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      Zoonoses and marginalised infectious diseases of poverty: Where do we stand?

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          Abstract

          Despite growing awareness of the importance of controlling neglected tropical diseases as a contribution to poverty alleviation and achieving the Millennium Development Goals, there is a need to up-scale programmes to achieve wider public health benefits. This implementation deficit is attributable to several factors but one often overlooked is the specific difficulty in tackling diseases that involve both people and animals - the zoonoses. A Disease Reference Group on Zoonoses and Marginalised Infectious Diseases (DRG6) was convened by the Special Programme for Research and Training in Tropical Diseases (TDR), a programme executed by the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO. The key considerations included: (a) the general lack of reliable quantitative data on their public health burden; (b) the need to evaluate livestock production losses and their additional impacts on health and poverty; (c) the relevance of cross-sectoral issues essential to designing and implementing public health interventions for zoonotic diseases; and (d) identifying priority areas for research and interventions to harness resources most effectively. Beyond disease specific research issues, a set of common macro-priorities and interventions were identified which, if implemented through a more integrated approach by countries, would have a significant impact on human health of the most marginalised populations characteristically dependent on livestock.

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          Re-evaluating the burden of rabies in Africa and Asia.

          To quantify the public health and economic burden of endemic canine rabies in Africa and Asia. Data from these regions were applied to a set of linked epidemiological and economic models. The human population at risk from endemic canine rabies was predicted using data on dog density, and human rabies deaths were estimated using a series of probability steps to determine the likelihood of clinical rabies developing in a person after being bitten by a dog suspected of having rabies. Model outputs on mortality and morbidity associated with rabies were used to calculate an improved disability-adjusted life year (DALY) score for the disease. The total societal cost incurred by the disease is presented. Human mortality from endemic canine rabies was estimated to be 55 000 deaths per year (90% confidence interval (CI) = 24 000-93 000). Deaths due to rabies are responsible for 1.74 million DALYs lost each year (90% CI = 0.75-2.93). An additional 0.04 million DALYs are lost through morbidity and mortality following side-effects of nerve-tissue vaccines. The estimated annual cost of rabies is USD 583.5 million (90% CI = USD 540.1-626.3 million). Patient-borne costs for post-exposure treatment form the bulk of expenditure, accounting for nearly half the total costs of rabies. Rabies remains an important yet neglected disease in Africa and Asia. Disparities in the affordability and accessibility of post-exposure treatment and risks of exposure to rabid dogs result in a skewed distribution of the disease burden across society, with the major impact falling on those living in poor rural communities, in particular children.
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            Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study.

            To study the diagnosis and outcomes in people admitted to hospital with a diagnosis of severe malaria in areas with differing intensities of malaria transmission. Prospective observational study of children and adults over the course a year. 10 hospitals in north east Tanzania. 17,313 patients were admitted to hospital; of these 4474 (2851 children aged under 5 years) fulfilled criteria for severe disease. Details of the treatment given and outcome. Altitudes of residence (a proxy for transmission intensity) measured with a global positioning system. Blood film microscopy showed that 2062 (46.1%) of people treated for malaria had Plasmodium falciparum (slide positive). The proportion of slide positive cases fell with increasing age and increasing altitude of residence. Among 1086 patients aged > or = 5 years who lived above 600 metres, only 338 (31.1%) were slide positive, while in children < 5 years living in areas of intense transmission (< 600 metres) most (958/1392, 68.8%) were slide positive. Among 2375 people who were slide negative, 1571 (66.1%) were not treated with antibiotics and of those, 120 (7.6%) died. The case fatality in slide negative patients was higher (292/2412, 12.1%) than for slide positive patients (142/2062, 6.9%) (P < 0.001). Respiratory distress and altered consciousness were the strongest predictors of mortality in slide positive and slide negative patients and in adults as well as children. In Tanzania, malaria is commonly overdiagnosed in people presenting with severe febrile illness, especially in those living in areas with low to moderate transmission and in adults. This is associated with a failure to treat alternative causes of severe infection. Diagnosis needs to be improved and syndromic treatment considered. Routine hospital data may overestimate mortality from malaria by over twofold.
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              A strategy to control transmission of Schistosoma japonicum in China.

              Schistosoma japonicum causes an infection involving humans, livestock, and snails and is a significant cause of morbidity in China. We evaluated a comprehensive control strategy in two intervention villages and two control villages along Poyang Lake in the southeastern province of Jiangxi, where annual synchronous chemotherapy is routinely used. New interventions, implemented from 2005 through 2007, included removing cattle from snail-infested grasslands, providing farmers with mechanized farm equipment, improving sanitation by supplying tap water and building lavatories and latrines, providing boats with fecal-matter containers, and implementing an intensive health-education program. During the intervention period, we observed changes in S. japonicum infection in humans, measured the rate of infection in snails, and tested the infectivity of lake water in mice. After three transmission seasons, the rate of infection in humans decreased to less than 1.0% in the intervention villages, from 11.3% to 0.7% in one village and from 4.0% to 0.9% in the other (P<0.001 for both comparisons). The rate of infection in humans in control villages fluctuated but remained at baseline levels. In intervention villages, the percentage of sampling sites with infected snails decreased from 2.2% to 0.1% in one grassland area and from 0.3% to no infection in the other (P<0.001 for both comparisons). The rate of infection in mice after exposure to lake water decreased from 79% to no infection (P<0.001). A comprehensive control strategy based on interventions to reduce the rate of transmission of S. japonicum infection from cattle and humans to snails was highly effective. These interventions have been adopted as the national strategy to control schistosomiasis in China. 2009 Massachusetts Medical Society
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                Author and article information

                Journal
                Parasit Vectors
                Parasites & Vectors
                BioMed Central
                1756-3305
                2011
                14 June 2011
                : 4
                : 106
                Affiliations
                [1 ]Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
                [2 ]WHO/EMRO (Eastern Mediterranean Regional Office) Consultant, Communicable Disease Control, c/o Elkoba Street, Apartment 52, Roxy, Cairo, Egypt
                [3 ]National Emerging Infectious Diseases Laboratories and Director, Collaborative Core Special Assistant to the President for Global Health, Boston University, Cross-town Center 391, 801 Massachusetts Avenue, Boston, USA
                [4 ]Molecular Parasitology Laboratory, Queensland Institute of Medical Research, 300 Herston Road, QLD Q 4029, Brisbane, Australia
                [5 ]Department of Veterinary Medicine and Public Health, Sokione University of Agriculture, Mail Box 3021, Morogoro, Tanzania
                [6 ]Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medicine, Veterinary Medicine and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
                [7 ]Philippine NGO Council on Population Health and Welfare, No. 304 Diplomat Condominium Bldg, Russel Avenue corner, Roxas Blvd., 1300 Pasay City, Philippines
                [8 ]Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430-Urb. Ingenieria-SMP-Lima 3 31 Lima, Peru
                [9 ]R-109, the Residency, City Centre, Salt Lake City, Calcutta 700 064, India
                [10 ]Department of Community Health Sciences, Brock University, 500 Glenridge Avenue, ON L2S 3A1, St. Catharines, Ontario, Canada
                [11 ]Riseal - Niger, 333, avenue des Zarmakoye, BP. 13724, Niamey, Niger
                [12 ]The University of Oklahoma Health Sciences Center, 801 Northeast 13th Street, Room 309AB, Post Office Box 26901, Oklahoma 73104, USA
                [13 ]ZOOM-IN Focal Point, TB Surveillance Officer, Tropical Disease Research, Communicable Disease Control, World Health Organization, Eastern Mediterranean Regional Office, Abdul Razzak Al Sanhouri Street, P.O. Box 7608, Nasr City Cairo 11371, Egypt
                [14 ]Sanitation and Hygiene, Protection of the Human Environment, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
                [15 ]Zoonoses and Veterinary Public Health, World Health Organization, 20 Avenue Appia 1211 Geneva, Switzerland
                [16 ]Department of Zoology, Faculty of Science, University of Khartoum, P.O. Box 321 11115 Khartoum, Sudan
                [17 ]Special Programme for Research and Training in Tropical Diseases (TDR) World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
                Article
                1756-3305-4-106
                10.1186/1756-3305-4-106
                3128850
                21672216
                5ca0e783-bdaa-48b6-9251-658aaab9aa09
                Copyright ©2011 Molyneux et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 7 June 2011
                : 14 June 2011
                Categories
                Short Report

                Parasitology
                Parasitology

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