Emerging and Neglected Infectious Diseases: Insights, Advances, and Challenges
Identifieur interne : 002E03 ( Pmc/Curation ); précédent : 002E02; suivant : 002E04Emerging and Neglected Infectious Diseases: Insights, Advances, and Challenges
Auteurs : Nicholas Israel Nii-Trebi [Ghana]Source :
- BioMed Research International [ 2314-6133 ] ; 2017.
Abstract
Infectious diseases are a significant burden on public health and economic stability of societies all over the world. They have for centuries been among the leading causes of death and disability and presented growing challenges to health security and human progress. The threat posed by infectious diseases is further deepened by the continued emergence of new, unrecognized, and old infectious disease epidemics of global impact. Over the past three and half decades at least 30 new infectious agents affecting humans have emerged, most of which are zoonotic and their origins have been shown to correlate significantly with socioeconomic, environmental, and ecological factors. As these factors continue to increase, putting people in increased contact with the disease causing pathogens, there is concern that infectious diseases may continue to present a formidable challenge. Constant awareness and pursuance of effective strategies for controlling infectious diseases and disease emergence thus remain crucial. This review presents current updates on emerging and neglected infectious diseases and highlights the scope, dynamics, and advances in infectious disease management with particular focus on WHO top priority emerging infectious diseases (EIDs) and neglected tropical infectious diseases.
Url:
DOI: 10.1155/2017/5245021
PubMed: 28286767
PubMed Central: 5327784
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<front><div type="abstract" xml:lang="en"><p>Infectious diseases are a significant burden on public health and economic stability of societies all over the world. They have for centuries been among the leading causes of death and disability and presented growing challenges to health security and human progress. The threat posed by infectious diseases is further deepened by the continued emergence of new, unrecognized, and old infectious disease epidemics of global impact. Over the past three and half decades at least 30 new infectious agents affecting humans have emerged, most of which are zoonotic and their origins have been shown to correlate significantly with socioeconomic, environmental, and ecological factors. As these factors continue to increase, putting people in increased contact with the disease causing pathogens, there is concern that infectious diseases may continue to present a formidable challenge. Constant awareness and pursuance of effective strategies for controlling infectious diseases and disease emergence thus remain crucial. This review presents current updates on emerging and neglected infectious diseases and highlights the scope, dynamics, and advances in infectious disease management with particular focus on WHO top priority emerging infectious diseases (EIDs) and neglected tropical infectious diseases.</p>
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<pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Biomed Res Int</journal-id>
<journal-id journal-id-type="iso-abbrev">Biomed Res Int</journal-id>
<journal-id journal-id-type="publisher-id">BMRI</journal-id>
<journal-title-group><journal-title>BioMed Research International</journal-title>
</journal-title-group>
<issn pub-type="ppub">2314-6133</issn>
<issn pub-type="epub">2314-6141</issn>
<publisher><publisher-name>Hindawi Publishing Corporation</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">28286767</article-id>
<article-id pub-id-type="pmc">5327784</article-id>
<article-id pub-id-type="doi">10.1155/2017/5245021</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Emerging and Neglected Infectious Diseases: Insights, Advances, and Challenges</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-5012-9564</contrib-id>
<name><surname>Nii-Trebi</surname>
<given-names>Nicholas Israel</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
<xref ref-type="corresp" rid="cor1"><sup>*</sup>
</xref>
</contrib>
</contrib-group>
<aff id="I1">Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana</aff>
<author-notes><corresp id="cor1">*Nicholas Israel Nii-Trebi: <email>nntrebi@chs.edu.gh</email>
</corresp>
<fn fn-type="other"><p>Academic Editor: André Talvani</p>
</fn>
</author-notes>
<pub-date pub-type="ppub"><year>2017</year>
</pub-date>
<pub-date pub-type="epub"><day>13</day>
<month>2</month>
<year>2017</year>
</pub-date>
<volume>2017</volume>
<elocation-id>5245021</elocation-id>
<history><date date-type="received"><day>13</day>
<month>8</month>
<year>2016</year>
</date>
<date date-type="rev-recd"><day>5</day>
<month>1</month>
<year>2017</year>
</date>
<date date-type="accepted"><day>16</day>
<month>1</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2017 Nicholas Israel Nii-Trebi.</copyright-statement>
<copyright-year>2017</copyright-year>
<license xlink:href="https://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>Infectious diseases are a significant burden on public health and economic stability of societies all over the world. They have for centuries been among the leading causes of death and disability and presented growing challenges to health security and human progress. The threat posed by infectious diseases is further deepened by the continued emergence of new, unrecognized, and old infectious disease epidemics of global impact. Over the past three and half decades at least 30 new infectious agents affecting humans have emerged, most of which are zoonotic and their origins have been shown to correlate significantly with socioeconomic, environmental, and ecological factors. As these factors continue to increase, putting people in increased contact with the disease causing pathogens, there is concern that infectious diseases may continue to present a formidable challenge. Constant awareness and pursuance of effective strategies for controlling infectious diseases and disease emergence thus remain crucial. This review presents current updates on emerging and neglected infectious diseases and highlights the scope, dynamics, and advances in infectious disease management with particular focus on WHO top priority emerging infectious diseases (EIDs) and neglected tropical infectious diseases.</p>
</abstract>
</article-meta>
</front>
<floats-group><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label>
<caption><p>Some past emerging infectious disease epidemics and probable factors for outbreak.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Year</th>
<th align="left" rowspan="1" colspan="1">Emerging disease</th>
<th align="left" rowspan="1" colspan="1">Pathogenic agent</th>
<th align="left" rowspan="1" colspan="1">Main probable factor</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">1958</td>
<td align="left" rowspan="1" colspan="1">Argentine haemorrhagic fever</td>
<td align="left" rowspan="1" colspan="1"><italic>ArenavirusJunin</italic>
virus</td>
<td align="left" rowspan="1" colspan="1">Changes in agricultural practices of corn harvest (maize mechanization)</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1981</td>
<td align="left" rowspan="1" colspan="1">Acquired immunodeficiency syndrome (AIDS)</td>
<td align="left" rowspan="1" colspan="1">Human immunodeficiency virus</td>
<td align="left" rowspan="1" colspan="1">Sexual contact/exposure to blood or tissues of an infected person</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1959</td>
<td align="left" rowspan="1" colspan="1">Bolivian haemorrhagic fever (BHF)</td>
<td align="left" rowspan="1" colspan="1"><italic>ArenavirusMachupo</italic>
virus</td>
<td align="left" rowspan="1" colspan="1">Population increase of rats gathering food</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1983</td>
<td align="left" rowspan="1" colspan="1">Crimean-Congo haemorrhagic fever</td>
<td align="left" rowspan="1" colspan="1">CCHF virus</td>
<td align="left" rowspan="1" colspan="1">Ecological changes favouring increased human exposure to ticks of sheep and small wild animals</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1996</td>
<td align="left" rowspan="1" colspan="1">Haemorrhagic colitis</td>
<td align="left" rowspan="1" colspan="1"><italic>Escherichia coli </italic>
O157:H7</td>
<td align="left" rowspan="1" colspan="1">Ingestion of contaminated food, undercooked beef, and raw milk</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1976</td>
<td align="left" rowspan="1" colspan="1">Malaria</td>
<td align="left" rowspan="1" colspan="1"><italic>Plasmodium falciparum</italic>
</td>
<td align="left" rowspan="1" colspan="1">Human behaviour/rainfall and drainage problems/mosquito breeding/neglect of eradication policy, economics, and growing interchange of populations</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1993</td>
<td align="left" rowspan="1" colspan="1">Hantavirus pulmonary syndrome (HPS)</td>
<td align="left" rowspan="1" colspan="1"><italic>HantavirusSin Nombre virus</italic>
</td>
<td align="left" rowspan="1" colspan="1">Human invasion of virus ecological niche; close contact with infected rodent natural reservoir; inhalation of infectious aerosolized rodent faces and urine</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1997</td>
<td align="left" rowspan="1" colspan="1">Highly pathogenic avian influenza (HPAI)</td>
<td align="left" rowspan="1" colspan="1">H5N1 virus</td>
<td align="left" rowspan="1" colspan="1">Animal-animal influenza virus gene reassortment; emergence of H5N1 avian influenza, extensive chicken farming</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1889, 1890, 1918, 1957</td>
<td align="left" rowspan="1" colspan="1">Pandemic Influenza</td>
<td align="left" rowspan="1" colspan="1"><italic>Paramyxovirus</italic>
influenza A</td>
<td align="left" rowspan="1" colspan="1">Animal-human virus reassortment and antigenic shift</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1969</td>
<td align="left" rowspan="1" colspan="1">Lassa fever</td>
<td align="left" rowspan="1" colspan="1"><italic>Arenavirus</italic>
Lassa virus</td>
<td align="left" rowspan="1" colspan="1">Hospital exposure to index case—rodent exposure</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1956</td>
<td align="left" rowspan="1" colspan="1">Marburg disease</td>
<td align="left" rowspan="1" colspan="1"><italic>Filovirus </italic>
Marburg virus</td>
<td align="left" rowspan="1" colspan="1">Trade (and use of wild imported monkeys); use of animal organs for specific purpose</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">2003</td>
<td align="left" rowspan="1" colspan="1">Severe acute respiratory syndrome (SARS)</td>
<td align="left" rowspan="1" colspan="1">SARS <italic>Coronavirus</italic>
</td>
<td align="left" rowspan="1" colspan="1">Hunting and feeding on infected wild animals (viverrids)</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1987</td>
<td align="left" rowspan="1" colspan="1">Rift Valley fever (RVF)</td>
<td align="left" rowspan="1" colspan="1"><italic>Bunyavirus</italic>
RVF virus</td>
<td align="left" rowspan="1" colspan="1">Dramatic increase in mosquito vector breeding sites (by dam filling); weather (rainfall) and cattle migration (guided by artificial water holes)</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1976</td>
<td align="left" rowspan="1" colspan="1">Ebola haemorrhagic fever</td>
<td align="left" rowspan="1" colspan="1"><italic>Filovirus</italic>
Ebola virus</td>
<td align="left" rowspan="1" colspan="1">Rainforest penetration by humans/close contact with infected game (hunting) or with host reservoirs (bats)/infected biological products/nosocomial/needle spread</td>
</tr>
<tr><td align="center" colspan="4" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">1953</td>
<td align="left" rowspan="1" colspan="1">Dengue haemorrhagic fever (DHF)</td>
<td align="left" rowspan="1" colspan="1">Dengue viruses 1, 2, 3, and 4</td>
<td align="left" rowspan="1" colspan="1">Increasing human population density in cities in a way that favours vector breeding sites (water storage), for example, <italic>Aedes aegypti</italic>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p><italic>Note</italic>
: adapted from “Encyclopedia of Infectious Diseases-Modern Methodologies” [<xref rid="B2" ref-type="bibr">2</xref>
].</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label>
<caption><p>Top priority emerging infectious diseases.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Emerging disease</th>
<th align="left" rowspan="1" colspan="1">Crimean-Congo haemorrhagic fever</th>
<th align="left" rowspan="1" colspan="1">Ebola virus disease & Marburg haemorrhagic fever</th>
<th align="left" rowspan="1" colspan="1">Middle East Respiratory Syndrome & SARS</th>
<th align="left" rowspan="1" colspan="1">Lassa Fever</th>
<th align="left" rowspan="1" colspan="1">Nipah</th>
<th align="left" rowspan="1" colspan="1">Rift Valley Fever</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Year of (re)emergence</td>
<td align="left" rowspan="1" colspan="1">(1) 12th Century,<break></break>
(2) 1944-45 & 1967</td>
<td align="left" rowspan="1" colspan="1">Ebola: 1976<break></break>
Marburg: 1967</td>
<td align="left" rowspan="1" colspan="1">MERS: 2012<break></break>
SARS: 2002</td>
<td align="left" rowspan="1" colspan="1">Isolated in 1969</td>
<td align="left" rowspan="1" colspan="1">1998-1999</td>
<td align="left" rowspan="1" colspan="1">In livestock: 1910s<break></break>
In humans: 1931 (all in Kenya)</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Causative organism</td>
<td align="left" rowspan="1" colspan="1"><italic>Nairovirus (CCHF virus)</italic>
</td>
<td align="left" rowspan="1" colspan="1">EVD: Ebola virus<break></break>
MHF: Marburg virus</td>
<td align="left" rowspan="1" colspan="1">MERS: MERS-CoV</td>
<td align="left" rowspan="1" colspan="1">Lassa virus</td>
<td align="left" rowspan="1" colspan="1">Nipah virus (NiV)</td>
<td align="left" rowspan="1" colspan="1">Rift Valley Fever (RVF) virus</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Type/class of organism</td>
<td align="left" rowspan="1" colspan="1">Virus (<italic>Bunyaviridae</italic>
)</td>
<td align="left" rowspan="1" colspan="1">Virus (<italic>Filoviridae</italic>
)</td>
<td align="left" rowspan="1" colspan="1">Virus (Coronaviridae)</td>
<td align="left" rowspan="1" colspan="1">Virus (Arenaviridae)</td>
<td align="left" rowspan="1" colspan="1">Virus (Paramyxoviridae)</td>
<td align="left" rowspan="1" colspan="1">Virus (Bunyaviridae)</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Vector/animal host</td>
<td align="left" rowspan="1" colspan="1"><italic>Hyalomma</italic>
tick,<break></break>
Domestic animals</td>
<td align="left" rowspan="1" colspan="1">Fruit bats species<break></break>
EVD: Pteropodidae<break></break>
MHF: <italic>Rousettus aegypti</italic>
</td>
<td align="left" rowspan="1" colspan="1">Not well known; camel is implicated as reservoir host</td>
<td align="left" rowspan="1" colspan="1"><italic>Mastomys</italic>
rats</td>
<td align="left" rowspan="1" colspan="1">Fruit bats of genus <italic>Pteropus</italic>
</td>
<td align="left" rowspan="1" colspan="1">(1) Mosquito species, mainly <italic>Aedes</italic>
sp.<break></break>
(2) Domestic remnant</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Epidemiology</td>
<td align="left" rowspan="1" colspan="1">Fatality rate of 10–40%, at least 140 outbreaks & >5000 cases since 1967</td>
<td align="left" rowspan="1" colspan="1">EVD: about 50% fatality. At least 31,076 cases with 12,922 deaths since 1976<break></break>
MHF: case fatality rate is up to 88%</td>
<td align="left" rowspan="1" colspan="1">MERS: case fatality approx. 36%; severe in people with weakened immune systems, with chronic diseases</td>
<td align="left" rowspan="1" colspan="1">At least 100,000 cases annually in the endemic regions of West Africa with case fatality rates of 5–10%</td>
<td align="left" rowspan="1" colspan="1">At least 477 people infected, 252 killed since 1998; case fatality rate of 40–70%</td>
<td align="left" rowspan="1" colspan="1">Commonly affects livestock, causing disease, abortion, and death in thousands of domesticated animals</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Populations at risk</td>
<td align="left" rowspan="1" colspan="1">Endemic in Africa, the Balkans, the Middle East, and Asia</td>
<td align="left" rowspan="1" colspan="1">EBV: Africa<break></break>
MHF: Frankfurt in Germany; Belgrade and Africa</td>
<td align="left" rowspan="1" colspan="1">MERS: people with chronic disease. Countries include Egypt, Oman, Qatar, and Saudi Arabia</td>
<td align="left" rowspan="1" colspan="1">Endemic in West Africa</td>
<td align="left" rowspan="1" colspan="1">Southeast Asia region</td>
<td align="left" rowspan="1" colspan="1">Africa and Arabian Peninsula</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Mode of transmission</td>
<td align="left" rowspan="1" colspan="1">(1) Tick bites<break></break>
(2) Zoonotic: contact with infected animal blood and with secretions or body fluids of infected persons</td>
<td align="left" rowspan="1" colspan="1">EBV: contact with blood, secretions, and body fluids/organs of infected (a) nonhuman primates and (b) humans<break></break>
MHF: mainly human-to-human</td>
<td align="left" rowspan="1" colspan="1">MERS is zoonotic: no human-to-human transmission; origin and exact route are unknown</td>
<td align="left" rowspan="1" colspan="1">Zoonotic: (1) exposure to urine or faeces of infected <italic>Mastomys </italic>
rats<break></break>
(2) Direct contact with body fluids of infected person</td>
<td align="left" rowspan="1" colspan="1">(1) Contact with excretion and secretion of infected bats<break></break>
(2) Direct contact with infected pigs</td>
<td align="left" rowspan="1" colspan="1">Zoonotic and Epizootic:<break></break>
Bite of infected mosquitoes (in humans and animals)</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Clinical presentations</td>
<td align="left" rowspan="1" colspan="1">Nonspecific: high fever, myalgia, headache, nausea, abdominal pain, and nonbloody diarrhoea</td>
<td align="left" rowspan="1" colspan="1">Clinically similar: fever, severe headache, diarrhoea, lethargy, and so on; impaired kidney function, internal /external bleeding, and nervous system problems (MHF)</td>
<td align="left" rowspan="1" colspan="1">Ranges from no symptoms to death. Generally fever, cough, and shortness of breath; pneumonia, gastrointestinal problems, and respiratory failure</td>
<td align="left" rowspan="1" colspan="1">About 80% of infections are asymptomatic. Symptoms are variable: fever, cough, malaise; pains, fluid in the lung cavity, facial swelling, bleeding, and more</td>
<td align="left" rowspan="1" colspan="1">(1) Barking pig syndrome (in pigs)<break></break>
(2) In humans: fever, muscle pain; brain inflammation leading to coma</td>
<td align="left" rowspan="1" colspan="1">Humans: include fever, muscle/joint pain; eye disease, meningoencephalitis, and haemorrhagic fever<break></break>
Animals: mortality and abortion</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Pathogenesis</td>
<td align="left" rowspan="1" colspan="1">Not well understood</td>
<td align="left" rowspan="1" colspan="1">Not well understood</td>
<td align="left" rowspan="1" colspan="1">Not well understood</td>
<td align="left" rowspan="1" colspan="1">Not well understood</td>
<td align="left" rowspan="1" colspan="1">Not well understood</td>
<td align="left" rowspan="1" colspan="1">Not well understood</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Diagnosis</td>
<td align="left" rowspan="1" colspan="1">(1) Virus isolation by cell culture<break></break>
(2) Viral genome detection (RT-PCR)<break></break>
(3) Serology (ELISA)</td>
<td align="left" rowspan="1" colspan="1">(1) Virus isolation by cell culture<break></break>
(2) Viral genome detection (RT-PCR)<break></break>
(3) Serology (e.g., ELISA)</td>
<td align="left" rowspan="1" colspan="1">(1) Mainly by molecular detection (RT-PCR)<break></break>
(2) Also serology (ELISA)</td>
<td align="left" rowspan="1" colspan="1">Only in reference labs: isolation by cell culture, viral genome detection (RT-PCR), and serology (ELISA & neutralization)</td>
<td align="left" rowspan="1" colspan="1">(1) Virus isolation<break></break>
(2) Histopathology<break></break>
(3) RT-PCR<break></break>
(4) Serology (ELISA, neutralization)</td>
<td align="left" rowspan="1" colspan="1">(1) Isolation by cell culture<break></break>
(2) Viral genome detection (RT-PCR)<break></break>
(3) Serology (ELISA)</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Treatment</td>
<td align="left" rowspan="1" colspan="1">No vaccine available:<break></break>
(1) General supportive care management<break></break>
(2) Ribavirin antiviral</td>
<td align="left" rowspan="1" colspan="1">No vaccine or specific antiviral treatment. General supportive care management</td>
<td align="left" rowspan="1" colspan="1">MERS: no vaccine or specific treatment. General supportive care management</td>
<td align="left" rowspan="1" colspan="1">No vaccine yet<break></break>
(1) Early supportive care<break></break>
(2) Ribavirin antiviral therapy seems effective</td>
<td align="left" rowspan="1" colspan="1">No vaccine available<break></break>
(1) Symptoms management;<break></break>
(2) Ribavirin antiviral treatment</td>
<td align="left" rowspan="1" colspan="1">No specific treatment; generally supportive therapy</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Prevention</td>
<td align="left" rowspan="1" colspan="1">Minimize tick burden in livestock, minimize human contact with vertebrate hosts</td>
<td align="left" rowspan="1" colspan="1">Awareness<break></break>
EVD: good hygiene; avoid contact with blood and body fluids<break></break>
MHF: protect pigs from fruit bats contact</td>
<td align="left" rowspan="1" colspan="1">MERS: general hygiene measures in contacting camels/other animals; avoid consumption of raw or undercooked animal products</td>
<td align="left" rowspan="1" colspan="1">(1) Good hygiene—in community, homes<break></break>
(2) Standard infection prevention and control measures in healthcare and lab settings</td>
<td align="left" rowspan="1" colspan="1">Avoid contact with infected secretions, excretions, blood, or tissues of infected pigs and bats</td>
<td align="left" rowspan="1" colspan="1">(1) Animal vaccination<break></break>
(2) Protection against vector bites<break></break>
(3) Animal health surveillance</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p><italic>Note</italic>
. Source of list: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/medicines/ebola-treatment/WHO-list-of-top-emerging-diseases/en.com">http://www.who.int/medicines/ebola-treatment/WHO-list-of-top-emerging-diseases/en/</ext-link>
[<xref rid="B69" ref-type="bibr">9</xref>
].</p>
</fn>
<fn><p>MERS: Middle East Respiratory Syndrome; SARS: Severe Acute Respiratory Syndrome.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab3" orientation="portrait" position="float"><label>Table 3</label>
<caption><p>Major neglected tropical diseases.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Disease</th>
<th align="left" rowspan="1" colspan="1">Causative agent</th>
<th align="center" rowspan="1" colspan="1">Transmission</th>
<th align="left" rowspan="1" colspan="1">Pathogenesis</th>
<th align="left" rowspan="1" colspan="1">Affected populations</th>
<th align="left" rowspan="1" colspan="1">Treatment and management</th>
<th align="left" rowspan="1" colspan="1">Prevention/public health response</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1"> Buruli ulcer</td>
<td align="left" rowspan="1" colspan="1"><italic>Mycobacterium ulcerans </italic>
(Bacterium)</td>
<td align="left" rowspan="1" colspan="1">Mode unknown</td>
<td align="left" rowspan="1" colspan="1">Destruction of skin & soft tissues, leading to ulcer</td>
<td align="left" rowspan="1" colspan="1">Poor rural communities; more in Africa, 33 countries</td>
<td align="left" rowspan="1" colspan="1">Rifampicin, streptomycin/amikacin, or surgery</td>
<td align="left" rowspan="1" colspan="1">Early detection and antibiotic treatment</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Chagas disease</td>
<td align="left" rowspan="1" colspan="1"><italic>Trypanosoma cruzi</italic>
(protozoan parasite)</td>
<td align="left" rowspan="1" colspan="1">Vector-borne</td>
<td align="left" rowspan="1" colspan="1">Cardiac or mixed alterations in chronic infection</td>
<td align="left" rowspan="1" colspan="1">~8 M people infected worldwide, mostly Latin America</td>
<td align="left" rowspan="1" colspan="1">Curable with benznidazole and nifurtimox</td>
<td align="left" rowspan="1" colspan="1">Vector (triatomine bug) control</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Dengue and chikungunya</td>
<td align="left" rowspan="1" colspan="1">Dengue virus sp.: DENV 1, DENV 2, DENV 3 & DENV 4 (Flaviviruses)</td>
<td align="left" rowspan="1" colspan="1">Dengue & chikungunya: mosquito sp. (<italic>Aedes aegypti & Ae. albopictus) </italic>
</td>
<td align="left" rowspan="1" colspan="1">Fatal: plasma leaking, bleeding, and organ impairment</td>
<td align="left" rowspan="1" colspan="1">Worldwide, ~100 countries; 50–100 mil infections/year. Esp. Asia & Latin America</td>
<td align="left" rowspan="1" colspan="1">Dengue: vaccine available; chikungunya: no vaccine</td>
<td align="left" rowspan="1" colspan="1">Control of mosquito vectors</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Dracunculiasis (Guinea worm disease)</td>
<td align="left" rowspan="1" colspan="1"><italic>Dracunculus medinensis</italic>
(Nematode parasite)</td>
<td align="left" rowspan="1" colspan="1">Drinking water containing parasite-infected water-fleas (<italic>Cyclops</italic>
)</td>
<td align="left" rowspan="1" colspan="1">Rarely fatal<break></break>
Leads to oedema and ulcer, usually of the feet</td>
<td align="left" rowspan="1" colspan="1">22 cases in 4 African countries in 2015</td>
<td align="left" rowspan="1" colspan="1">No vaccine available yet</td>
<td align="left" rowspan="1" colspan="1">Improved drinking water sources. Near eradication</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Echinococcosis</td>
<td align="left" rowspan="1" colspan="1"><italic>E. granulosus </italic>
and<break></break>
<italic>E. multilocularis </italic>
(<italic>Echinococcus </italic>
parasites)</td>
<td align="left" rowspan="1" colspan="1">Through faeces of dogs, foxes & other carnivores</td>
<td align="left" rowspan="1" colspan="1">Involves liver and other organs. Progressive and fatal if untreated</td>
<td align="left" rowspan="1" colspan="1">>I M people worldwide affected at any one time</td>
<td align="left" rowspan="1" colspan="1"> Expensive and complicated to treat</td>
<td align="left" rowspan="1" colspan="1">Complex<break></break>
Regular deworming of domestic carnivores helps</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Endemic treponematoses (Yaws)</td>
<td align="left" rowspan="1" colspan="1"><italic>T. Pallidum</italic>
subspecies <italic>pertenue </italic>
(bacterium)</td>
<td align="left" rowspan="1" colspan="1">Person-to-person (nonsexual) with infected fluid</td>
<td align="left" rowspan="1" colspan="1">Disfigurement of the nose and bones; hyperkeratosis</td>
<td align="left" rowspan="1" colspan="1">Africa, Asia, Latin America, and the Pacific</td>
<td align="left" rowspan="1" colspan="1"> Azithromycin<break></break>
Benzathine penicillin</td>
<td align="left" rowspan="1" colspan="1">No vaccine: early diagnosis and targeted treatment</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Foodborne trematodiases</td>
<td align="left" rowspan="1" colspan="1">Trematode parasite sp<italic>. Clonorchis</italic>
, <italic>Opisthorchis</italic>
, <italic>Fasciola,</italic>
and <italic>Paragonimus</italic>
</td>
<td align="left" rowspan="1" colspan="1">Zoonotic: consumption of raw/poorly cooked food</td>
<td align="left" rowspan="1" colspan="1">Organ-specific, reflects adult worm final location</td>
<td align="left" rowspan="1" colspan="1">>70 countries worldwide, mainly East Asia and South America</td>
<td align="left" rowspan="1" colspan="1">Use of anthelminthic medicines</td>
<td align="left" rowspan="1" colspan="1">Reduce infection risk; control associated morbidity</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Human African trypanosomiasis (sleeping sickness)</td>
<td align="left" rowspan="1" colspan="1">Trypanosoma parasite sp. <break></break>
<italic>T. brucei gambiense </italic>
(98%)<break></break>
<italic>T. brucei rhodesiense</italic>
(2%)</td>
<td align="left" rowspan="1" colspan="1">By bites of infected tsetse fly (of Glossina genus)</td>
<td align="left" rowspan="1" colspan="1">Affects central nervous system, causing neurological (and sleep) disorders</td>
<td align="left" rowspan="1" colspan="1">Occurs in 36 sub-Saharan Africa countries (>70% of cases occur in DR Congo)</td>
<td align="left" rowspan="1" colspan="1">Drugs available. Depends on disease stage and parasite species</td>
<td align="left" rowspan="1" colspan="1">Free antitrypanosome medicines provided by WHO; efforts at elimination</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Leishmaniasis</td>
<td align="left" rowspan="1" colspan="1">Protozoan <italic>Leishmania</italic>
parasites (over 20 species)</td>
<td align="left" rowspan="1" colspan="1">Bite of infected female phlebotomine sandflies</td>
<td align="left" rowspan="1" colspan="1">Infection rarely leads to disease development</td>
<td align="left" rowspan="1" colspan="1">Worldwide. Risk increased by poverty</td>
<td align="left" rowspan="1" colspan="1">Complex; depends on several factors</td>
<td align="left" rowspan="1" colspan="1">Complex; combination of intervention strategies</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Leprosy (Hansen disease)</td>
<td align="left" rowspan="1" colspan="1"><italic>Mycobacterium leprae</italic>
(bacterium)</td>
<td align="left" rowspan="1" colspan="1">By air (from nose & mouth) through close contact</td>
<td align="left" rowspan="1" colspan="1">Damage of peripheral nerves leading to paralysis</td>
<td align="left" rowspan="1" colspan="1">Southeast Asia Region</td>
<td align="left" rowspan="1" colspan="1">Multidrug (Dapsone, rifampicin & clofazimine)</td>
<td align="left" rowspan="1" colspan="1">Early diagnosis and treatment to avert disability</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Lymphatic filariasis (elephantiasis)</td>
<td align="left" rowspan="1" colspan="1"><italic> Filarioidea </italic>
nematodes: <italic>Wuchereria bancrofti</italic>
, <italic>Brugia malayi</italic>
, and <italic>B. timori</italic>
</td>
<td align="left" rowspan="1" colspan="1">By mosquito sp. (<italic>Culex</italic>
, <italic>Anopheles</italic>
, and <italic>Aedes</italic>
)</td>
<td align="left" rowspan="1" colspan="1">Invade lymphatic system; disrupt immune system</td>
<td align="left" rowspan="1" colspan="1">WHO Southeast Asia & Africa; >120 M people</td>
<td align="left" rowspan="1" colspan="1">Albendazole + ivermectin/diethylcarbamazine citrate</td>
<td align="left" rowspan="1" colspan="1">Morbidity management; mass drug administration</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Onchocerciasis (river blindness)</td>
<td align="left" rowspan="1" colspan="1"><italic>Onchocerca volvulus </italic>
(parasite)</td>
<td align="left" rowspan="1" colspan="1">Bite of blackfly (<italic>Simulium damnosum</italic>
sp. mainly)</td>
<td align="left" rowspan="1" colspan="1">Parasites migrate throughout the body, casing a variety of symptoms</td>
<td align="left" rowspan="1" colspan="1">36 countries: Africa, Arabian peninsula & Americas</td>
<td align="left" rowspan="1" colspan="1">Ivermectin (manufactured Merck & Co, free)</td>
<td align="left" rowspan="1" colspan="1">Yearly ivermectin administration to affected populations</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Rabies</td>
<td align="left" rowspan="1" colspan="1">Rabies virus</td>
<td align="left" rowspan="1" colspan="1">Bites/scratches of affected domestic/wild animals</td>
<td align="left" rowspan="1" colspan="1">Affects central nervous system, leads to death</td>
<td align="left" rowspan="1" colspan="1">All continents but Antarctica. Mostly in Asia & Africa</td>
<td align="left" rowspan="1" colspan="1">Postexposure prophylaxis (with vaccine course)</td>
<td align="left" rowspan="1" colspan="1">Preventive immunization of people; vaccinating dogs</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Schistosomiasis (Bilharzia)</td>
<td align="left" rowspan="1" colspan="1"><italic>Schistosoma</italic>
parasite sp.: <italic>S. haematobium, S. mansoni, and S. japonicum</italic>
</td>
<td align="left" rowspan="1" colspan="1">Contact with infested fresh water bodies</td>
<td align="left" rowspan="1" colspan="1">Live in blood vessels, body tissues & damage organs</td>
<td align="left" rowspan="1" colspan="1">At least 90% of estimated cases are in Africa</td>
<td align="left" rowspan="1" colspan="1">Drug available: Praziquantel therapy</td>
<td align="left" rowspan="1" colspan="1">Good water/sanitation, snail control; preventive therapy</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Soil-transmitted helminthiases</td>
<td align="left" rowspan="1" colspan="1"><italic>Helminth </italic>
parasite<italic> species Ascaris lumbricoides, Trichuris trichiura, Necator americanus & A. duodenale</italic>
</td>
<td align="left" rowspan="1" colspan="1">Parasite eggs in human faeces-contaminated soil</td>
<td align="left" rowspan="1" colspan="1">Intestinal damage and blood loss. Rarely fatal</td>
<td align="left" rowspan="1" colspan="1">Worldwide: esp. sub-Saharan Africa, the Americas, China, and East Asia. ~2 billion people</td>
<td align="left" rowspan="1" colspan="1">Medicines available: Albendazole and Mebendazole</td>
<td align="left" rowspan="1" colspan="1">Deworming people at risk, improved sanitation, education</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Taeniasis/ cysticercosis</td>
<td align="left" rowspan="1" colspan="1"><italic>Taenia</italic>
(tapeworm) parasites<break></break>
<italic>T. solium (pork tapeworm)T. saginata</italic>
(beef tapeworm)</td>
<td align="left" rowspan="1" colspan="1">Ingestion of larval cysts through contaminated food (pork or beef) or water</td>
<td align="left" rowspan="1" colspan="1">Intestinal; central nervous system attack. Can be fatal</td>
<td align="left" rowspan="1" colspan="1">Africa, Asia, and Latin America</td>
<td align="left" rowspan="1" colspan="1">Drug available: Praziquantel and niclosamide</td>
<td align="left" rowspan="1" colspan="1">Veterinary, human health, and environmental approach</td>
</tr>
<tr><td align="center" colspan="7" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"> Trachoma</td>
<td align="left" rowspan="1" colspan="1"><italic>Chlamydia trachomatis</italic>
(bacterium)</td>
<td align="left" rowspan="1" colspan="1">Eye-seeking flies, poor water and sanitation</td>
<td align="left" rowspan="1" colspan="1">Leading infectious cause of blindness globally</td>
<td align="left" rowspan="1" colspan="1">51 countries, 1.2 M people blind, 232 M at risk</td>
<td align="left" rowspan="1" colspan="1">Surgery, antibiotics, and facial cleanliness</td>
<td align="left" rowspan="1" colspan="1">Environmental improvement; target: elimination by 2020</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p><italic>Note</italic>
. M: million.</p>
</fn>
<fn><p>Source of list: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/neglected_diseases/diseases/en/">http://www.who.int/neglected_diseases/diseases/en/</ext-link>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
</record>
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