These neglected tropical diseases range from a variety of worms, roundworms, whipworms, and hookworms known as geohelminths. On to diseases such as lymphatic filariasis, a parasite that is spread via mosquitoes, which when the mosquito bites the human being and transmits it, the parasites nest and multiply in the lymphatic system, causing a lot of disfigurement and swelling. Some of you actually may have seen this depending on where you live. Two conditions such as schistosomiasis, it's a condition in which a fluke which lives in the water, infects snails that goes to part of this maturation process in snails. Human beings get in the water, the flukes leave the snails, penetrate the human via the skin then move on into the intestines and the urinary track. Long-term can cause a variety of blood vessel and organ damage, cancer of the bladder. We actually even know that because it can cause genital lesions that can increase the risk of HIV as well. Schistosomiasis is quite common in many parts of the world. I don't need to go through all three, through all of these because you can study them yourself. But I do think you should be aware of these neglected tropical diseases so that you don't neglect them in your study of global health. There are many keys to success to prevent neglected tropical diseases. Improving sanitation, hygiene, education, finding ways to control both the vector and the agent. We also can use MDA or Mass Drug Administration strategies. In fact, there is what we call a rapid impact package of medicines that can actually treat the top seven neglected tropical diseases in schools and communities. It's very common, even in places where I work on the kids who are frequently dewormed. Also for other neglected tropical diseases such as trachoma, which was in the last slide. Type of chlamydia that's transmitted via flies or fingers frequently into the eyes, causing inflammation, irritation can eventually cause blindness. Strategies such as SAFE have been devised, using surgery when necessary to correct any structural problems that the trachoma is called using antibiotics to treat the infection, and practicing face washing and in modifying the environment to reduce the risk of infection. These are all important ways to prevent these NTD. So please study those slides to learn a little more. Finally, the stealth bombs. I've talked about infectious disease, we talked about the fact that how things like tuberculosis can become drug resistance. Well, in fact, not only can there be a rise in drug resistance, but we can find that old infectious diseases that seem to have become latent can reemerge and that new diseases can emerge. So here we have re-emerging infectious diseases and the rise of drug resistance. I call these the bombs because they can have an impact and a rapid one. If one just thinks about cholera in Haiti after the earthquake, the H1N1 in the world, or the 2014 Ebola outbreak in West Africa becomes very easy for one to understand how quickly these issues can become the bombs. Many reasons for this, microbes adapt, they change. We humans are susceptible to many infectious diseases. Ecosystems change, populations change, there are economic, and political changes, there's poverty and inequality in world. Antibiotics may be used or drugs may be used inappropriately or not given sufficiently, allowing mutation to take place. Wars and other crises can create situations in which diseases can be transmitted. We do not have enough drug development, access to distribution for meeting infectious diseases, and with modern travel and international commerce, increasingly diseases know no borders. So these re-emerging infectious diseases, in particular, can be new or old friends, as I said, that can resurface and perhaps even be more virulent. Take the case of dengue fever, for example, an infectious disease that is transmitted by mosquitoes, affect so between 50 and 100 million people annually, until 1981, it had not been in Latin America in quite a while, and now it's throughout Latin America, and now recently is in the Southern United States. Even with something like the flu, we know that every year the flu viruses mutate. Sometimes they just go through minor changes, which is called drifts, sometimes major changes called shifts. But whether shift or drift the flu because it changes can have differing impacts various years, new ones all the time. We're still worried about H5N1 avian flu. Newer strains that are just emerging H7N9, actually worry me a little bit more. New ones are coming out all the time. Think about MERS, Middle Eastern Respiratory virus. Bats are likely the origins, camels likely intermediate hosts. We don't know for certain but I am pleased to say that photograph of me with a camel was taken a couple of years before we knew about MERS, before it emerged. That camel liked me by the way and normally camels hate me I don't know why. Anyway, we had a bond we can just say that. These new pathogens are identified annually. In fact, most new infectious diseases that emerge are originate in animals. We call them zoonoses. That's why it's so important when we're thinking about global health, we don't just think about the health of humans, but we think about environmental health and animal health as well. Hence a new initiative called One Health, where people who specialize in human, animal, and environmental medicine all work together. Now the drug resistance of the stealth bombs. Well, like anything else with genes, viruses have genetic changes as do bacteria and parasites. They can become resistant to current medications. Now, these changes can result from natural mutations or as I said earlier, from an inappropriate or improper use of medications or from both. Many problems arise because of this. This is why there are many many strains of multiple drug resistant tuberculosis that require more extended and actually more costly treatment with more side effects. Recently, cases of extremely drug resistant tuberculosis have been found and at least one case of totally drug-resistant tuberculosis. We know now that many malaria drugs no longer work in particular regions. Artemisinin, which is our new drug of choice, that we use quite a lot is now showing some signs of resistance and non-adherence to HIV regimens or to ARVs, whether it's through conscious means or just not having the resources or the access to take them, has created new HIV resistant viral strains that we're calling superbugs. In terms of the growth of anti-viral, anti-bacterial drug resistance, the Center for Disease Control in the United States has called the situation alarming. How do we diffuse these bombs? Well, there are many ways. Political financial support, addressing the underlying social determinants, thinking about the impacts of interventions and political actions, developing and distributing affordable vaccines. I've prepared a list here that I want you to study but a lot of this based on knowledge, support, people working together, countries working together, organizations working together because infectious diseases know no boundaries and the impact and the consequences are significant. Give you three examples before we close. After 2010 earthquake in Haiti, cholera arrived, we talked about cholera before, with the UN. At least one Nepalese peace-keeper had the virus, and through faulty sewage it got into the water supply at a UN camp and spread into the river, which is the drinking source and the source of water. There have now been over 600,000 cases of cholera in Haiti and 8,000 deaths. Cholera had not been known in Haiti since the 19th Century. Polio, we know that we're still having difficulty eliminating polio in Pakistan. Well, there are some reasons for that. Political conflict, rumors over that the side effects of the polio vaccine would cause infertility and that's been targeted Muslims by Christians, ethnic and religious strife, and as happened in Pakistan, the use of healthcare providers to provide military intelligence have caused a decrease in trust and disrupted our attempt to eradicate polio globally. This issue goes back much much longer than recent history. For example, we actually know that one of the ways that HIV spread was accelerated in Sub-Saharan Africa was the reuse of syringes in the early days of trying to provide vaccinations for other diseases. The unholy trinity, the plebeians, and the stealth bombs, all playing a major role in the infectious disease burden in global health.
