaired by Sara Lustigman at the Lindsley F. Kimball Research Institute, New York Blood Center in New York, United States of America. Boakye A. Boatin serves as the co-chair, currently affiliated with two institutions, the Institute of Parasitology, McGill University (Montreal, Canada), and the Noguchi Memorial Institute of Medical Research, University of Ghana (Legon, Ghana). The career research fellow is based at the Council for Scientific and Industrial Research, Water Research Institute, in Ghana. The writing core team includes Sara Lustigman, Boakye A. Boatin, María-Gloria Basáñez (United Kingdom), and Roger K. Prichard (Canada). The geographical representation of the remaining nine members reveals two from Africa (Côte d'Ivoire and Ghana), two from Asia (Thailand and People's Republic of China), two from Latin America (Brazil and Peru), two from Oceania (Australia), and one from the Middle East (Egypt).</p><p>At the outset, the group identified research gaps and pursued a multi-criteria assessment, including stakeholder consultation, and Delphi approach that ultimately resulted in a consolidated list of the 10 top research priorities. This forms the “white paper” of the DRG4, i.e., recognising and pursuing these priorities in order to achieve control and elimination of major human helminthiases. This “white paper” is co-authored by the entire group <xref rid="pntd.0001646-Boatin1" ref-type="bibr">[2]</xref>. Next, an in-depth analysis outlines the problem of human helminthiases, emphasising the omnipresence of single and multiple species parasitic worm infections and their intricate relationship with poverty <xref rid="pntd.0001646-Lustigman1" ref-type="bibr">[1]</xref>. Visualising this collection as house, the reviews highlighting the problem of human helminthiases, and issues towards control and elimination, are like the foundation upon which the building is erected (<xref ref-type="fig" rid="pntd-0001646-g002">Figure 2</xref>). Key proposed responses for the helminthiases control and elimination agenda are reviewed in four separate pieces that are the main building blocks of the house. These include basic research and enabling technologies <xref rid="pntd.0001646-Lustigman2" ref-type="bibr">[3]</xref>, new and improved intervention tools and strategies, such as drugs, vaccines, and for some of the helminthiases also vector control <xref rid="pntd.0001646-Prichard1" ref-type="bibr">[6]</xref>, diagnostics <xref rid="pntd.0001646-McCarthy1" ref-type="bibr">[4]</xref>, and mathematical modelling to inform policy and reinforce research <xref rid="pntd.0001646-Basez1" ref-type="bibr">[5]</xref>. Understanding social-ecological contexts, environmental determinants, and health systems forms the first layer of the roof <xref rid="pntd.0001646-Gazzinelli1" ref-type="bibr">[7]</xref>. Health research and capacity building in developing country settings is of such pivotal importance that it is layered on top of a well-built house, and hence reinforces the agenda <xref rid="pntd.0001646-OseiAtweneboana1" ref-type="bibr">[8]</xref>.</p><fig id="pntd-0001646-g002" position="float"><object-id pub-id-type="doi">10.1371/journal.pntd.0001646.g002</object-id><label>Figure 2</label><caption><title>A research agenda for the control and elimination of major helminthiasis put forth by DRG4.</title><p>This figure synthesises the key written outputs from DRG4, visualising this collection of eight reviews as a house (strong foundation, major building blocks and a two-layered roof).</p></caption><graphic xlink:href="pntd.0001646.g002"></graphic></fig><p>It is, perhaps, interesting to note that key research and development (R&D) issues have already been discussed in connection with a malaria eradication research agenda (malERA). Facilitated by a 2-year broadly integrative and iterative process led by a core team, and assisted by various experts groups and involving more than 250 scientists, programme managers and decision-makers from the public and private sectors in a series of consultations, the malERA went live in a special issue of <italic>PLoS Medicine</italic> in early 2011 <xref rid="pntd.0001646-Alonso1" ref-type="bibr">[27]</xref>. Similar R&D issues were identified in parallel by the malERA and the series presenting the research agenda for helminth infections of humans. Once the collection of malERA papers came out, they served as an inspiration to also publish the comprehensive R&D agenda pertaining to human helminthiases in a collection of reviews, and <italic>PLoS Neglected Tropical Diseases</italic> was deemed a suitable outlet. Both agendas feature basic science and enabling technologies <xref rid="pntd.0001646-Lustigman2" ref-type="bibr">[3]</xref>, <xref rid="pntd.0001646-The1" ref-type="bibr">[31]</xref>, diagnoses and diagnostics <xref rid="pntd.0001646-McCarthy1" ref-type="bibr">[4]</xref>, <xref rid="pntd.0001646-The2" ref-type="bibr">[32]</xref>, modelling <xref rid="pntd.0001646-Basez1" ref-type="bibr">[5]</xref>, <xref rid="pntd.0001646-The3" ref-type="bibr">[33]</xref>, and health systems issues <xref rid="pntd.0001646-Gazzinelli1" ref-type="bibr">[7]</xref>, <xref rid="pntd.0001646-The4" ref-type="bibr">[34]</xref>. While the helminthiases agenda has a single chapter on interventions (due to the fact that, for instance, interventions such as anti-helminth vaccines are in earlier stages of development for use in humans <xref rid="pntd.0001646-Bergquist1" ref-type="bibr">[35]</xref>), in the malERA, there are three separate contributions for interventions: drugs, vaccines, and vector control <xref rid="pntd.0001646-The5" ref-type="bibr">[36]</xref>–<xref rid="pntd.0001646-The7" ref-type="bibr">[38]</xref>. This difference further emphasises the neglect in R&D funding for novel and repositioned intervention tools to control human helminth infections as opposed to malaria <xref rid="pntd.0001646-Keiser2" ref-type="bibr">[39]</xref>. Additionally, the malERA views the issues of monitoring, evaluation, and surveillance (the latter further developed as “surveillance as an intervention”) of such great importance that space is given for a full contribution <xref rid="pntd.0001646-The8" ref-type="bibr">[40]</xref>. Together with a piece on cross-cutting issues for eradication, lessons learned from the first malaria eradication era in the 1950s and 1960s, and the aforementioned umbrella <xref rid="pntd.0001646-Alonso1" ref-type="bibr">[27]</xref>, the malERA certainly is a key resource for developing control and elimination/eradication agendas for human infectious diseases, including human helminthiases. However, the research agenda for helminthiases is unique in its contribution of a separate article fully considering the issues of capacity building for health research and disease control in endemic countries <xref rid="pntd.0001646-OseiAtweneboana1" ref-type="bibr">[8]</xref>, which is absent in the malERA collection. Both collections therefore should be considered together as prime examples of major outputs produced by think tanks, driven by core writing teams and stakeholder engagement in the current global efforts to help control and eliminate poverty-related diseases <xref rid="pntd.0001646-WHO1" ref-type="bibr">[21]</xref>.</p></sec><sec id="s4"><title>Going Live in <italic>PLoS Neglected Tropical Diseases</italic></title><p>In terms of writing, the various DRGs and TRGs were charged to produce annual reports. Additionally, the groups were requested to have these reports further developed into stand-alone comprehensive Technical Report Series, to be published by the WHO. Unfortunately, at the time these reports were submitted to TDR, the organisation sailed through troubled waters, delaying internal processing and external peer review. Yet, there is new traction and it is hoped that the planned WHO Technical Report Series will soon come to bear. In the meantime, the Disease Reference Group on Zoonoses and Marginalized Infectious Diseases (DRG6) disseminated a most useful overview article through the open-access journal <italic>Parasites & Vectors</italic><xref rid="pntd.0001646-Molyneux1" ref-type="bibr">[41]</xref>.</p><p>The efforts made by DRG4 to produce no less than eight major reviews are commended and <italic>PLoS Neglected Tropical Diseases</italic> clearly is an appropriate outlet for this collection of articles. To wit, within 2–3 years after the launch of <italic>PLoS Neglected Tropical Diseases</italic> in late 2007, this open-access vehicle established itself as the leading peer-reviewed journal in tropical medicine. Two seminal papers published in 2005 and 2006 provided an initial list of 15 neglected tropical diseases, the majority of which were due to helminth infections <xref rid="pntd.0001646-Molyneux2" ref-type="bibr">[42]</xref>, <xref rid="pntd.0001646-Hotez3" ref-type="bibr">[43]</xref>. Indeed, all of the six helminthiases emphasised by DRG4 were part of the initial scope of <italic>PLoS Neglected Tropical Diseases</italic>. Meanwhile, the scope of the journal has broadened considerably <xref rid="pntd.0001646-Hotez4" ref-type="bibr">[44]</xref>, and now also includes a growing number of bacterial, protozoal, viral, and ectoparasitic infections, but helminthiases still figure prominently. Indeed, as shown in <xref ref-type="table" rid="pntd-0001646-t003">Table 3</xref>, more than 20% of the over 1,300 original articles, reviews, and front-matter pieces focus on helminth infections.</p><table-wrap id="pntd-0001646-t003" position="float"><object-id pub-id-type="doi">10.1371/journal.pntd.0001646.t003</object-id><label>Table 3</label><caption><title>Number and Percentage of Helminth-Related Articles Published in <italic>PLoS Neglected Tropical Diseases</italic>.</title></caption><alternatives><graphic id="pntd-0001646-t003-3" xlink:href="pntd.0001646.t003"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="center" span="1"></col></colgroup><thead><tr><td align="left" rowspan="1" colspan="1">Search Strategy</td><td align="left" rowspan="1" colspan="1">No. (%) of Hits</td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><italic>PLoS Neglected Tropical Diseases</italic></td><td align="left" rowspan="1" colspan="1">1335 (100)</td></tr><tr><td align="left" rowspan="1" colspan="1">Protozoan infections</td><td align="left" rowspan="1" colspan="1">294 (22.0)</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Helminth infections</bold></td><td align="left" rowspan="1" colspan="1"><bold>277 (20.7)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1">Viral infections</td><td align="left" rowspan="1" colspan="1">212 (15.9)</td></tr><tr><td align="left" rowspan="1" colspan="1">Bacterial infections</td><td align="left" rowspan="1" colspan="1">185 (13.9)</td></tr><tr><td align="left" rowspan="1" colspan="1">Fungal infections</td><td align="left" rowspan="1" colspan="1">11 (0.8)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ectoparasitic infections</td><td align="left" rowspan="1" colspan="1">0</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Helminths (parasitic worms)</bold></td><td align="left" rowspan="1" colspan="1"><bold>481 (36.0)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Trematodes</bold></td><td align="left" rowspan="1" colspan="1"><bold>103 (7.7)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Nematodes</bold></td><td align="left" rowspan="1" colspan="1"><bold>101 (7.6)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Cestodes</bold></td><td align="left" rowspan="1" colspan="1"><bold>26 (1.9)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1">Helminthic diseases</td><td align="left" rowspan="1" colspan="1">260 (19.5)</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Schistosomiasis</bold></td><td align="left" rowspan="1" colspan="1"><bold>138 (10.3)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Lymphatic filariasis</bold></td><td align="left" rowspan="1" colspan="1"><bold>57 (4.3)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Soil-transmitted helminthiasis</bold></td><td align="left" rowspan="1" colspan="1"><bold>36 (2.7)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Onchocerciasis</bold></td><td align="left" rowspan="1" colspan="1"><bold>34 (2.5)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1">Echinococcosis</td><td align="left" rowspan="1" colspan="1">25 (1.9)</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Cysticercosis</bold></td><td align="left" rowspan="1" colspan="1"><bold>23 (1.7)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Taeniasis</bold></td><td align="left" rowspan="1" colspan="1"><bold>20 (1.5)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1">Toxocariasis</td><td align="left" rowspan="1" colspan="1">7 (0.5)</td></tr><tr><td align="left" rowspan="1" colspan="1">Loiasis</td><td align="left" rowspan="1" colspan="1">6 (0.4)</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Food-borne trematodiasis</bold></td><td align="left" rowspan="1" colspan="1"><bold>1 (0.1)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1">Dracunculiasis</td><td align="left" rowspan="1" colspan="1">0</td></tr><tr><td align="left" rowspan="1" colspan="1">Important helminth species</td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Schistosoma mansoni</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>80 (6.0)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Hookworm</bold></td><td align="left" rowspan="1" colspan="1"><bold>49 (3.7)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Schistosoma japonicum</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>39 (2.9)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Trichuris trichiura</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>32 (2.4)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Ascaris lumbricoides</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>31 (2.3)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Brugia malayi</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>21 (1.6)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Strongyloides stercoralis</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>17 (1.3)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Taenia solium</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>15 (1.1)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Wuchereria bancrofti</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>14 (1.0)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Onchocerca volvulus</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>13 (1.0)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Clonorchis sinensis</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>8 (0.6)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Fasciola hepatica</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>8 (0.6)</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold><italic>Opisthorchis viverrini</italic></bold></td><td align="left" rowspan="1" colspan="1"><bold>6 (0.4)</bold></td></tr></tbody></table></alternatives><table-wrap-foot><fn id="nt104"><label></label><p>Search performed on PubMed on March 15, 2012, using the advanced search builder. In a first step, the term “<italic>PLoS Neglected Tropical Diseases</italic>” was entered in the field “journal”, which revealed 1,335 hits. In subsequent steps, helminth-specific terms were added using the Boolean operator “AND”. Bold text in the table indicates parasites, parasitic infections, and diseases covered by the Disease Reference Group on Helminth Infections (DRG4).</p></fn></table-wrap-foot></table-wrap></sec><sec id="s5"><title>Lessons Learned and Next Steps</title><p>Sixty-five years after the landmark publication of Norman R. Stool entitled “This Wormy World” <xref rid="pntd.0001646-Stoll1" ref-type="bibr">[45]</xref>, it is clear that helminthiases are still widespread and continue to pose a huge public health problem. Indeed, a situation analysis reveals that more than half of the word's population is at risk of helminth infection, more than a billion people are currently infected, often with multiple species, and helminthiases are rife where poverty and malnutrition prevail, in the face of lack of access to basic infrastructure (e.g., clean water and sanitation) and hygiene <xref rid="pntd.0001646-Pullan1" ref-type="bibr">[17]</xref>, <xref rid="pntd.0001646-King1" ref-type="bibr">[20]</xref>, <xref rid="pntd.0001646-Ziegelbauer1" ref-type="bibr">[46]</xref>. These facts form the foundation of the current article collection <xref rid="pntd.0001646-Lustigman1" ref-type="bibr">[1]</xref>, <xref rid="pntd.0001646-Boatin1" ref-type="bibr">[2]</xref>. Responses on how to control and eventually eliminate human helminthiases require ethically, technically and scientifically sound research to improve current tools and strategies, as summarised in the present helminthiasis agenda <xref rid="pntd.0001646-Boatin1" ref-type="bibr">[2]</xref>–<xref rid="pntd.0001646-Prichard1" ref-type="bibr">[6]</xref>. Research and capacity building must accompany the entire process and innovation is key to developing and validating the next generation of tools and strategies <xref rid="pntd.0001646-OseiAtweneboana1" ref-type="bibr">[8]</xref>.</p><p>For example, there is a need for developing rapid and inexpensive integrated mapping approaches for those helminthiases where the extent of the problem is not yet appreciated <xref rid="pntd.0001646-Brooker1" ref-type="bibr">[47]</xref>. The recent development of high-resolution, spatially explicit global databases for helminthiases and other neglected tropical diseases provides an exciting new opportunity for targeting control interventions, and subsequent monitoring, evaluation, and surveillance <xref rid="pntd.0001646-Brooker2" ref-type="bibr">[48]</xref>, <xref rid="pntd.0001646-Hrlimann1" ref-type="bibr">[49]</xref>. Importantly, once the emphasis shifts from morbidity control towards transmission control and finally local elimination, the need for highly accurate diagnostics tools must be stressed. Indeed, the diagnostics must be adapted to the current stage of a control programme <xref rid="pntd.0001646-Bergquist2" ref-type="bibr">[50]</xref>. Moreover, lessons learned from past successful helminthiases control and elimination programmes emphasise the need for integrated approaches with close collaboration between different sectors (e.g., health, education, and water) and long-term political commitment <xref rid="pntd.0001646-Holveck1" ref-type="bibr">[51]</xref>–<xref rid="pntd.0001646-Utzinger1" ref-type="bibr">[53]</xref>. These issues must be seen in rapidly changing demographic, health systems, and social-ecological contexts <xref rid="pntd.0001646-Gazzinelli1" ref-type="bibr">[7]</xref>. A deep understanding at different spatial and temporal scales is mandatory so that some of the most ancient afflictions of humankind can be consigned to history in the not too distant future.</p></sec></body><back><ack><p>Thanks are addressed to the core writing team of DRG4 and Prof. Marcel Tanner from the Swiss Tropical and Public Health Institute for a series of useful and constructive comments regarding the current editorial.</p></ack><fn-group><fn fn-type="COI-statement"><p>J.U. served as a member on the Thematic Reference Group Environment, Agriculture and Human Health (TRG4), funded by the Special Programme for Research and Training in Tropical Diseases (TDR), based at and executed by the World Health Organization (WHO), and co-sponsored by UNICEF, UNDP, the World Bank, and WHO.</p></fn><fn fn-type="financial-disclosure"><p>The author received no specific funding to write this editorial.</p></fn></fn-group><ref-list><title>References</title><ref 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