NewsBites: Updates from CDC’s Division of Parasitic Diseases and Malaria

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Summer 2017

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3-Drug Therapy Shows Promise in Fight Against Lymphatic Filariasis

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The year 2020 has been identified by the World Health Organization (WHO) as the target for defeating lymphatic filariasis (LF), the painful, mosquito-borne ailment that causes feet, legs, arms, and other parts of the body to swell enormously. And as this date approaches, new approaches are being introduced that may protect people from LF.


Great progress has been made against this disease that affects more than 120 million people in 74 countries. But a new, three-drug regimen that is currently being tested is seen as a powerful tool for protecting people from LF and hopefully meeting the 2020 target.

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DPDM NewsBites

Castries

Keeping Paradise Safe for Children

Saint Lucia is known for its beautiful waterfalls, views and great tropical weather. However the Caribbean island paradise has also been plagued with schistosomiasis.  Although Saint Lucia had a high number of people infected with the Schistosoma mansoni parasite in the past, economic development in the country has led to a drastic reduction of schistosomiasis. DPDM staff are providing technical assistance to the Saint Lucia Ministry of Health & Wellness and the Pan American Health Organization in Castries, Saint Lucia, to initiate a survey for schistosomiasis among approximately 2,000 school age children. The survey will assess current rates of schistosomiasis and either help verify the disease has been eliminated, or design a strategy for transmission elimination.  


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Testing the Tests 

The World Health Organization (WHO), in conjunction with CDC and the Foundation for Innovative New Diagnostics (FIND), published the Malaria Rapid Diagnostic Test Performance. Results of WHO product testing of malaria RDTs: round 7 (2015-2016). This report, which evaluated rapid diagnostic rests (RDTs) for malaria, provided a comparative measure of performance in a standardized way to distinguish between well and poorly performing tests. In round 7, 46 RDTs from 27 manufacturers were assessed. For the first time the evaluation included an assessment of product compliance with best practices for malaria RDT labelling and instructions for use. 


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‘Tis the Season … for Summertime Parasitic Diseases

Warmer months can bring increases in the number of cases of parasitic diseases in the United States. While these diseases can be treated, prevention is key and usually includes a few simple steps:

Most human cases of babesiosis in the United States are caused by the parasite Babesia microti. Babesia microti is spread in nature by Ixodes scapularis ticks (also called blacklegged ticks or deer ticks). Tickborne transmission is most common in parts of the Northeast and upper Midwest, and it usually peaks during the warm months.  Babesia infection can range in severity from asymptomatic to life threatening, but the infection is both treatable and preventable. People should try to avoid areas that are known to be infested with ticks, or use preventive measures, including daily tick checks. Avoiding ticks can also help prevent other tick-borne diseases.

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Notable Publications

Addressing the challenges of Chagas disease an emerging health concern in the United States in Infectious Diseases in Clinical Practice

Burden and impact of Plasmodium vivax in pregnancy: A multi-centre prospective observational study in PLoS Neglected Tropical Diseases

Long term health outcomes among Returned Peace Corps Volunteers after malaria prophylaxis, 1995–2014 in Travel Medicine and Infectious Disease

SMansoni

Featured Parasite: 
Schistosoma

Schistosomiasis, also known as bilharzia, is a disease caused by parasitic worms. Infection with Schistosoma mansoni, S. haematobium, and S. japonicum parasites causes illness in humans. Although the parasitic worms that cause schistosomiasis are not found in the United States, more than 200 million people are infected and 700 million people are at risk in 74 countries worldwide. In terms of impact this disease is second only to malaria as the most devastating parasitic disease, and is the most deadly Neglected Tropical Disease (NTD), killing an estimated 280,000 people each year in the African region alone.

July is recognized as World Schistosomiasis Awareness Month. Learn more about schistosomiasis and what CDC is doing to combat NTDs around the world.


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Fight Against Lymphatic Filariasis

The three-drug regimen (ivermectin, diethylcarbamazine, and albendazole) was first tested in Papua New Guinea, and preliminary studies show that it works. Further testing to determine the safety and acceptability are currently underway in five countries – Indonesia, India, Fiji, Papua New Guinea, and Haiti.

The efforts in those counties are expected to yield safety and efficacy data needed by WHO to justify the therapy being used on a much larger scale in countries where LF remains endemic.

In real terms, meeting WHO’s requirements means pre- and post-treatment assessments from at least 10,000 people treated with the triple therapy across multiple settings. This “cohort event monitoring” is a proven tool that validates the safety of new drug regimens for public use.

With its long history of fighting LF, DPDM is providing key assistance this time as well. In Haiti, for example, DPDM provided technical assistance to the Ministry of Public Health and Population (MSPP) to ensure proper monitoring of the study in that country. The primary objective was to determine the frequency, type, and severity of adverse reactions in patients following 3-drug therapy compared to the standard 2-drug therapy. Enrollment started November 1, 2016 and was completed February 10, 2017. A total of 6,016 participants were enrolled in the study, with 3,009 people receiving the 2-drug therapy and 3,007 receiving the 3-drug treatment.

An initial analysis, conducted by Washington University, examined the safety results for the first 10,000 participants exposed to the 3-drug therapy in Haiti, India, Indonesia, and Papua New Guinea. Results were shared with WHO in May, and will help inform decisions about whether the 3-drug regimen should be recommended.

Preliminary results from Haiti showed that receiving three drugs was as safe and well-accepted compared to receiving only two drugs, foreshadowing what may be some good news to come.

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'Tis the Season...for Summertime Parasitic Diseases

Baylisascaris infection is caused by a roundworm found in raccoons. This roundworm can infect people as well as a variety of other animals, including dogs. Human infections are rare, but can be severe if the parasites invade the eye, organs or the brain. Baylisascaris procyonis is found in raccoons and is thought to pose the greatest risk to humans because of the often close association of raccoons to human dwellings. If raccoons have set up a den or a latrine in your yard, raccoon feces and material contaminated with raccoon feces should be removed carefully and burned, buried, or sent to a landfill. Care should be taken to avoid contaminating hands and clothes. Wild animals, including raccoons, should not be fed or kept as pets. Most infections are in children and others who are more likely to put dirt or animal waste in their mouth by mistake, so washing after working or playing outdoors is good practice for preventing a number of diseases, including Baylisascaris.

Cyclosporiasis is an intestinal infection caused by the microscopic parasite Cyclospora cayetanensis. People can become infected with Cyclospora by consuming food or water contaminated with the parasite. Cyclosporiasis can occur at any time of the year, but most of the reported cases and outbreaks in the United States occur during spring and summer months, particularly during May through August. People living or traveling in countries where cyclosporiasis is endemic may be at increased risk for infection, so following safe food and water habits, especially when traveling, is recommended.  In the United States, cyclosporiasis outbreaks have occurred since the mid-1990s with large outbreaks occurring annually since 2013.

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Mark Your Calendars

August 20 is World Mosquito Day

sir ronald ross

Recognition of this insect’s impact on human health is observed annually on August 20, marking Sir Ronald Ross's 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 worldwide.