Monthly Archives: February 2018

STH Community Earns an Overall Green Score for 3rd Consecutive Year

With the 2012 launch of the London Declaration on Neglected Tropical Diseases (NTDs), stakeholders from across the globe resolved to control, eliminate, or eradicate 10 NTDs by 2020. As outlined in the recently-published London Declaration’s 5th Progress Report, those efforts have surpassed a major milestone: delivery of treatment, for at least one NTD, to more than 1 billion people in a single year.

Despite immense challenges, tremendous progress has been made against soil-transmitted helminthiasis (STH), with STH control programs alone treating over 531 million children in 2016. For the third year in a row, the STH community earned an overall green score – the highest possible – on the Scorecard. The STH community also earned individual green scores on three out of four milestones: program support, drug requests filled, and coverage/impact.

The program support milestone reflects the commitment of the STH Coalition, a multi-sectoral group of more than 60 partners, to accelerate global progress in combating STH. Among those partners are Johnson & Johnson and GlaxoSmithKline[1] whose donations of deworming drugs have been the enabling factor for the drug requests filled the category. By collectively distributing deworming drugs to an almost mind-boggling number of at-risk people in 2016, ministries of health in recipient countries made the green ‘coverage/impact’ score possible.

Still, as indicated by a yellow score in the research category, there is room for improvement. At its annual meeting in November, the STH Advisory Committee, the scientific and technical body that guides the work of the STH Coalition, compiled recommendations for addressing a list of current operational research (OR) gaps. Committee recommendations called for OR to pilot a comprehensive monitoring and evaluation (M&E) framework tied to defined STH endpoints, and development and field-testing of improved diagnostic tests to measure progress toward those endpoints. To learn more about the operational research gaps and to read the full STH Advisory Committee report click here.

[1] GLAXOSMITHKLINE, GSK and the GSK Logo are trademarks of the GSK group of companies and are used with the permission of GSK.

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Human and Veterinary Scientists Address Potential Drug Resistance

Collaboration with STH Coalition Partners and STH Experts yields important progress

Experts are concerned about the potential emergence of drug resistance in the parasites that cause soil-transmitted helminthiasis (STH), a disease infecting over one billion people. During their annual meeting last November the STH Advisory Committee, an independent body of experts, called for donors and others to support new research in this critical area.

Although drug resistance in STH helminths infecting humans has not been confirmed, studies in livestock, which experience infections from similar parasites, suggest the risk is substantial. Veterinary scientists have long since established that drug resistance in livestock to benzimidazoles (the class of drugs most commonly used to treat related parasites in humans) is common. Scientists are concerned that the mutations in STH parasites may not be detected early enough to prevent the rapid spread of resistance. This is due, in part, to the absence of a diagnostic test sensitive enough to detect early resistance, which is when programs are able to intervene effectively.

The STH Coalition is a group of over 60 organizations supporting STH control globally. Over the past year, the Coalition has convened scientists to collaboratively address drug resistance for STH. As a result, the University of Calgary, University of Georgia, Ghent University, and the U.S. Centers for Disease Control and Prevention (CDC) forged a partnership to advance much-needed research.

The University of Calgary is developing a new, more sensitive diagnostic test using genomic scanning techniques, originally developed for animal parasites, to identify specific gene mutations that enable drug resistance. Veterinary scientists at the University of Georgia are developing animal models to culture resistant worms and quality measures for the new assay. The University of Ghent has developed and is validating related laboratory protocols for global use, while the CDC will support field testing of the new diagnostics.

STH Advisory Committee experts have noted that time is of the essence. Partners need additional funding to continue this important research. The collaborative undertaking could produce a reliable diagnostic algorithm for the detection of drug resistance in as little as three years, but it cannot do so without more funding.

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STH by the numbers: Mixed progress on preventive chemotherapy coverage among all children at risk of STH

Note: This article was updated on March 13, 2018 to reflect revised global coverage figures

The World Health Organization (WHO) recommends countries with ≥20% prevalence of soil-transmitted helminthiasis (STH) at baseline administer preventive chemotherapy (PC) to preschool-age (PSAC: ages 1-4) and school-age children (SAC: ages 5-14). The related WHO target is ≥75% treatment coverage of PSAC and SAC in all countries requiring preventive chemotherapy (PC) by 2020. Ministries of health annually report PC coverage by risk group[i] to monitor progress toward the indicated target. Using publicly available WHO data, we analyzed progress in PC coverage among all children in countries requiring PC. The analysis considers any country reporting zero treatments or lacking reported data as not having conducted PC.

From 2006 to 2016, countries requiring PC for STH decreased from 130 to 103 (-21%),[1] while global treatment coverage[2] for all children increased from 15% to 60% (Figure 1). In 2016, over 500 million children requiring PC received PC, an 18% increase from 2015. Of countries requiring PC in 2016, 50 (49%) treated PSAC and SAC (Table 1). Of countries requiring PC in 2016, 50 (49%) treated PSAC and SAC (Table 1). This is the highest proportion of countries treating both risk groups in a given year. However, the number of countries treating both risk groups has largely remained the same from 2006 (47) to 2016 (50). Data from the last three years bear this out; of 53 countries not providing PC to both risk groups in 2016, 38 (72%) also did not provide PC to both risk groups in 2014 or 2015.

In 2016, 20 (19%) countries treated only SAC and five (5%) only treated PSAC. Of these 25 countries, only 9 (36%) reached 75% PC coverage among all children. More than half of the countries treating both risk groups reached the 75% coverage target for all children in 2016. Considering all countries (N=103), regardless of which risk group(s) they treated, 35 (34%) reached the ≥75% PC coverage target for all children in 2016 (Figure 2). With the 2020 target quickly approaching, the failure to meet the coverage target in the majority of countries is obviously concerning. And while most countries (73%) conducted PC for at least one risk group in 2016, a marked 165 million (20%) children requiring PC live in countries not conducting any PC or in countries where their risk group did not receive PC.

Globally, PC coverage rates have increased substantially as have the number of children treated. The WHO strategy of focusing on countries with large numbers of at-risk children [3] has been a key contributing factor to increased coverage. However, achievement of the WHO coverage target by 2020 is uncertain given, among other factors, the lack of treatment of both risk groups in most countries. It would be difficult to argue that a country unable to cover both risk groups – which share similar levels of risk – implements effective STH control programming. Partners should prioritize technical and financial support toward those countries that have been consistently unable to treat PSAC and SAC. Quantifying the exact impact of inconsistent PSAC and SAC treatment across years is not possible, given available data, but it is reasonable to assume that inconsistent targeting undermines progress. Failure to treat both risk groups leaves a large reservoir of infection negatively impacting the entire community. Finally, missing the target will mean millions of at-risk children go unreached, undermining achievement of the WHO goal of eliminating moderate-to-high intensity infections in all children.

*Inclusion of information in STH by the Numbers does not constitute “publication” of that information.

[1]World Health Organization. PCT Databank

[2]Data source for number of countries requiring preventive chemotherapy by year: World Health Organization. Weekly Epidemiological Record

[3]Data source for preventive chemotherapy coverage: WHO PCT Databank. Accessed January 19, 2018 and available at http://www.who.int/neglected_diseases/preventive_chemotherapy/sth/en/

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Out Now: 2017 Advisory Committee Report

The STH Advisory Committee is an independent group of experts in the areas of policy, strategy, research, and program implementation related to soil-transmitted helminthiasis control. Individual STHAC members are specialists in child health, clinical medicine, diagnostic sciences, education, epidemiology, parasitology, public health program implementation, spatial statistics, and water, sanitation and hygiene.

As the technical and scientific arm of the STH Coalition, the STHAC holds an annual meeting to address current programmatic and technical issues relevant to the global campaign to control STH. While considering the latest research, the STHAC formulates guidance to the World Health Organization, STH Coalition partners, implementers, pharma, and researchers. The 2017 meeting participants included STHAC members and observers. Children Without Worms serves as the secretariat for the STHAC.

Read the Full Report

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