NewsBites: Spotlight on CDC's Parasitic Disease Work

 
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Fall 2016


What's Inside:


Mark Your Calendar for 2017

April 25 is World Malaria Day, a day to celebrate the gains made in the fight against malaria, and to highlight global efforts to control malaria and mobilizes action to combat the disease.

Sir Ronald Ross

August 20 is World Mosquito Day. Recognition of this insect’s impact on human health is observed annually on August 20, marking Sir Ronald Ross's (pictured) discovery in 1897 that female mosquitoes transmit malaria between people. Learn more about CDC’s history with malaria and how CDC is studying mosquitoes to identify ways to prevent and control malaria

October 13 is World Sight Day, an annual awareness day to focus global attention to blindness and vision impairment, organized by the International Agency for the Prevention of Blindness (IAPB). On this day, DPDM recognizes trachoma, the world’s leading cause of preventable blindness, and onchocerciasis (also known as River Blindness), which is transmitted through repeated bites by blackflies. Worldwide, onchocerciasis is second only to trachoma as an infectious cause of blindness.

worrell-kiberia

October 15 is Global Handwashing Day, a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases (including NTDs) and save lives.

October 17 is International Day for the Eradication of Poverty, which was created by the United Nations to bring attention to the many causes of poverty, and how it impacts people around the world.  NTDs affect the world’s poorest people, trapping them in a cycle of poverty and disease. 

November 6 is observed annually as Malaria Day in the Americas. Spearheaded by the Pan American Health Organization, it serves as an opportunity to highlight successful efforts to prevent and control malaria in the Americas.  

    November 19 is World Toilet Day, which raises awareness about the global sanitation crisis and the need to improve access to sanitation and hygiene services around the world.


    Featured Parasite: Taenia Solium

    brain cysts

    Taenia solium is the parasite that causes cysticercocis (or neurocystericercosis when cysts are found in the brain). Cysticercosis is a parasitic tissue infection that occurs after a person ingests tapeworm eggs. The larvae get into tissues such as muscle and brain, and form cysts there (these are called cysticerci).  When cysts are found in the brain, the condition is called neurocysticercosis.  One of the CDC identified NPIs, neurocystercercosis is a common infectious cause of seizures in some parts of the U.S.

    Tapeworm eggs are spread through food, water, or surfaces contaminated with feces.  Humans swallow the eggs when they eat contaminated food or put contaminated fingers in their mouth. Importantly, someone with a tapeworm can infect him-or herself with tapeworm eggs (this is called autoinfection), and can infect others in the family. Eating pork cannot give you cysticercosis. Not all cases of cysticercosis need treatment. 

    However, it can be treated with anti-parasitic drugs in combination with anti-inflammatory drugs, and in some cases, surgery is necessary to remove cysts.

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    Welcome to NewsBites

    A quarterly e-update designed to inform you about CDC's efforts to protect the public from parasitic diseases.

    Interested in a program update? Use the links to the left under 'What's Inside' to navigate to the full story or scroll below.  


    Parise

    Director's Welcome
    Wow, it has been 23 years since I joined CDC as an Epidemic Intelligence Officer in the Malaria Branch. It’s an exciting time to be working in the parasitic disease field. Great strides have been made in global control of these diseases. Since 2000, we’ve seen a dramatic decline in the number of malaria cases worldwide, and malaria mortality rates have declined by 62%. More than 1 billion treatments have been distributed via mass drug administration to control Neglected Tropical Diseases (NTDs), and cases of Guinea worm disease have dropped from 3.5 million in the mid-1980s to only 22 cases worldwide in 2015. But there is still much work to be done. Malaria killed about 438,000 people last year—most of those deaths among children under 5 in sub-Saharan Africa—and there were an estimated 214 million cases of malaria worldwide. More than 1 billion people in the world still suffer from one or more NTDs, and millions of people in the United States are affected by parasitic infections that most of us, including health care providers, know little about.

    This is why we in the Division are committed to working with you and other partners and collaborators to help protect and improve the health of individuals from parasitic diseases, around the world and here at home. 

    CAPT Monica E. Parise, MD
    Director, Division of Parasitic Diseases and Malaria

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    Malaria Around the World

    Breaking down silos
    DPDM and other colleagues, the Nigeria Field Epidemiology and Laboratory Training Program (NFELTP), National Stop Transmission of Polio Program (NSTOP), and the President’s Malaria Initiative (PMI) are collaborating on an activity to leverage assets and approaches used in polio eradication efforts to aid in the fight against malaria. The Nigeria Malaria Frontline project focuses on Zamfara and Kano states in Nigeria and involves expanding the capacity of public health officers to address malaria.  A baseline assessment has been completed, and a training of trainers has been conducted on four of nine malaria modules covering case management, malaria in pregnancy, and malaria surveillance, in addition to a malaria 101 module. Newly trained officers are already beginning to put the training to use.

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    Neglected Tropical Diseases

    A little drop of blood can go a long way
    DPDM scientists traveled to Bogota, Colombia to help train staff from the Ministries of Health, National Institutes of Health, and National Public Health Laboratories in Colombia, Mexico and Paraguay on the use of multiplex serological assays for integrated surveillance. The Pan-American Health Organization (PAHO) convened the meeting and led each country through the development of action plans for how multiplex surveillance could complement their existing surveillance programs and further strengthen laboratory capacity in these countries. The multiplex assays provide efficiencies by allowing for detection of antibodies against multiple pathogens in a single test using less than a drop of blood.  DPDM has been evaluating the use of the multiplex assay in various settings.


    On the way to the end
    Congratulations to Guatemala, which in October 2016 joined Columbia, Ecuador and Mexico as the fourth country in the Americas to be granted verification of elimination of onchocerciasis (a blinding neglected tropical disease) by the World Health Organization (WHO). Guatemala is one of six countries in the Americas that have been affected by onchocerciasis. Prior to achieving elimination, it had been the most affected nation in the Americas, with more than 40 percent of the population at risk of infection. DPDM has been providing technical assistance on how to eliminate onchoceriasis from the region.

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    Laboratory Strengthening & Capacity

    Are three better than two?
    DPDM staff are working with the Haiti Ministry of Public Health and Population (MSPP) on a safety trial of triple drug therapy for lymphatic filariasis (LF). This is part of a multi-country trial supported through Bill and Melinda Gates Foundation funding to Washington University. Researchers hope to demonstrate that the triple-drug therapy of ivermectin, diethylcarbamazine and albendazole is a safe alternative to the two-drug therapy (diethylcarbamazine and albendazole) for mass treatment to eliminate lymphatic filariasis. The triple drug therapy has been shown to be more effective than the double drug therapy in eliminating microfilaria from the blood, and could serve as a powerful tool to accelerate the elimination of lymphatic filariasis globally.


    Parasites in the United States

    Lab Image

    A new way to help solve an “old” problem  
    A breakthrough in pathogen detection has led to a new way to detect the Cyclospora parasite (often transmitted through contaminated foods) in Guatemala. In June 2016, DPDM staff traveled to the University del Valle de Guatemala (UVG) to share a new, portable microscope designed for resource-limited countries (LED-based UV-fluorescent microscope system) and to implement the Universal Nucleic Acid Extraction (UNEX) method (a DNA extraction technique), that will enhance their ability to detect cyclosporiasis cases and control outbreaks. Outbreaks of cyclosporiasis have occurred in the U.S. since the mid-1990s with large outbreaks occurring annually since 2013; there were 384 laboratory-confirmed cases of cyclosporiasis in 2016.

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    Helping take the “neglected” out of NPIs
    In the United States, CDC has identified five parasitic diseasesChagas disease, cysticercosis, toxocariasis, toxoplasmosis, and trichomoniasis—as important for public health action because of the numbers affected, severity of disease, and ability to prevent and treat them. These Neglected Parasitic Infections (NPIs) have received relatively little attention. To help improve awareness of the infections among health care providers and to aid in diagnosis and treatment, CDC developed two continuing medical education (CME) and continuing nursing education (CNE) units. These interactive courses offer in-depth information on the diseases, including signs and symptoms and how to evaluate, diagnose, and treat patients:

    Chagas Disease: What US Clinicians Need to Know

    Neurocysticercosis: Diagnosis and Management of Patients Living in the United States

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    Publication Highlights

    Strongyloidiasis at a long-term care facility for the developmentally disabled-Arizona, 2015
    In June 2015, the Pinal County Public Health Services District in Arizona was notified of a suspected strongyloidiasis infection in a resident of a long-term–care facility for developmentally disabled persons. Strongyloides stercoralis is an intestinal nematode endemic in the tropics and subtropics. Infection is usually acquired through skin contact with contaminated soil, or less commonly, from person to person through fecal contamination of the immediate environment. Immunosuppressed persons can develop strongyloides hyperinfection syndrome, which can be fatal. This article focused on the investigation that was conducted to determine the infection source and identify additional cases. Although no source was identified, Strongyloides might have been introduced by an infected resident or employee from a region where it is endemic.

    Elimination of Taenia solium Transmission in Northern Peru
    Taeniasis and cysticercosis are two parasitic infections that are major causes of seizures and epilepsy. Infection by the parasite Taenia solium requires transmission between humans and pigs. The disease is considered to be eradicable, but data on attempts at regional elimination are lacking. The authors conducted a three-phase control program in Tumbes, Peru, to determine whether regional elimination would be feasible. This paper provides the proof of principle that cysticercosis could be eliminated.

    Transmission of Balamuthia mandrillaris by Organ Transplantation
    In 2009 and 2010, two clusters of organ transplant-transmitted Balamuthia mandrillaris, a free-living amoeba, were detected by recognition of severe unexpected illness in multiple recipients from the same donor. This paper presents the investigations of those clusters.

    Development of a pharmacovigilance safety monitoring tool for the rollout of single low‑dose primaquine and artemether‑lumefantrine to treat Plasmodium falciparum infections in Swaziland: a pilot study
    As malaria programs move towards elimination, stopping onward transmission from all detected cases becomes increasingly important. Countries remain reluctant to adopt the 2012 World Health Organization recommendation for single low-dose primaquine (SLD PQ) for Plasmodium falciparum transmission-blocking due to concerns over drug-related haemolysis risk, especially among glucose-6-phosphate dehydrogenase-deficient (G6PDd) individuals, without evidence demonstrating that it can be safely deployed in their settings. Pharmacovigilance methods provide a systematic way of collecting safety data and supporting the rollout of SLD PQ treatment.

    Effectiveness of insecticide-treated bednets in malaria prevention in Haiti: a case-control study
    Insecticide-treated bednets (ITNs) are effective in preventing malaria where vectors primarily bite indoors and late at night, but their effectiveness is uncertain where vectors bite outdoors and earlier in the evening. The authors studied the effectiveness of ITNs following a mass distribution in Haiti from May to September, 2012, where the Anopheles albimanus vector bites primarily outdoors and often when people are awake. In this case-control study, the authors found no evidence that mass ITN campaigns reduce clinical malaria in this observational study in Haiti despite good physical integrity and bioefficacy of the ITNs and no permethrin resistance among local mosquitoes. They suggest that alternative malaria control strategies should be prioritized in Haiti.

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