Getting ahead of the curve for the most neglected diseases: top issues at ASTMH

A guest blog by Oliver Yun, Medical Editor, Doctors Without Borders/Médecins Sans Frontières, New York

The 58th annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH) took place November 18-22 in Washington, DC. Each year, this conference brings together tropical medicine experts from all over the world to share and discuss data, policy, and future strategies to tackle a wide range of diseases primarily affecting the world’s poor.

Malaria always receives plenty of attention at ASTMH, and this year’s sessions and posters often focused on innovation and staying “ahead of the curve”. Themes included vaccine development; better rapid diagnostic tests (RDTs); improving drug regimens, including increased, intelligent use of artemisinin-combination therapy (ACTs); emergence of artemisinin resistance in southeast Asia, which was addressed in part through pharmacovigilance, looking at underdosing, and tracking resistance spread; and eradication, which entails the lofty goal of zero malaria transmission worldwide.

Besides malaria, other disease that were extensively discussed included the major “worm” diseases, flaviviruses, kinetoplastids, tick-borne diseases, and bacterial infections. For bacterial diseases, vaccination was a prominent theme. Methods of immunization and vaccination strategies for pneumonia, which is the number-one killer of children in the developing world, were discussed. For diarrheal diseases, late-breaking clinical trial results of a new rotavirus vaccine were presented.

This year’s meeting also looked more systemically at infectious disease in developing countries. Malnutrition and anemia were brought to the fore, separately and together, examining how infection contributes to both conditions and vice versa in resource-poor settings. The burdens of malnutrition and anemia coupled with infectious diseases were discussed, in the contexts of health outcomes, immune function, pregnancy, child development, and interventional strategies.

Considering diseases more collectively, the neglected tropical diseases (NTDs) as a whole was a predominant theme this year. With the meeting located in Washington, DC, it was natural and relevant to discuss the recently announced US Global Health Initiative (GHI), which will include a NTD component. Although still being defined, GHI’s NTD strategy currently includes 7 diseases but excludes other important diseases, including the “most neglected” of the neglected diseases namely sleeping sickness, Chagas disease, leishmaniasis, and Buruli ulcer. These four diseases are considered “tool-deficient” by the WHO and require more innovative and intensive solutions, as exemplified by talks at ASTMH including calculating drug needs and costs for visceral leishmaniasis in India and Africa, and novel vector control strategies and vaccine development potential for Chagas disease.

Broader-scope subjects and issues worth highlighting included drug development progress and partnerships by the Drugs for Neglected Diseases initiative (DNDi); the Affordable Medicines Facility – malaria (AMFm), which was recently launched by the Global Fund to Fight AIDS, Tuberculosis and Malaria to bring more ACTs to markets; increased support and capacity building for international health research and research ethics in developing countries; and control of communicable diseases in post-conflict settings.

Timely topics included a look at the global financial crisis and its effects on global health, and analyses of the impact of climate change on developing-country diseases and associated initiatives, including early-warning systems for specific diseases, tracking and mapping of disease dynamics, and health forecasting.

New and welcome this year at ASTMH were the society’s Global Health Sessions. These included special speakers on global health, including Harold Varmus, current co-chair of US President Barack Obama’s Council of Advisors on Science and Technology, former director of NIH, and co-founder of PLoS.

Of great practical use for junior researchers, non-English-speaking scientists, and developing-country researchers were educational sessions on manuscript writing, preparation, and submission, put on separately by two journals: the American Journal of Tropical Medicine and Hygiene, and PLoS Neglected Tropical Diseases.

For further information on specific meeting content, check out the “Education” page of the ASTMH meeting website.

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