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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
THE CAUSES AND IMPACTS OF NEGLECTED TROPICAL AND ZOONOTIC DISEASES
Opportunities for Integrated Intervention Strategies
Eileen R. Choffnes and David A. Relman, Rapporteurs
Forum on Microbial Threats
Board on Global Health
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This project was supported by contracts between the National Academy of Sciences and the U.S. Department of Health and Human Services: National Institutes of Health, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, Food and Drug Administration, and the Fogarty International Center; U.S. Department of Defense, Department of the Army: Global Emerging Infections Surveillance and Response System, Medical Research and Materiel Command, and the Defense Threat Reduction Agency; U.S. Department of Veterans Affairs; U.S. Department of Homeland Security; U.S. Agency for International Development; American Society for Microbiology; Sanofi Pasteur; Burroughs Wellcome Fund; Pfizer, Inc.; GlaxoSmithKline; Infectious Diseases Society of America; and the Merck Company Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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Additional copies of this report are available from the
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Copyright 2011 by the National Academy of Sciences. All rights reserved.
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Cover image: The life cycles of hookworms and schistosomes. Reprinted with the permission of Nature Reviews: Microbiology.
Suggested citation: IOM (Institute of Medicine). 2011. The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies. Washington, DC: The National Academies Press.
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
FORUM ON MICROBIAL THREATS1
DAVID A. RELMAN (Chair),
Stanford University and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
JAMES M. HUGHES (Vice-Chair),
Global Infectious Diseases Program, Emory University, Atlanta, Georgia
LONNIE J. KING (Vice-Chair),
Ohio State University, Columbus, Ohio
KEVIN ANDERSON,
Department of Homeland Security, Washington, DC
RUTH L. BERKELMAN,
Emory University, Center for Public Health Preparedness and Research, Rollins School of Public Health, Atlanta, Georgia
ENRIQUETA C. BOND, Consultant,
Marshall, Virginia
ROGER G. BREEZE,
Centaur Science Group, Washington, DC
STEVEN J. BRICKNER,2
SJ Brickner Consulting, LLC, Ledyard, Connecticut
PAULA R. BRYANT,
Medical S&T Division, Defense Threat Reduction Agency, Fort Belvoir, Virginia
JOHN E. BURRIS,
Burroughs Wellcome Fund, Research Triangle Park, North Carolina
PETER DASZAK,
EcoHealth Alliance, New York, New York
JEFFREY DUCHIN,
Public Health–Seattle and King County, Seattle, Washington
JONATHAN EISEN,
Genome Center, University of California, Davis, California
MARK B. FEINBERG,
Merck Vaccine Division, Merck & Co., West Point, Pennsylvania
JACQUELINE FLETCHER,
Oklahoma State University, Stillwater, Oklahoma
S. ELIZABETH GEORGE,2
Biological and Chemical Countermeasures Program, Department of Homeland Security, Washington, DC
JESSE L. GOODMAN, Chief Scientist and Deputy Commissioner,
Food and Drug Administration, Rockville, Maryland
EDUARDO GOTUZZO,
Instituto de Medicina Tropical–Alexander von Humbolt, Universidad Peruana Cayetano Heredia, Lima, Peru
CAROLE A. HEILMAN,
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
DAVID L. HEYMANN,
Health Protection Agency, London, United Kingdom
PHILIP HOSBACH,
Sanofi Pasteur, Swiftwater, Pennsylvania
STEPHEN A. JOHNSTON,
Arizona BioDesign Institute, Arizona State University, Tempe, Arizona
1
Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
2
Forum member until December 31, 2010.
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
KENT KESTER,
Walter Reed Army Institute of Research, Silver Spring, Maryland
GERALD T. KEUSCH,
Boston University School of Medicine and Boston University School of Public Health, Boston, Massachusetts
RIMA F. KHABBAZ,
Centers for Disease Control and Prevention, Atlanta, Georgia
STANLEY M. LEMON,
School of Medicine, University of North Carolina, Chapel Hill, North Carolina
EDWARD McSWEEGAN,
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
MARK A. MILLER,
Fogarty International Center, Bethesda, Maryland
PAUL F. MILLER,
Pfizer, Inc., Groton, Connecticut
STEPHEN S. MORSE,2
Center for Public Health Preparedness, Columbia University, New York, New York
GEORGE POSTE,
Complex Adaptive Systems Initiative, Arizona State University, Tempe, Arizona
JOHN C. POTTAGE, JR.,
ViiV Healthcare, Collegeville, Pennsylvania
GARY A. ROSELLE,
Veterans Health Administration, Department of Veterans Affairs, Washington, DC
ALAN S. RUDOLPH,
Defense Threat Reduction Agency, Fort Belvoir, Virginia
KEVIN RUSSELL,
Global Emerging Infections Surveillance and Response System, Department of Defense, Silver Spring, Maryland
JANET SHOEMAKER,
American Society for Microbiology, Washington, DC
P. FREDERICK SPARLING,
University of North Carolina, Chapel Hill, North Carolina
TERENCE TAYLOR,
International Council for the Life Sciences, Arlington, Virginia
MURRAY TROSTLE,
U.S. Agency for International Development, Washington, DC
MARY E. WILSON,
Harvard School of Public Health, Harvard University, Boston, Massachusetts
Staff
EILEEN CHOFFNES, Director
LEIGHANNE OLSEN, Program Officer
KATHERINE McCLURE, Senior Program Associate
COLLIN WEINBERGER, Research Associate3
ROBERT GASIOR, Senior Program Assistant4
3
Forum staff member until May 2011.
4
Forum staff member until February 2011.
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
BOARD ON GLOBAL HEALTH1
Richard Guerrant (Chair), Thomas H. Hunter Professor of International Medicine and Director,
Center for Global Health, University of Virginia School of Medicine, Charlottesville
Jo Ivey Boufford (IOM Foreign Secretary), President,
New York Academy of Medicine, New York
Claire V. Broome, Adjunct Professor,
Division of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
Jacquelyn C. Campbell, Anna D. Wolf Chair and Professor,
Johns Hopkins University School of Nursing, Baltimore, Maryland
Thomas J. Coates, Professor,
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Gary Darmstadt,2 Director,
Family Health Division, Global Health Program, Bill & Melinda Gates Foundation, Seattle, Washington
Valentin Fuster, Director,
Wiener Cardiovascular Institute and Kravis Cardiovascular Health Center, and
Professor,
Cardiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York
James Hospedales,3 Coordinator,
Chronic Disease Project, Health Surveillance and Disease Management Area, Pan American Health Organization/World Health Organization, Washington, DC
Peter J. Hotez, Professor and Chair,
Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, DC
Clarion Johnson,3 Global Medical Director,
Medicine and Occupational Medicine Department, Exxon Mobil, Fairfax, Virginia
Fitzhugh Mullan, Professor,
Department of Health Policy, George Washington University, Washington, DC
Guy H. Palmer,3 Regents Professor of Pathology and Infectious Diseases and Director of the School for Global Animal Health,
Washington State University, Pullman
Jennifer Prah Ruger,3 Associate Professor,
Division of Health Policy and Administration, Yale University School of Public Health and Yale University School of Medicine, New Haven, Connecticut
Staff
Patrick Kelley, Director
Angela Mensah, Program Associate
1
Institute of Medicine boards do not review or approve individual workshop summaries and are not asked to endorse conclusions and recommendations. The responsibility for the content of the workshop summary rests with the authors and the institution.
2
Board member since December 2010.
3
Board member since September 2010.
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:
Enriqueta Bond, Consultant
Richard L. Guerrant, Division of Infectious Diseases and International Health, School of Medicine, University of Virginia
Carole A. Heilman, National Institute of Allergy and Infectious Diseases, National Institutes of Health
David Heymann, Health Protection Agency
Regina Rabinovich, Infectious Disease and Global Health Program, Bill & Melinda Gates Foundation
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Dr. Melvin Worth. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
Acknowledgments
The Forum on Emerging Infections was created by the Institute of Medicine (IOM) in 1996 in response to a request from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The purpose of the Forum is to provide structured opportunities for leaders from government, academia, and industry to regularly meet and examine issues of shared concern regarding research, prevention, detection, and management of emerging, reemerging, and novel infectious diseases in humans, plants, and animals. In pursuing this task, the Forum provides a venue to foster the exchange of information and ideas, identify areas in need of greater attention, clarify policy issues by enhancing knowledge and identifying points of agreement, and inform decision makers about science and policy issues. The Forum seeks to illuminate issues rather than resolve them. For this reason, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Its value derives instead from the diversity of its membership and from the contributions that individual members make throughout the activities of the Forum. In September 2003, the Forum changed its name to the Forum on Microbial Threats.
The Forum on Microbial Threats and the IOM wish to express their warmest appreciation to the individuals and organizations who gave their valuable time to provide information and advice to the Forum through their participation in the planning and execution of this workshop. A full list of presenters, and their biographical information, may be found in Appendixes B and F, respectively. We would also like to express our deepest appreciation and gratitude to those that helped to identify or provided images illustrating the diseases of interest found in Text Box WO-6, including Doris Bravo (National Veterinary Services
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
Tables, Figures, and Boxes
TABLES
WO-1
High-Prevalence and Other Vector-Borne Neglected Tropical Diseases,
8
WO-2
Environmental Classification of Water- and Excreta-related Infections,
10
WO-3
Four NTDs Slated for Eradication or “Elimination,”
28
WO-4
Laboratory-Confirmed Dengue Fever in Study Sites Compared to Reported National Incidence,
42
A1-1
Evolution of Change in Epidemiological Parameters of Chagas Disease in LAC,
118
A1-2
Diseases, Foci, Population at Risk, and Treatment Coverage in Group 1 Countries,
124
A1-3
Diseases, Foci, Population at Risk, and Treatment Coverage in Group 2 Countries,
125
A1-4
Pre-SAC and SAC Population at Risk for Soil-Transmitted Helminths (STHs) in LAC, 2009,
126
A2-1
Studies in Conflict and Neglected Tropical Diseases Since 2007,
136
A2-2
Summary of Six Space-Time Clusters of Sleeping Sickness Incidence, Africa 1976–2004,
143
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
A3-1
Zero-order correlations among average national IQ (LVE), log DALY owing to infectious disease, average winter high temperature, distance from EEA, literacy, average years of education (AVED), % enrolling in secondary education, % completing all secondary education, and GDP,
162
A3-2
Zero-order correlations between average national intelligence and log DALY owing to infectious disease within each of Murdock’s (1949) six world regions,
162
A3-3
Multiple regression analyses predicting average national intelligence using LVE and WEAM (in parentheses where different) by log DALY owing to infectious disease, log distance from EEA, average winter high temperature, average years of education (AVED), and log GDP,
163
A3-S-1
Zero-order correlations among average National IQ (LVCD), log DALY infectious disease, average winter high temperature, distance from EEA, literacy, average years of education (AVED), % enrolling in secondary education, % completing all secondary education, and GDP,
170
A3-S-2
Zero-order correlations among average National (WEAM), log DALY infectious disease, average winter high temperature, distance from EEA, literacy, average years of education (AVED), % enrolling in secondary education, % completing all secondary education, and GDP,
171
A3-S-3
Multiple regression analyses predicting average national intelligence using LVE and WEAM (in parentheses when different) by log DALY infectious disease, log distance from EEA, average winter high temperature, and average years of education (AVED),
172
A5-1
Disease-Specific Guidelines,
187
A5-2
Principal Drug Distribution Strategy in Endemic Districts,
190
A5-3
WHO Guidelines for Disease-Specific Mapping,
193
A5-4
Mapping of Districts in NTD Control Program Countries,
194
A5-5
NTD Control Program-Supported Treatments,
197
A5-6
Number of Tablets of Donated Drugs Provided to National NTD Programs in Year 3 of the NTD Control Program,
198
A5-7
Programmatic Coverage in NTD Control Program Countries,
199
A6-1
Current Situation of Ocular Morbidity and Transmission of Onchocerciasis Within the Americas Region, 2010,
213
A6-2
Four NTDs Slated for Eradication or “Elimination,”
219
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
A7-1
The Neglected Tropical Diseases,
223
A7-2
On the Outside Looking In: NTDs of Global Importance Not Typically Found on Lists of Diseases,
225
A7-3
Neglected Infections Amid Wealth: Major Neglected Infections of Poverty in the United States and Europe,
226
A7-4
The Seven Major NTDs Targeted for Integrated Control and Elimination with “Rapid Impact Packages,”
230
A8-1
Selected U.S. Census Bureau 2006 Poverty Data,
239
A8-2
Estimated Prevalence of Neglected Infections of Poverty in the US,
242
A8-3
Priority Needs for Enhanced Surveillance, Treatment, and Prevention Efforts for the High Priority Neglected Infections of Poverty,
256
A9-1
Impact of hookworm, schistosomiasis, HIV/AIDS, and malaria,
266
A9-2
Successful vaccines against helminth infections,
275
A9-3
Ranking of Lead Candidate Necator americanus Vaccine Antigens,
277
A9-4
Ranking of Lead Candidate Schistosoma mansoni Vaccine Antigens,
282
A10-1
Summary of the Bill & Melinda Gates Foundation Strategy Refresh Process,
298
A10-2
Summary of Bill & Melinda Gates Foundation Investments in NOIDs Through 2010,
304
A14-1
Tests Commonly Used by NTD Programs,
349
A15-1
MDA and Pregnancy,
372
A15-2
Selected NTDs and Children’s Health and Development,
373
A16-1
Neglected Disease R&D Funding 2008,
391
A16-2
NTD R&D Funding 2008,
392
A16-3
Top 12 Funders of R&D for NTDs, 2008,
392
A17-1
Population at Risk,
417
A17-2
Projected Health Impact-LF Related,
418
A17-3
Projected Health Impact-Beyond LF,
419
A18-1
Sub Populations of the “Benefit Cohort Population,”
444
A18-2
Benefit Cohort Population: Individuals and Person Years,
450
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A18-3
Epidemiological and Cost Estimates Used in the Economic Benefit Model,
452
A18-4
GPELF MDA Treatments (2000–2007),
458
A18-5
Total Costs Prevented Over Lifetime of Benefit Cohort Population,
460
A18-6
Total Costs Prevented per Individual in the Benefit Cohort Population,
461
A18-7
Lifetime Economic Benefits per Region,
463
A18-8
Health System Economic Benefits,
463
A18-9
Sensitivity Analysis for Chronic Disease Reversal Following MDA,
465
A18-10
Country-Specific Benefit-Cost Ratios,
468
A19-1
Main Steps for the Development of Scientific Knowledge for NTD Control,
483
A19-2
Steps for the Promotion of Implementation of NTD Control,
484
A19-3
Steps for the Building of Consensus Among Partners and Donors,
485
A20-1
Trends in Journal Articles Incorporating Terms Related to “Neglected Disease,” 1998–2009,
492
A20-2
Trends in Journal Articles Incorporating Terms Related to “Determinants of Health,” 1998–2009,
494
A20-3
Journal Articles Using Terms from Both Paradigms, 1998–2009,
495
A20-4
Inclusion of Drug or Vaccine Mention in Literature on Neglected Diseases, 1998–2009,
496
A20-5
Inclusion of Terms in Journal Articles on Trachoma, 1998–2009,
497
FIGURES
WO-1
Geographical overlap and distribution of the seven most common neglected tropical diseases,
5
WO-2
Depiction of the classical model of the Triangular trade,
7
WO-3
The convergence model,
12
WO-4
WHO list of neglected tropical diseases,
18
WO-5
Life cycle for dracunculiasis,
20
WO-6
Geographic distribution and transmission status of the 13 onchocerciasis foci of the Americas (2010),
23
WO-7
Onchocerciasis control programs in Africa,
24
WO-8
Life cycle of schistosomiasis,
32
WO-9
Dengue virus infection,
41
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
WO-10
Distribution of NTDs in Africa and countries with integrated NTD control programs in sub-Saharan Africa,
51
WO-11
Endemic zoonotic diseases by district in Mali,
55
WO-12
Classification of NIDs and other poverty-related infections,
57
WO-13
Group I: elimination targets,
58
WO-14
Diseases targeted for drastic disease burden reductions,
59
WO-15
Global funding for NTDs by disease,
78
WO-16
Top 12 funders of NTD research, 2008 (US$),
79
WO-17
Opportunities for “vaccine diplomacy,”
85
WO-6-1
Anthrax,
86
WO-6-2
Ascariasis,
87
WO-6-3
Bovine tuberculosis,
88
WO-6-4
Brucellosis,
89
WO-6-5
Buruli ulcer (Mycobacterium ulcerans),
90
WO-6-6
Chagas disease,
91
WO-6-7
Hydatid disease,
92
WO-6-8
Cysticercosis,
93
WO-6-9
Dengue,
94
WO-6-10
Guinea worm (Dracunculus medinensis),
95
WO-6-11
Hookworm (Nematode Ancylostoma caninum),
96
WO-6-12
Leishmaniasis (Leishmania),
97
WO-6-13
Leprosy (Mycobacterium leprae),
98
WO-6-14
Lymphatic filariasis,
99
WO-6-15
Onchocerciasis,
10
WO-6-16
Rabies,
101
WO-6-17
Schistosomiasis,
102
WO-6-18
Parasitic roundworm associated with Toxocariasis (larvae),
103
WO-6-19
Trachoma,
104
WO-6-20
Trichuriasis (Whipworm),
105
WO-6-21
Human African Trypanosomiasis (Trypanosoma brucei),
106
WO-6-22
Yaws infection (Treponema pertenue),
107
A1-1
Overlapping of six neglected infectious diseases,
127
A1-2
Elimination and control of NIDs in LAC: Putting the pieces together,
129
A2-1
Search protocol and results,
134
A2-2
Conceptual framework for effect of conflict on NTDs,
142
A2-3
Map of the distribution of sleeping sickness incidence, Africa 1976–2004,
143
A2-4
Malaria in Timor Leste, 2004–2007,
149
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
A3-1
Log DALY owing to infectious disease and average national IQ correlate (a) at r = −0.82 (LVE) and (b) at r = −0.76 (WEAM; n = 184, p < 0.0001),
161
A5-1
A. Persons reached (dark bars) and treatments provided (light bars) during each of the first three years of the Neglected Tropical Disease (NTD) Control Program. B. Cumulative totals of persons reached (dark line) and treatments provided (light line) over the first three years of the NTD Control Program,
196
A5-2
Number of districts covered by mass drug administration (MDA) treatment during the first three years of the Neglected Tropical Disease (NTD) Control Program in the seven implementing countries (an aggregated total of 526 districts in these countries),
200
A5-3
Number of workers in training programs supported by the Neglected Tropical Disease Control Program,
201
A5-4
Distribution of expenditures by the Neglected Tropical Disease Control Program during its first three years,
202
A6-1
Number of reported cases of dracunculiasis by year: 1989–2009,
211
A6-2
Geographic distribution of malaria and lymphatic filariasis on the island of Hispaniola in 2006,
216
A6-3
Prevalence of Trachomatus inflammation-follicular (TF) in children 1–9 years of age in Ghana and Ethiopia, 2007–2008,
218
A8-1
Location of counties that represent spatial clusters in which poverty rates are at least two standard deviations higher than the national mean,
240
A9-1
Global distributions and life cycles of hookworms and schistosomes,
268
A9-2
Necator americanus degradation of host blood components and potential vaccine targets,
276
A9-3
Schistosoma mansoni tegument,
283
A10-1
BMGF NOIDs investment by disease through 2010 with payments through 2014,
295
A10-2
BMGF NOIDs commitments by tool and strategic approach through 2010,
296
A10-3
Overview of drug donation for the NTDs,
299
A10-4
Research and development investments for NOIDs globally, 2009,
301
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
A11-1
Drug rate use for the treatment of second-stage T.b. gambiense: eflornithine versus melarsoprol (2003–2009),
314
A11-2
Institutional rate use of eflornithine: National Sleeping Sickness Control Programs versus nongovernmental organizations (2003–2009),
314
A11-3
Classification of human African trypanosomiasis-endemic countries according to cases reported in 2009,
317
A11-4
Evolution of reported cases of both forms of human African trypanosomiasis (1998–2009),
318
A11-5
Atlas of human African trypanosomiasis,
319
A12-1
Life cycle of Schistosoma spp. parasites,
324
A12-2
Disability-related health outcomes included in meta-analysis of schistosomiasis-related health impact,
330
A12-3
Reduced protective antibody response to anti-Haemophilus influenza b vaccination among children of mothers with schistosomiasis and/or filariasis during pregnancy,
332
A12-4
New estimates of schistosomiasis cases in 1995 and in 2005 according to the Global Burden of Disease Program’s world regions,
334
A12-5
Projected impact of different antischistosomal treatment strategies for S. haematobium, in which dipstick screening for hematuria may be used (as a proxy) to detect active infection,
337
A12-6
How long to treat: Without some modification of the local ecological factors that favor Schistosoma transmission (sewage contamination, snail habitat, and local surface water use) there is a tendency for local levels of schistosomiasis to recur within 10 to 15 years of stopping a drug treatment campaign,
338
A14-1
A generalized NTD program life cycle is presented schematically in this figure,
349
A14-2
Age-specific prevalence of Wuchereria bancrofti microfilaremia, antigenemia, and antifilarial antibody reactivity,
351
A15-1
Young woman with infant daughter in Papau Province, Indonesia, seeks medical care,
357
A15-2
The Eight Millennium Development Goals (MDGs),
358
A15-3
The convergence model,
360
A15-4
Global distribution of NTDs,
365
A15-5
Child swarmed with flies, which cause infection leading to trachoma,
367
A15-6
Women walking in river, South Asia,
368
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
A15-7
To address NTDs, the cycle of poverty must be broken,
377
A15-8
Women are key to NTD prevention efforts,
378
A16-1
Top country funders of NTD R&D, 2008,
393
A16-2
Share of NTD funding by disease, 2008,
394
A16-3
Top 12 funders of kinetoplastid R&D, 2008,
395
A16-4
Kinetoplastid investment by research area for each disease, 2008,
398
A16-5
Top 12 funders of dengue R&D, 2008,
400
A16-6
Dengue funding by product area, 2008,
402
A16-7
Top 12 funders of helminth R&D, 2008,
403
A16-8
Helminth funding by product area, 2008,
405
A16-9
Top 12 funders of leprosy R&D, 2008,
407
A16-10
Leprosy funding by product area, 2008,
409
A16-11
Top 12 funders of trachoma R&D, 2008,
410
A16-12
Trachoma funding by product area, 2008,
411
A16-13
Buruli ulcer funding by product area, 2008,
411
A16-14
Top 12 funders of Buruli ulcer R&D, 2008,
412
A16-15
Assessing health return on investment,
413
A17-1
Cumulative treatments in GPELF,
424
A17-2
Cumulative totals of donated drugs (Panel A), albendazole and invermectin (Mectizan), and purchased drug (Panel B) DEC, used in GPELF between 2000 and 2007,
425
A17-3
Effect of MDA on microfilaremia prevalence,
426
A17-4
Clearance of microfilaremia from each sentinel site (approximately 500 persons per site) reporting to the Global Programme after 5 rounds of MDA treatment (n = 68),
427
A18-1
General formula for calculating economic benefits,
448
A18-2
Duration of economic benefits,
449
A18-3
Total economic benefits by category,
461
A18-4
Cumulative economic benefits resulting from the first 8 years of the GPELF,
464
A18-5
Potential economic impact of the GPELF,
476
A20-1
Concurrent growth in “neglected disease” and “determinants of health” discourse 1998–2009,
495
A20-2
Overview of points of intervention to address disease and improve health security,
498
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
A21-1
Amastigotes of T. cruzi within host cells,
513
A21-2
A setting of active transmission in the Gran Chaco region and the pyrethroid-resistant Triatoma infestans collected from the structure,
516
BOXES
WO-1
Ancient Scourges, New Names,
6
WO-2
Definitions of Elimination, Eradication, and Control,
19
WO-3
NTDs Targeted by WHO for Elimination or Eradication,
20
WO-4
Cumulative Burdens of the NZDs,
50
WO-5
Common Features of Integrated Control Programs for Overlapping NTDs and NZDs, Malaria, and Other Infectious Diseases of Poverty,
52
WO-6
Key Neglected Diseases of Poverty,
86
A2-1
The Impact of Conflict on Neglected Diseases,
141
A9-1
Immune Evasion and Regulation of Helminth Infections,
267
A14-1
World Health Assembly Resolutions Targeting NTDs,
347
A17-1
The Global Programme to Eliminate LF—Its First 8 Years,
430
A19-1
NTDs and Their Common Features,
482
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The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies
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