Unequal Distribution of Innovation Efforts for Neglected Tropical Diseases: The Role of Funding Evaluation Criteria

Background: International research and innovation efforts for neglected tropical diseases have increased in recent decades due to disparities in overall health research funding in relation to global burden of disease. However, within the field of neglected tropical diseases some seem far more neglected than others. In this research the aim is to investigate the distribution of resources and efforts, as well as the mechanisms that underpin funding allocation for neglected tropical diseases. Methodology: A systematic literature review was conducted to establish a comprehensive overview of known indicators for innovation efforts related to a wide range of neglected tropical diseases. Articles were selected based on a subjective evaluation of their relevance, the presence of original data, and the breadth of their scope. This was followed by thirteen in-depth open-ended interviews with representatives of private, public and philanthropic funding organizations, concerning evaluation criteria for funding research proposals. Results: The findings reveal a large difference in the extent to which the individual diseases are neglected with notable differences between absolute and relative efforts. Criteria used in the evaluation of research proposals relate to potential impact, the probability of success and strategic fit. Private organizations prioritize strategic fit and economic impact;philanthropic organizations prioritize short-term societal impact;and public generally prioritize the probability of success by accounting for follow-up funding and involvement of industry. Funding decisions of different types of organizations are highly interrelated. Conclusions: This study shows that the evaluation of funding proposals introduces and retains unequal funding distribution, reinforcing the relative neglect of diseases. Societal impact is the primary rationale for funding but application of it as a funding criterion is associated with significant challenges. Furthermore, current application of evaluation criteria leads to a primary focus on short-term impact. Through current practice, the relatively most neglected diseases will remain so, and a long-term strategy is needed to resolve this.

Neglected tropical diseases in the People’s Republic of China: progress towards elimination

Since the founding of the People's Republic of China in 1949,considerable progress has been made in the control and elimination of the country's initial set of 11 neglected tropical diseases.Indeed,elimination as a public health problem has been declared for lymphatic filariasis in 2007 and for trachoma in 2015.The remaining numbers of people affected by soil-transmitted helminth infection,clonorchiasis,taeniasis,and echinococcosis in 2015 were 29.1 million,6.0 million,366200,and 166100,respectively.In 2017,after more than 60 years of uninterrupted,multifaceted schistosomiasis control,has seen the number of cases dwindling from more than 10 million to 37600.Meanwhile,about 6000 dengue cases are reported,while the incidence of leishmaniasis,leprosy,and rabies are down at 600 or fewer per year.Sustained social and economic development,going hand-in-hand with improvement of water,sanitation,and hygiene provide the foundation for continued progress,while rigorous surveillance and specific public health responses will consolidate achievements and shape the elimination agenda.Targets for poverty elimination and strategic plans and intervention packages post-2020 are important opportunities for further control and elimination,when remaining challenges call for sustainable efforts.

Neglected tropical diseases:an effective global response to local poverty-related disease priorities

Background:Neglected tropical diseases(NTDs)have long been overlooked in the global health agenda.They are intimately related to poverty,cause important local burdens of disease,but individually do not represent global priorities.Yet,NTDs were estimated to affect close to 2 billion people at the turn of the millennium,with a collective burden equivalent to HIV/AIDS,tuberculosis,or malaria.A global response was therefore warranted.Main text:The World Health Organization(WHO)conceived an innovative strategy in the early 2000s to combat NTDs as a group of diseases,based on a combination of five public health interventions.Access to essential NTD medicines has hugely improved thanks to strong public-private partnership involving the pharmaceutical sector.The combination of a WHO NTD roadmap with clear targets to be achieved by 2020 and game-changing partner commitments endorsed in the London Declaration on Neglected Tropical Diseases,have led to unprecedented progress in the implementation of large-scale preventive treatment,case management and care of NTDs.The coming decade will see as challenges the mainstreaming of these NTD interventions into Universal Health Coverage and the coordination with other sectors to get to the roots of poverty and scale up transmissionbreaking interventions.Chinese expertise with the elimination of multiple NTDs,together with poverty reduction and intersectoral action piloted by municipalities and local governments,can serve as a model for the latter.The international community will also need to keep a specific focus on NTDs in order to further steer this global response,manage the scaling up and sustainment of NTD interventions globally,and develop novel products and implementation strategies for NTDs that are still lagging behind.Conclusions:The year 2020 will be crucial for the future of the global response to NTDs.Progress against the 2020 roadmap targets will be assessed,a new 2021–2030 NTD roadmap will be launched,and the London Declaration commitments will need to be renewed.It is hoped that during the coming decade the global response will be able to further build on today’s successes,align with the new global health and development frameworks,but also keep focused attention on NTDs and mobilize enough resources to see the effort effectively through to 2030.

Control of neglected tropical diseases in Asia Pacific: implications for health information priorities

Poverty magnifies limitations posed by traditional biases and environmental risks.Any approach towards disease control needs to recognise that socially embedded vulnerabilities can be as powerful as externally imposed infections.Asia Pacific has a specific panorama of infectious diseases,which,in common with other endemic areas,have a tendency to emerge or re-emerge if not carefully monitored.Sustained control aiming at elimination requires strong emphasis on surveillance and response.Well-designed informatics platforms can improve support systems and strengthen control activities,as they rapidly locate high-risk areas and provide detailed,up-to-date information on the performance of ongoing control programmes.

Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases

Neglected Tropical Diseases(NTDs)are both drivers and manifestations of poverty and social inequality.Increased advocacy efforts since the mid-2000s have led to ambitious new control and elimination targets set for 2020 by the World Health Organisation.While these global aspirations represent significant policy momentum,there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged,understood and engaged.However a number of recent publications have emphasised the“neglected”status of applied social science research on NTDs.In light of the 2020 targets,this paper explores the social science/NTD literature and unpacks some of the ways in which social inquiry can help support effective and sustainable interventions.Five priority areas are discussed,including on policy processes,health systems capacity,compliance and resistance to interventions,education and behaviour change,and community participation.The paper shows that despite the multifaceted value of having anthropological and sociological perspectives integrated into NTD programmes,contemporary efforts underutilise this potential.This is reflective of the dominance of top-down information flows and technocratic approaches in global health.To counter this tendency,social research needs to be more than an afterthought;integrating social inquiry into the planning,monitoring and evaluating process will help ensure that flexibility and adaptability to local realities are built into interventions.More emphasis on social science perspectives can also help link NTD control to broader social determinants of health,especially important given the major social and economic inequalities that continue to underpin transmission in endemic countries.

Whatever happened to China’s neglected tropical diseases?

Before the founding of the People's Republic of China 70 years ago,both extreme poverty and parasitic infections and other neglected tropical diseases were highly prevalent.Owing to social development,particularly economic reforms since the 1980s,poverty has since been dramatically reduced,and China became increasingly urbanized and industrialized.In parallel,China's economic transformation translated into similar and remarkable reductions in neglected tropical diseases.Qian and colleagues report in their review published in Infectious Diseases of Poverty,the elimination or near elimination as a public health problem of lymphatic filariasis,trachoma,soil-transmitted helminth infections,schistosomiasis and other neglected tropical diseases.Of note,neglected tropical disease control and poverty reduction each appear to reinforce the other.China's formula for success in parasitic and neglected tropical disease control might translate to other parts of the world,such as in sub-Saharan Africa through China's new Belt and Road Initiative.

Neglected tropical diseases and global burden of disease in China

Recently,the mortality of 240 causes in China including a subnational analysis during 1990-2013 was published in The Lancet.This comprehensive analysis will undoubtedly impact policymaking regarding public health in China.However,it is unfavourable in some degree to neglected tropical diseases,which is the subject of this Letter to the Editor.Policymakers,especially those in less developed provinces of China,should fully consider the burden of neglected tropical diseases,which will benefit the control and final elimination of these diseases in the country.

The monetary value of human lives lost due to neglected tropical diseases in Africa

Background:Neglected tropical diseases(NTDs)are an important cause of death and disability in Africa.This study estimates the monetary value of human lives lost due to NTDs in the continent in 2015.Methods:The lost output or human capital approach was used to evaluate the years of life lost due to premature deaths from NTDs among 10 high/upper-middle-income(Group 1),17 middle-income(Group 2)and 27 low-income(Group 3)countries in Africa.The future losses were discounted to their present values at a 3%discount rate.The model was re-analysed using 5%and 10%discount rates to assess the impact on the estimated total value of human lives lost.Results:The estimated value of 67860 human lives lost in 2015 due to NTDs was Int$5112472607.Out of that,14.6%was borne by Group 1,57.7%by Group 2 and 27.7%by Group 3 countries.The mean value of human life lost per NTD death was Int$231278,Int$109771 and Int$37489 for Group 1,Group 2 and Group 3 countries,respectively.The estimated value of human lives lost in 2015 due to NTDs was equivalent to 0.1%of the cumulative gross domestic product of the 53 continental African countries.Conclusions:Even though NTDs are not a major cause of death,they impact negatively on the productivity of those affected throughout their life-course.Thus,the case for investing in NTDs control should also be influenced by the value of NTD morbidity,availability of effective donated medicines,human rights arguments,and need to achieve the NTD-related target 3.3 of the United Nations Sustainable Development Goal 3(on health)by 2030.

The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals

The Sustainable Development Goals(SDGs)call for an integrated response,the kind that has defined Neglected Tropical Diseases(NTDs)efforts in the past decade.NTD interventions have the greatest relevance for SDG3,the health goal,where the focus on equity,and its commitment to reaching people in need of health services,wherever they may live and whatever their circumstances,is fundamentally aligned with the target of Universal Health Coverage.NTD interventions,however,also affect and are affected by many of the other development areas covered under the 2030 Agenda.Strategies such as mass drug administration or the programmatic integration of NTD and WASH activities(SDG6)are driven by effective global partnerships(SDG17).Intervention against the NTDs can also have an impact on poverty(SDG1)and hunger(SDG2),can improve education(SDG4),work and economic growth(SDG8),thereby reducing inequalities(SDG10).The community-led distribution of donated medicines to more than 1 billion people reinforces women’s empowerment(SDG5),logistics infrastructure(SDG9)and non-discrimination against disability(SDG16).Interventions to curb mosquito-borne NTDs contribute to the goals of urban sustainability(SDG11)and resilience to climate change(SDG13),while the safe use of insecticides supports the goal of sustainable ecosystems(SDG15).Although indirectly,interventions to control waterand animal-related NTDs can facilitate the goals of small-scale fishing(SDG14)and sustainable hydroelectricity and biofuels(SDG7).NTDs proliferate in less developed areas in countries across the income spectrum,areas where large numbers of people have little or no access to adequate health care,clean water,sanitation,housing,education,transport and information.This scoping review assesses how in this context,ending the epidemic of the NTDs can impact and improve our prospects of attaining the SDGs.

The 2017 Oslo conference report on neglected tropical diseases and emerging/re-emerging infectious diseases-focus on populations underserved

Background:In 2017,the Centre for Global Health(CGH)at the University of Oslo in collaboration with the Coalition for Epidemic Preparedness Innovations(CEPI)and the Norwegian Agency for Development Cooperation(Norad)held a meeting to discuss together with leading figures in disease control,research and development the issue of neglected tropical diseases and emerging/re-emerging infectious diseases.This commentary has taken up this discussion and the conclusions drawn at this meeting to make a case for the opportunity the Sustainable Development Goals(SDGs)provide in highlighting the interconnectedness of factors that are relevant in the successful fight against neglected tropical diseases(NTDs)and emerging infectious diseases(EIDS).Main body:Despite NTDs being endemic and EIDS being epidemic,in order to prevent both disease groups effectively,it is important to appreciate that they share essential health determining faaors,namely:neglect,poverty,a lack of access to clean water and sanitation facilities and an absence of or severely limited provision of healthcare as well as in many cases a zoonotic nature.Instead of looking to"simple disease management for the answer,the SDGs help to understand the interplay of multiple priority areas and thereby help to promote a more holistic approach to addressing these two disease groups.Conclusions:Their commonalities mean that the Global Health community should leverage opportunities and efforts in the prevention and elimination of both NTDs and EIDs.Doing so using a One Health approach is considered to offer a"public health best-buy".Concrete solutions are proposed.

Mortality Trends for Neglected Tropical Diseases in the State of Sergipe,Brazil,1980-2013

Background:Neglected Tropical Diseases are a set of communicable diseases that affect the population so low socioeconomic status,particularly 1.4 billion people who are living below the poverty level.This study has investigated the magnitude and mortality time trends for these diseases in the state of Sergipe,Northeast Region of Brazil.Methods:We conducted an ecological study of time series,based on secondary data derived from the Mortality Information System of the Ministry of Health.The mortality rates(crude,age-standardized rates and proportional ratio)were calculated from the deaths due to Neglected Tropical Diseases in the state of Sergipe,from 1980 to 2013.The time trends were obtained using the Joinpoint regression model.Results:Three hundred six thousand and eight hundred seventy-two deaths were certified in the state and Neglected Tropical Diseases were mentioned as the underlying cause in 1,203 certificates(0.39%).Mean number of deaths was 35.38 per year,and crude and age-standardized mortality rates were,respectively:2.16 per 100000 inhabitants(95%CI:1.45-2.87)and 2.87 per 100000 inhabitants(95%CI:1.93-3.82);the proportional mortality ratio was 0.41%(95%CI:0.27-0.54).In that period,Schistosomiasis caused 654 deaths(54.36%),followed by Chagas disease,with 211(17.54%),and by Leishmaniases,with 142(11.80%)deaths.The other diseases totalized 196 deaths(16.30%).There were increasing mortality trends for Neglected Tropical Diseases,Schistosomiasis and Chagas disease in the last 15 years,according to the age-standardized rates,and stability of the mortality trends for Leishmaniases.Conclusions:The Neglected Tropical Diseases show increasing trends and are a real public health problem in the state of Sergipe,since they are responsible for significant mortality rates.The following diseases call attention for showing greater number of deaths in the period of study:Schistosomiasis,Chagas disease and Leishmaniases.We finally suggest that public managers take appropriate actions to develop new strategies in epidemiological and therapeutic surveillance,and in the follow-up of these patients.

Efforts to mitigate the economic impact of the COVID-19 pandemic:potential entry points for neglected tropical diseases

Background:The damage inflicted by the coronavirus diseases 2019(COVID-19)pandemic upon humanity is and will continue to be considerable.Unprecedented progress made in global health over the past 20 years has reverted and economic growth has already evaporated,giving rise to a global recession,the likes of which we may not have experienced since the Second World War.Our aim is to draw the attention of the neglected tropical disease(NTD)community towards some of the major emerging economic opportunities which are quickly appearing on the horizon as a result of COVID-19.Main text:This scoping review relied on a literature search comprised of a sample of articles,statements,and press releases on initiatives aimed at mitigating the impact of COVID-19,while supporting economic recovery.Of note,the donor scenario and economic development agendas are highly dynamic and expected to change rapidly as the COVID-19 pandemic unfolds,as are donor and lender priorities.Con elusions:The NTD community,particularly in low-and middle-income countries(LMICs),will need to work quickly,diligently,and in close collaboration with decision-makers and key stakeholders,across sectors at national and international level to secure its position.Doing so might enhance the odds of grasping potential opportunities to access some of the massive resources that are now available in the form of contributions from corporate foundations,trust funds,loans,debt relieve schemes,and other financial mechanisms,as part of the ongoing and future economic development agendas and public health priorities driven by the COVID-19 pandemic.This paper should serve as a starting point for the NTD community to seek much needed financial support in order to sustain and revitalize control and elimination efforts pertaining to NTDs in LMICs.

Community-based interventions for the prevention and control of helmintic neglected tropical diseases

In this paper,we aim to systematically analyze the effectiveness of community-based interventions(CBIs)for the prevention and control of helminthiasis including soil-transmitted helminthiasis(STH)(ascariasis,hookworms,and trichuriasis),lymphatic filariasis,onchocerciasis,dracunculiasis,and schistosomiasis.We systematically reviewed literature published before May 2013 and included 32 studies in this review.Findings from the meta-analysis suggest that CBIs are effective in reducing the prevalence of STH(RR:0.45,95%CI:0.38,0.54),schistosomiasis(RR:0.40,95%CI:0.33,0.50),and STH intensity(SMD:−3.16,95 CI:−4.28,−2.04).They are also effective in improving mean hemoglobin(SMD:0.34,95%CI:0.20,0.47)and reducing anemia prevalence(RR:0.90,95%CI:0.85,0.96).However,it did not have any impact on ferritin,height,weight,low birth weight(LBW),or stillbirths.School-based delivery significantly reduced STH(RR:0.49,95%CI:0.39,0.63)and schistosomiasis prevalence(RR:0.50,95%CI:0.33,0.75),STH intensity(SMD:−0.22,95%CI:−0.26,−0.17),and anemia prevalence(RR:0.87,95%CI:0.81,0.94).It also improved mean hemoglobin(SMD:0.24,95%CI:0.16,0.32).We did not find any conclusive evidence from the quantitative synthesis on the relative effectiveness of integrated and non-integrated delivery strategies due to the limited data available for each subgroup.However,the qualitative synthesis from the included studies supports community-based delivery strategies and suggests that integrated prevention and control measures are more effective in achieving greater coverage compared to the routine vertical delivery,albeit it requires an existing strong healthcare infrastructure.Current evidence suggests that effective community-based strategies exist and deliver a range of preventive,promotive,and therapeutic interventions to combat helminthic neglected tropical diseases(NTDs).However,there is a need to implement and evaluate efficient integrated programs with the existing disease control programs on a larger scale throughout resource-limited regions especially to reach the unreachable.

Ancylostoma ceylanicum and other zoonotic canine hookworms:neglected public and animal health risks in the Asia-Pacific region

Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can under-mine current MDA and proposed animal deworming-based control efforts.

Local tips, global impact: community-driven measures as avenues of promoting inclusion in the control of neglected tropical diseases: a case study in Kenya

Background:Neglected tropical diseases(NTDs)affect poor populations with little or no’’political voice’to influence control activities.While most NTDs have interventions that work,the biggest challenge remains in delivering targeted interventions to affected populations residing in areas experiencing weak health systems.Despite the upward development trends in most countries of sub-Saharan Africa(SSA),the healthcare worker to population ratio remains exceptionally low,with some areas not served at all;thus,there is a need to involve other personnel for school and community-based healthcare approaches.Nonetheless,the current community-based programs suffer from inconsistent community participation due to a lack of coordinated response,and an expanded intervention agenda that lacks context-specific solutions applicable to rural,urban,and marginalized areas.Methods:This research investigated the capacity of local communities to address the burden of NTDs.Informed by the social theory of human capability,the research collected primary qualitative data by conducting key informant interviews and focus group discussions of people infected or affected by NTDs.The interview data were collected and transcribed verbatim for thematic analysis using Nvivo version 12.Results:Our findings reveal,first,a need for intersectoral collaboration between governments and affected populations for inclusive and sustainable NTD solutions.Second,a’’bottom-up’approach that enhances capacity building,sensitization,and behaviour change for improved uptake of NTD interventions.Third,the enforcement of Public Health Legislative Acts that mandates the reporting and treatment of NTDs such as leprosy.Fourth,the establishment of support groups and counseling services to assist persons suffering from debilitating and permanent effects of NTDs.Conclusions:Our research demonstrates the importance of human agency in encouraging new forms of participation leading to the co-production of inclusive and sustainable solutions against NTDs.

Frequency and distribution of neglected tropical diseases in Mozambique:a systematic review

Background:Neglected tropical diseases(NTDs)affect more than one billion people living in vulnerable conditions.In spite of initiatives recently contributing to fill NTDs gaps on national and local prevalence and distribution,more epidemiological data are still needed for effective control and elimination interventions.Main text:Mozambique is considered one of the countries with highest NTDs burden although available data is scarce.This study aims to conduct a systematic review on published available data about the burden and distribution of the different NTDs across Mozambique since January 1950 until December 2018.We identified manuscripts from electronic databases(Pubmed,EmBase and Global Health)and paper publications and grey literature from Mozambique Ministry of Health.Manuscripts fulfilling inclusion criteria were:crosssectional studies,ecological studies,cohorts,reports,systematic reviews,and narrative reviews capturing epidemiological information of endemic NTDs in Mozambique.Case-control studies,letters to editor,case reports and case series of imported cases were excluded.A total of 466 manuscripts were initially identified and 98 were finally included after the revision following PRISMA guidelines.Eleven NTDs were reported in Mozambique during the study span.Northern provinces(Nampula,Cabo Delgado,Niassa,Tete and Zambezia)and Maputo province had the higher number of NTDs detected.Every disease had their own report profile:while schistosomiasis have been continuously reported since 1952 until nowadays,onchocerciasis and cysticercosis last available data is from 2007 and Echinococcosis have never been evaluated in the country.Thus,both space and time gaps on NTDs epidemiology have been identified.Conclusions:This review assembles NTDs burden and distribution in Mozambique.Thus,contributes to the understanding of NTDs epidemiology in Mozambique and highlights knowledge gaps.Hence,the study provides key elements to progress towards the control and interruption of transmission of these diseases in the country.

Neglected tropical diseases activities in Africa in the COVID-19 era:the need for a"hybrid" approach in COVID-endemic times

With the coronavirus disease 2019(COVID-19)pandemic showing no signs of abating,resuming neglected tropical disease(NTD)activities,particularly mass drug administration(MDA)Z is vital.Failure to resume activities will not only enhance the risk of NTD transmission,but will fail to leverage behaviour change messaging on the importance of hand and face washing and improved sanitation--a common strategy for several NTDs that also reduces the risk of COVID-19 spread.This so-called"hybrid approach"will dem on strate best practices for mitigating the spread of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)by incorporating physical distancing,use of masks,and frequent hand-washing in the delivery of medicines to endemic communities and support action against the transmission of the virus through water,sanitation and hygiene interventions promoted by NTD programmes.Unless MDA and morbidity management activities resume,achievement of NTD targets as projected in the WHO/NTD Roadmap(2021-2030)will be deferred,the aspirational goal of NTD programmes to enhance universal health coverage jeopardised and the call to leave no one behind'a hollow one.We outline what implementing this hybrid approach,which aims to strengthen health systems,and facilitate integration and cross-sector collaboration,can achieve based on work undertaken in several African countries.

Urgent needs in fostering neglected tropical diseases(NTDs)laboratory capacity in WHO Western Pacific Region:results from the external quality assessment on NTDs diagnosis in 2012-2015

Background:Neglected tropical diseases(NTDs)are a heterogeneous group of mainly chronic,debilitating and often stigmatizing diseases that largely affects low-income and politically marginalized populations,causing a large burden of public health,social and economies in the NTDs endemic countries.NTDs are caused by infections with a range of pathogen,including bacteria,parasites,protozoa and viruses.The accurate diagnosis of NTDs is important for reducing morbidity,preventing mortality and for monitoring of control programs.External Quality Assessment(EQA),a component of laboratory quality assurance,aims to assess the performance of participating laboratories in detecting parasitic infections.The aim of this paper is to report the findings and put forward the recommendations on capacity build from the EQA results of participating NTDs laboratories in selected countries in the WHO Western Pacific Region from 2012 to 2015.Methods:Reference or public health laboratories at national level working on NTDs in 6 countries participated in EQAs organized by the National Institute of Parasitic Diseases(NIPD)of Chinese Center for Disease Control and Prevention(CDC)based in Shanghai,China.Two representatives of each participating laboratory were invited to NIPD to detect NTDs’parasitic infections using the same prepared samples for serological tests(IHA and ELISA)and helminth eggs’morphological tests(Direct smear and Kato-Katz).All of the results were scored and analyzed by using SPSS statistics 19.0 software.Results:The percentage of participants who had EQA score≥60 during 2012-2015 for direct smear test were 80.00%(2012),71.43%(2013),100%(2014)and 75.00%(2015),whereas for Kato-Katz test were 80.00%(2012),57.14%(2013),100%(2014)and 37.50%(2015),respectively.The detection rate of helminth eggs varied in different species,with Ascaris lumbricoides being the highest at 94.07%in average.All laboratories did very well with ELISA tests as shown by the high scores in all four years except Lab A in the first and last EQA.For the positive or negative judgments of serum samples,the total coincidence rates of ELISA between 2012 and 2015 were 90.00%,99.29%,94.29%and 98.75%,respectively.While the total coincidence rates of IHA were respectively 100%,95.00%,90.00%and 97.50%.However,detecting low levels of serum antibody remained problematic for IHA when the titres of samples were taken into consideration.Conclusion:This study demonstrate that EQA scheme have been beneficial to the participating laboratories.The EQA programme identifies certain deficiencies which were needed to overcome and improved the laboratories’performance in helminthiasis diagnosis.However,further optimization of accuracy and uniformity in NTDs diagnosis remains a big challenge.

Rabies in a postpandemic world:resilient reservoirs,redoubtable riposte,recurrent roadblocks,and resolute recidivism

Rabies is an ancient disease.Two centuries since Pasteur,fundamental progress occurred in virology,vaccinology,and diagnostics—and an understanding of pathobiology and epizootiology of rabies in testament to One Health—before common terminological coinage.Prevention,control,selective elimination,and even the unthinkable—occasional treatment—of this zoonosis dawned by the twenty-first century.However,in contrast to smallpox and rinderpest,eradication is a wishful misnomer applied to rabies,particularly post-COVID-19 pandemic.Reasons are minion.Polyhostality encompasses bats and mesocarnivores,but other mammals represent a diverse spectrum of potential hosts.While rabies virus is the classical member of the genus,other species of lyssaviruses also cause the disease.Some reservoirs remain cryptic.Although global,this viral encephalitis is untreatable and often ignored.As with other neglected diseases,laboratory-based surveillance falls short of the notifiable ideal,especially in lower-and middleincome countries.Calculation of actual burden defaults to a flux within broad health economic models.Competing priorities,lack of defined,long-term international donors,and shrinking local champions challenge human prophylaxis and mass dog vaccination toward targets of 2030 for even canine rabies impacts.For prevention,all licensed vaccines are delivered to the individual,whether parenteral or oral–essentially‘one and done’.Exploiting mammalian social behaviors,future‘spreadable vaccines’might increase the proportion of immunized hosts per unit effort.However,the release of replication-competent,genetically modified organisms selectively engineered to spread intentionally throughout a population raises significant biological,ethical,and regulatory issues in need of broader,transdisciplinary discourse.How this rather curious idea will evolve toward actual unconventional prevention,control,or elimination in the near term remains debatable.In the interim,more precise terminology and realistic expectations serve as the norm for diverse,collective constituents to maintain progress in the field.

Therapeutic response and safety of different treatments for cutaneous leishmaniasis in patients: A retrospective cross-sectional study

Objective:To analyze the therapeutic response and safety of different treatments for cutaneous leishmaniasis,received by patients in the Program for the Study and Control of Tropical Diseases-PECET-Medellín-Colombia.Methods:This is a retrospective cross-sectional study of patients attended at PECET Research Center during 2016-2021.Relevant information regarding sociodemographic characteristics,history of leishmaniasis,characterization of current infection,treatment received,follow-up of therapeutic response and safety was collected from the medical records.Data were analyzed with Pearson's Chi-square association tests and Mann-Whitney U test using statistical software.Results:A total of 486 clinical records of patients were analyzed,and 356 received treatment.Eight different therapeutic alternatives(systemic,local and in combination)were analyzed.The therapeutic response of the different alternatives used(except thermotherapy)was higher than 50%.Most frequent adverse events were myalgias,arthralgias and headache,and vesicles for systemic and local treatment,respectively.Conclusions:Safety profile and performance of local therapeutic alternatives and combined schemes for the treatment of uncomplicated cutaneous leishmaniasis are an interesting option for the management of the disease.