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 l...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.展开更多
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...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.展开更多
With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been ...With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been well understood and evaluated.We undertook a scoping review to identify current TB strategies,research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets.Databases of Embase,MEDLINE,Global health and EBM reviews were searched for original studies,review articles,and policy papers published in English between January 1990 and December 2015.Articles examining TB strategy,program,guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria.Most of them were qualitative studies,issued in high-and middle-income countries and after 2000.To break the chain of TB transmission and reactivation in the elderly,infection control,interventions of avoiding delay in diagnosis and containment are essential for preventing transmission,especially in elderly institutions and aged immigrants;screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people;optimizing early case-finding with a high index of suspicion,systematic screening for prioritized high-risk groups,initial empirical and adequate follow-up treatment with close monitoring and evaluation,as well as enhanced programmatic management are fundamental pillars for active TB elimination.Evaluation of TB epidemiology,risk factors,impacts and cost-effectiveness of interventions,adopting accurate and rapid diagnostic tools,shorter and less toxic preventive therapy,are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway.The framework and principals identified in this study will help to evaluate and improve current program,develop targeted strategy,as well as raise more discussions on the research priority settings and policy transitions.Given the scarceness of policy and evaluated interventions,as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries,the increasing need of a ready TB program for the elderly warrants further research.展开更多
Background:Artemisinin-based combination therapies are recommended as first-line treatments for uncomplicated falciparum malaria,but there is little evaluation of their efficacy and effects on uncomplicated malaria-as...Background:Artemisinin-based combination therapies are recommended as first-line treatments for uncomplicated falciparum malaria,but there is little evaluation of their efficacy and effects on uncomplicated malaria-associated anaemia in children aged 2 years and under.Methods:Parasitological efficacy and effects on malaria-associated anaemia were evaluated in 250 malarious children aged 2 years and under,and efficacy was evaluated in 603 malarious children older than two but younger than 5 years of age following treatment with artesunate-amodiaquine(AA)or artemether-lumefantrine(AL).Kinetics of the disposition of parasitaemia following treatment were evaluated using a non-compartment model.Late-appearing anaemia(LAA)was diagnosed using the following criteria:clearance of parasitaemia,fever and other symptoms occurring within 7 days of starting treatment,adequate clinical and parasitological response on days 28–42,haematocrit(HCT)≥30%at 1 and/or 2 weeks,a fall in HCT to<30%occurring at 3–6 weeks,absence of concomitant illness at 1–6 weeks,and absence of asexual parasitaemia detected using both microscopy and polymerase chain reaction(PCR)at 1–6 weeks.Results:Overall,in children aged 2 years and under,the PCR-corrected parasitological efficacy was 97.2%(95%CI 92.8–101.6),which was similar for both treatments.In children older than 2 years,parasitological efficacy was also similar for both treatments,but parasite prevalence 1 day after treatment began was significantly higher,and fever and parasite clearance times were significantly faster in the AA-treated children compared with the AL-treated children.Declines in parasitaemia were monoexponential with an estimated elimination half-time of 1 h.Elimination half-times were similar for both treatments.In children aged 2 years and under who were anaemic at presentation,the mean anaemia recovery time was 12.1 days(95%CI 10.6–13.6,n=127),which was similar for both treatments.Relatively asymptomatic LAA occurred in 11 children(4.4%)aged 2 years and under,the recovery from which was uneventful.Conclusion:This study showed that AA and AL are efficacious treatments for uncomplicated falciparum malaria in Nigerian children aged 2 years and under,and that AA clears parasitaemia and fever significantly faster than AL in children older than 2 years.Both treatments may cause a relatively asymptomatic LAA with uneventful recovery in a small proportion of children aged 2 years and under.Trials registration:Pan African Clinical Trial Registry PACTR201508001188143,3 July 2015;PACTR201510001189370,3 July 2015;PACTR201508001191898,7 July 2015 and PACTR201508001193368,8 July 2015 http://www.pactr.org.展开更多
Emerging and re-emerging zoonotic diseases represent a public health challenge of international concern.They include a large group of neglected tropical diseases(NTDs),many of which are of zoonotic nature.Coronavirus ...Emerging and re-emerging zoonotic diseases represent a public health challenge of international concern.They include a large group of neglected tropical diseases(NTDs),many of which are of zoonotic nature.Coronavirus disease 201g(COVID-19),another emerging zoonotic disease,has just increased the stakes exponentially.Most NTDs are subject to the impact of some of the very same human-related activities triggering other emerging and re-emerging diseases,including COVID-19,severe acute respiratory syndrome(SARS),bird flu and swine flu.It is conceivable that COVID-19 will exacerbate the NTDs,as it will divert much needed financial and human resources.There is considerable concern that recent progress achieved with control and elimination efforts will be reverted.Future potential strategies will need to reconsider the determinants of health in NTDs in order to galvanize efforts and come up with a comprehensive,well defined programme that will set the stage for an effective multi-sectorial approach.In this Commentary,we propose areas of potential synergies between the COVID-19 pandemic control efforts other health and non-health sector initiatives and NTD control and elimination programmes.展开更多
中国卫生部发布《2006—2012年全国消除麻疹行动计划》以来，全国采取了一系列消除麻疹策略与措施并取得明显进展，但中国处于消除麻疹的关键时期，面临着新的挑战，麻疹流行病学特征也发生了变化，尤其需要统一和澄清对一些技术问题的...中国卫生部发布《2006—2012年全国消除麻疹行动计划》以来，全国采取了一系列消除麻疹策略与措施并取得明显进展，但中国处于消除麻疹的关键时期，面临着新的挑战，麻疹流行病学特征也发生了变化，尤其需要统一和澄清对一些技术问题的认识。中国疾病预防控制中心（Center for Disease Control and Prevention，CDC）免疫规划中心收集、汇总各级CDC专业人员近年来关注的问题，并会同世界卫生组织驻华代表处，组织国内外专家深人研讨了主要的技术问题，包括消除麻疹与接种疫苗、麻疹病例的传染来源、保护〈8月龄婴儿、爆发疫情的应急免疫活动、医院传播的作用和控制意义、特殊人群及场所等，形成专家解读共识，供相关部门和专业人员在消除麻疹中参考。展开更多
基金This work was financially supported by the WHO Regional Office for the Western Pacific,the National Science and Technology Major Program(Grant No.2012ZX10004-220)the data analysis was partially supported by China-UK Global Health Support Programme(Grant No.GHSP-CS-OP2).
文摘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.
文摘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.
基金This scoping review was kindly supported by the Health and Medical Research Fund[Number:CU-15-C12]Food and Health Bureau,Hong Kong Special Administrative Region,China.
文摘With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been well understood and evaluated.We undertook a scoping review to identify current TB strategies,research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets.Databases of Embase,MEDLINE,Global health and EBM reviews were searched for original studies,review articles,and policy papers published in English between January 1990 and December 2015.Articles examining TB strategy,program,guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria.Most of them were qualitative studies,issued in high-and middle-income countries and after 2000.To break the chain of TB transmission and reactivation in the elderly,infection control,interventions of avoiding delay in diagnosis and containment are essential for preventing transmission,especially in elderly institutions and aged immigrants;screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people;optimizing early case-finding with a high index of suspicion,systematic screening for prioritized high-risk groups,initial empirical and adequate follow-up treatment with close monitoring and evaluation,as well as enhanced programmatic management are fundamental pillars for active TB elimination.Evaluation of TB epidemiology,risk factors,impacts and cost-effectiveness of interventions,adopting accurate and rapid diagnostic tools,shorter and less toxic preventive therapy,are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway.The framework and principals identified in this study will help to evaluate and improve current program,develop targeted strategy,as well as raise more discussions on the research priority settings and policy transitions.Given the scarceness of policy and evaluated interventions,as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries,the increasing need of a ready TB program for the elderly warrants further research.
基金supported by a Swiss Pharma Nigeria PLC Grant given to AS,and by World Bank Malaria Booster Project and the Global Fund for Malaria to Federal Ministry of Health,Abuja,Nigeria through Drug Therapeutic Efficacy Testing in Nigeria.
文摘Background:Artemisinin-based combination therapies are recommended as first-line treatments for uncomplicated falciparum malaria,but there is little evaluation of their efficacy and effects on uncomplicated malaria-associated anaemia in children aged 2 years and under.Methods:Parasitological efficacy and effects on malaria-associated anaemia were evaluated in 250 malarious children aged 2 years and under,and efficacy was evaluated in 603 malarious children older than two but younger than 5 years of age following treatment with artesunate-amodiaquine(AA)or artemether-lumefantrine(AL).Kinetics of the disposition of parasitaemia following treatment were evaluated using a non-compartment model.Late-appearing anaemia(LAA)was diagnosed using the following criteria:clearance of parasitaemia,fever and other symptoms occurring within 7 days of starting treatment,adequate clinical and parasitological response on days 28–42,haematocrit(HCT)≥30%at 1 and/or 2 weeks,a fall in HCT to<30%occurring at 3–6 weeks,absence of concomitant illness at 1–6 weeks,and absence of asexual parasitaemia detected using both microscopy and polymerase chain reaction(PCR)at 1–6 weeks.Results:Overall,in children aged 2 years and under,the PCR-corrected parasitological efficacy was 97.2%(95%CI 92.8–101.6),which was similar for both treatments.In children older than 2 years,parasitological efficacy was also similar for both treatments,but parasite prevalence 1 day after treatment began was significantly higher,and fever and parasite clearance times were significantly faster in the AA-treated children compared with the AL-treated children.Declines in parasitaemia were monoexponential with an estimated elimination half-time of 1 h.Elimination half-times were similar for both treatments.In children aged 2 years and under who were anaemic at presentation,the mean anaemia recovery time was 12.1 days(95%CI 10.6–13.6,n=127),which was similar for both treatments.Relatively asymptomatic LAA occurred in 11 children(4.4%)aged 2 years and under,the recovery from which was uneventful.Conclusion:This study showed that AA and AL are efficacious treatments for uncomplicated falciparum malaria in Nigerian children aged 2 years and under,and that AA clears parasitaemia and fever significantly faster than AL in children older than 2 years.Both treatments may cause a relatively asymptomatic LAA with uneventful recovery in a small proportion of children aged 2 years and under.Trials registration:Pan African Clinical Trial Registry PACTR201508001188143,3 July 2015;PACTR201510001189370,3 July 2015;PACTR201508001191898,7 July 2015 and PACTR201508001193368,8 July 2015 http://www.pactr.org.
文摘Emerging and re-emerging zoonotic diseases represent a public health challenge of international concern.They include a large group of neglected tropical diseases(NTDs),many of which are of zoonotic nature.Coronavirus disease 201g(COVID-19),another emerging zoonotic disease,has just increased the stakes exponentially.Most NTDs are subject to the impact of some of the very same human-related activities triggering other emerging and re-emerging diseases,including COVID-19,severe acute respiratory syndrome(SARS),bird flu and swine flu.It is conceivable that COVID-19 will exacerbate the NTDs,as it will divert much needed financial and human resources.There is considerable concern that recent progress achieved with control and elimination efforts will be reverted.Future potential strategies will need to reconsider the determinants of health in NTDs in order to galvanize efforts and come up with a comprehensive,well defined programme that will set the stage for an effective multi-sectorial approach.In this Commentary,we propose areas of potential synergies between the COVID-19 pandemic control efforts other health and non-health sector initiatives and NTD control and elimination programmes.
文摘中国卫生部发布《2006—2012年全国消除麻疹行动计划》以来，全国采取了一系列消除麻疹策略与措施并取得明显进展，但中国处于消除麻疹的关键时期，面临着新的挑战，麻疹流行病学特征也发生了变化，尤其需要统一和澄清对一些技术问题的认识。中国疾病预防控制中心（Center for Disease Control and Prevention，CDC）免疫规划中心收集、汇总各级CDC专业人员近年来关注的问题，并会同世界卫生组织驻华代表处，组织国内外专家深人研讨了主要的技术问题，包括消除麻疹与接种疫苗、麻疹病例的传染来源、保护〈8月龄婴儿、爆发疫情的应急免疫活动、医院传播的作用和控制意义、特殊人群及场所等，形成专家解读共识，供相关部门和专业人员在消除麻疹中参考。
