Regional Approach Needed for NTD Control in Conflict-Ridden Middle Eastern Countries
WASHINGTON, D.C.—February 28, 2012—Today, the open-access journal PLoS Neglected Tropical Diseases published a comprehensive report showcasing the high burden of neglected tropical diseases (NTDs) in the Middle East and North Africa (MENA) region, with particularly high prevalence rates in Egypt and Yemen. The report, authored by global health leaders Dr. Peter Hotez, Dr. Lorenzo Savioli and professor Alan Fenwick, reveals the high prevalence and uneven distribution of NTDs such as schistosomiasis, lymphatic filiariasis, dengue fever and Rift Valley fever in the MENA region and suggests opportunities for NTD control, especially in high risk populations in Egypt and Yemen.
“Great strides have been made towards eliminating several endemic NTDs in the Middle East and North Africa,” said Dr. Hotez, President of the Sabin Vaccine Institute, Director of the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development and Dean of the National School of Tropical Medicine at Baylor College of Medicine. “But in some countries, ongoing conflict threatens this progress. The ongoing instability in this region encourages populations to migrate, which spreads diseases that were once controlled. Conflict also stymies opportunities for regionally-based research and development, education programs and public health initiatives that could help prevent disease and lift people out of extreme poverty.”
The MENA region has had better success combating some NTDs than others. According to the World Health Organization (WHO), only 4 percent of school-aged and pre-school children in the MENA at risk for soil-transmitted helminths infections, the most pervasive of the NTDs, receive periodic treatments. This is significantly less than the global average.
There have also been several outbreaks of dengue and Rift Valley fever in the last two decades in MENA countries that had not seen the diseases for more than 50 years. These mosquito-transmitted diseases are of particular concern for the more than one million migrating pilgrims passing through Saudi Arabia on their way to and from Mecca for the Hajj.
On the other hand, through successful mass drug administration (MDA) programs, lymphatic filariasis (LF), or elephantiasis, has been eliminated in all MENA countries except Egypt and Yemen. Egypt is on the cusp of LF elimination, but in Yemen, civil unrest may cause a setback in the elimination efforts.
MDA programs, along with economic development initiatives, have also helped to drastically reduce or eliminate schistosomiasis, or snail fever, another common NTD. While the largest numbers of schistosomiasis cases in the MENA region still occur in Egypt, Yemen and Algeria, these two key interventions supported by the United States Agency for International Development (USAID), the World Bank, and the Egyptian Ministry of Health and Population have stimulated efforts to eliminate the disease in Egypt.
“The 15 year elimination program against schistosomiasis in Egypt has produced impressive results, especially since the country still has millions of relatively poor people living in rural areas. The Egypt model is now being used as an example for countries like Yemen and could even be a model for elimination of other NTDs, including the soil-transmitted helminthes (STH), LF and other diseases of poverty,” said professor Alan Fenwick, Director of the Schistosomiasis Control Initiative.
However, poverty is still a key obstacle to successful NTD treatment and elimination programs. According to the World Bank, 21 countries comprise the MENA region. Of the 400 million people that live in the area, more than 65 million live on less than $2 USD per day. Almost all of those living in poverty suffer from one or more of the NTDs that negatively impact child development and worker productivity. In the MENA region, Egypt and Yemen have the largest number of people living in poverty and also have the highest rates of several NTDs.
“Poverty and NTDs go hand-in-hand,” said Dr. Lorenzo Savioli, Director of the Department of Control of Neglected Tropical Diseases at the World Health Organization. “It is not coincidence that countries with the highest poverty rates are those with the highest NTD infection rates in the region. Our research finds that localized and regional control efforts will help stop disease migration due to conflict and ultimately help serve as a regional model for control.”
This latest study suggests that targeted interventions for Egypt and Yemen are necessary for NTD control and elimination, particularly for STH infections and vector-borne NTDs like dengue and Rift Valley fever. A regional plan for elimination that includes locally-based and locally-funded research and development, education and other treatment and control programs would help to eliminate disease transmission from migrating populations and ultimately control and eliminate NTDs throughout the MENA region.
“One way to promote regional control efforts is by working with wealthier countries, such as Saudi Arabia and the United Arab Emirates, to help fund and develop vaccination and treatment programs in the MENA region,” adds Dr. Hotez.
To read the full article visit www.plos.org
NTDs are a group of 17 parasitic and bacterial infections that are the most common afflictions of the world's poorest people. They blind, disable and disfigure their victims, trapping them in a cycle of poverty and disease. Research shows that treating NTDs lifts millions out of poverty by ensuring that children stay in school to learn and prosper; by strengthening worker productivity; and by improving maternal and child health.
About Sabin Vaccine Institute
Sabin Vaccine Institute is a non-profit, 501(c)(3) organization of scientists, researchers, and advocates dedicated to reducing needless human suffering caused by vaccine preventable and neglected tropical diseases. Sabin works with governments, leading public and private organizations, and academic institutions to provide solutions for some of the world's most pervasive health challenges. Since its founding in 1993 in honor of the oral polio vaccine developer, Dr. Albert B. Sabin, the Institute has been at the forefront of efforts to control, treat, and eliminate these diseases by developing new vaccines, advocating use of existing vaccines, and promoting increased access to affordable medical treatments. For more information please visit www.sabin.org.