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Diagnostic Needs for Neglected Tropical Diseases (NTD) Programs


Background: Neglected tropical diseases (NTDs) are bacterial and parasitic infections that disproportionately affect poor and marginalized populations around the world. A subset of NTDs, including lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma and intestinal helminth infections, can be targeted effectively through mass chemotherapy. These NTDs are not considered to cause appreciable mortality; however, they are associated with high levels of morbidity because of the chronic nature of many of the infections. Blindness and disability due to these NTDs increase in prevalence with age, reducing the productivity of adults. Intestinal helminths, among the commonest of infections, have profound effects on the growth and cognitive development of children. The past five years have seen significant increases in the number of countries implementing NTD programs and in the number of persons being treated. These increases are the direct result of generous donations of drugs from pharmaceutical manufacturers and new funding support from the US Agency for International Development (USAID) and the Department for International Development (DFID), among others. Reducing the morbidity caused by NTDs is an objective of the Global Health Initiative (GHI) and the global elimination of lymphatic filariasis and trachoma are specific GHI targets. Available diagnostic tools for lymphatic filariasis (LF), trachoma, schistosomiasis, onchocerciasis and intestinal helminth infections do not at present meet the needs of the control programs. Project Goal: Diagnostic tests are needed to guide programmatic decisions on community treatment for diseases addressed by mass drug administration (MDA). Despite the molecular revolution in biology, little of the new found knowledge of parasite genes and gene products is being translated into tools than can be used in the field to guide program decisions. Tools for mapping and monitoring program impact are still conventional parasitologic methods, based on microscopy. These tests lack sensitivity and are not adequate for NTD programs with elimination endpoints. New antibody tests could provide more sensitive tools to monitor transmission, facilitate decision-making, and conduct surveillance. The potential advantages of antibody-based tests for post-MDA surveillance supports the efforts to develop a standard platform therefore opening opportunities for integrated surveillance for NTDs. Impact: Development of improved diagnostic tools will address one of CDC’s efforts to address lymphatic filariasis (LF in the Americas) and the GHI targets on NTDs. They will also enhance the commitment of donors and policy makers to the control and elimination programs for NTDs by providing higher quality information and increased confidence that public health goals are being met. Significant savings in human and financial resources could be obtained through the development of improved diagnostic tools.
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