VACCINE-PREVENTABLE: WHAT YOU CAN DO Tuesday, June 30, 2015 1PM - - PowerPoint PPT Presentation

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VACCINE-PREVENTABLE: WHAT YOU CAN DO Tuesday, June 30, 2015 1PM - - PowerPoint PPT Presentation

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MAKING NTDs VACCINE-PREVENTABLE: WHAT YOU CAN DO Tuesday, June 30, 2015 1PM 2PM (Central Time) www.immunizeUSA.org Housekeeping Items Slides from todays presentations will be uploaded onto our website www.immunizeUSA.org.

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www.immunizeUSA.org

MAKING NTDs VACCINE-PREVENTABLE: WHAT YOU CAN DO

Tuesday, June 30, 2015 1PM – 2PM (Central Time)

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www.immunizeUSA.org

Housekeeping Items

  • Slides from today’s presentations will be

uploaded onto our website www.immunizeUSA.org.

  • Questions can be typed into the

question box on the right-hand

  • f your screen.
  • Please take a moment to fill out the

post-webinar survey.

  • If for some reason you have to step away

from the computer or phone, please do not place your phone on hold.

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www.immunizeUSA.org

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www.immunizeUSA.org

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www.immunizeUSA.org

Stakeholder Engagement

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www.immunizeUSA.org

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www.immunizeUSA.org

Peter J. Hotez, MD, PhD

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Peter Hotez MD PhD

@PeterHotez

Tropical Infectious Disease Threats to Texas

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“Other Diseases”

The Neglected Tropical Diseases

NTDs: The most common afflictions of the “bottom billion”

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Expected number of cases in 2010 and 95% confidence intervals of the neglected tropical diseases (mean and uncertainty) as extrapolated from the Global Burden of Disease Study 2010.

  • Ascariasis

819 million Total number of cases

  • Trichuriasis

465 million Total number of cases

  • Hookworm Disease

439 million Total number of cases

  • Dengue

390 million Apparent + inapparent cases

  • Schistosomiasis

252 million Total number of cases

  • Lymphatic Filariasis

36 million* Lymphedema and/or hydrocele

  • Onchocerciasis

30 million Total number of cases (adult worm)

  • Food-borne Trematodiases

16 million* Heavy and cerebral infections

  • CutaneousLeishmaniasis

10 million Total number of cases

  • Chagas disease

7.5 million Symptomatic cases

  • Trachoma

4.4 million* Low vision and blindness cases

  • Cysticercosis

1.4 million* Epilepsy cases only

  • Echinococcosis

1.1 million* Symptomatic liver, lung, CNS cases

  • Visceral leishmaniasis

76,000 Total number of cases

  • African Trypanosomiasis

37,000* Symptomatic cases

  • Rabies

1,100 Incident cases

  • Yellow Fever

100 Incident cases

  • Yaws

ND

  • Buruli ulcer

ND

  • Ebola

ND

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Comparison of worm index vs. HDI

Hotez PJ, Herricks JR (2015) Helminth Elimination in the Pursuit of Sustainable Development Goals: A "Worm Index" for Human Development. PLoS Negl Trop Dis 9(4): e0003618. doi:10.1371/journal.pntd.0003618 http://127.0.0.1:8081/plosntds/article?id=info:doi/10.1371/journal.pntd.0003618

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Looking beyond Africa: The Large Middle Income Countries in Asia and the Americas

Where do the NTDs occur?

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Blue Marble Health: The poor living among the wealthy.

Hotez PJ (2013) NTDs V.2.0: “Blue Marble Health”—Neglected Tropical Disease Control and Elimination in a Shifting Health Policy Landscape. PLoS Negl Trop Dis 7(11): e2570. doi:10.1371/journal.pntd.0002570 http://www.plosntd.org/article/info:doi/10.1371/journal.pntd.0002570

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Poverty in the United States

Hotez PJ (2012) Engaging a Rising China through Neglected Tropical Diseases. PLoS Negl Trop Dis 6(11): e1599. doi:10.1371/journal.pntd.0001599 http://www.plosntd.org/article/info:doi/10.1371/journal.pntd.0001599

46 million Americans living poverty 20 million in extreme poverty 4-5 million on less <$2 per day

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The Other America (1962)

To be sure, the other America is not impoverished in the same sense as those poor nations where millions cling to hunger as a defense against starvation. This country has escaped such

  • extremes. That does not change the fact that tens of millions of

Americans are, at this very moment, maimed in body and spirit, existing at levels beneath those necessary for human decency…They are without adequate housing and education and medical care.

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Hotez PJ. Neglected infections of poverty in the United States of

  • America. PLoS Neglected Tropical Diseases 2008; 2: e56
  • Online database PubMed
  • 1972-2007 (25 years)
  • MSHs: Neglected diseases, poverty,

specific geographic regions, racial, ethnic, and socioeconomic groups

  • NTDs on the PLoS NTDs journal scope

website page

  • Reference lists of identified articles
  • Hand-searched copies
  • Prevalence rates among selected

communities multiplied by published estimates

  • f at risk populations (in some cases the

populations of one of the 8 Americas)

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Parasitic Infections

  • Chagas disease
  • Cysticercosis
  • Toxocariasis
  • Trichomoniasis

Arbovirus Infections

  • Chikungunya
  • Dengue Fever

Neglected Infections of Poverty: “The NTDs” in the Southern United States

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  • Dr. Carlos Chagas
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Chagas Disease and Chagasic Cardiomyopathy

  • Chronic Chagas Disease

– Cardiomyopathy (Chamber enlargement)

  • 10-30% patients years

after infection

  • Left Ventricular

Aneurysm

  • Conduction defects

– Megacolon and Megaesophagous

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Maternal-to-Child-Transmission

  • Maternal Chagas Disease

– 40,000 pregnant women in North America – 5% vertical transmission – Rx contraindicated

  • Congenital Chagas Disease

– 1st documented US case (2010) – 10-40% symptomatic – LBW/Low APGAR Scores – Hepatosplenomegaly – Cardiac failure – Respiratory distress – Meningoencephalitis – Neonatal death

Diagnosis of Congenital Chagas

  • Giemsa stain of blood
  • PCR
  • Repeat testing 4-6 weeks
  • Maternal antibodies wane after

9-12 months Rx >90% effective

  • Benznidazole/Nifurtimox
  • Not FDA approved
  • Available through CDC protocols
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Chagas Disease: The Costs

  • Economic Costs
  • Lost worker productivity
  • Healthcare costs

– $7.2 billion globally – $864 million USA – About one-half in Texas?

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Chagas Transmission in the U.S. Risk Factors

  • Triatomines in U.S.

‐ 26 states ‐ Generally sylvatic ‐ Triatoma sanguisuga (6% T. cruzi infection rate) ‐ T. protracta (20% T. cruzi infection rate) ‐ T. leticularia

  • Increased domesticity
  • Zoonotic transmission from dogs (8%)
  • Limited Physician Awareness
  • Risk highest in lower latitudes in southern portion

‐ Transmission 64-100oF ‐ Higher risk range upon 1.8oF increase in temp by 2030

Lambert et al Geospatial Health 2008

Sarkar: Univ Texas Austin

  • Dr. Sahotra Sarkar, University of Texas at Austin
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Autochthonous Chagas Disease in Texas

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“A scientist who is also a human being cannot rest while knowledge which might reduce suffering rests on the shelf.” –Dr. Albert B. Sabin

Sabin Vaccine Institute & Texas Children’s Hospital Center for Vaccine Development

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Sabin PDP Pipeline and Disease Portfolio

  • Built

structure

  • Launched

Hookworm Program

2000 to 2004

  • Expanded

Hookworm Program

  • Schisto

Program

  • Relocated to

TMC

2004 to 2011

  • Added 7

additional programs

  • Expansion of

capabilities

2011 to 2015

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Chagas Disease Vaccine

  • Bivalent recombinant

protein

– Tc24 – TSA-1 – Additional antigens – E6020/GLA-SE

  • Status

– Preclinical testing in Houston and Mexico – Supported by SWEEMRI, Carlos Slim Health Institute, TCH

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Conduction deficits detected in 20% of animals by 70 days of infection

Altered Heart Rate Ectopic activity Atrial flutter

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Severe heart failure seen in ~20% of animals by 180 DPI

Uninfected mouse Chronically infected mouse

  • Mobitz Type 2 conduction block
  • Severe Heart Failure
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Toxocariasis (Toxocara canis)

  • Canine zoonosis
  • Larval helminth infection

‐Visceral larval migrans ‐Ocular larval migrans ‐Covert toxocariasis

  • Rise of Asthma?
  • Developmental delays?
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Toxocariasis and Developmental Delays

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  • Leading cause of epilepsy among Hispanic Americans
  • (41,400-169,000 cases) based on 1.8% seroprevalence
  • Ventura County, CA and 9.4 million HAs living in poverty
  • 10% of seizures presenting to ED in Los Angeles

Cysticercosis (Taenia solium)

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The Global Dengue Pandemic

  • 390 million dengue

infections annually

– Bhatt et al 2013 Nature – India 132 million – Indonesia 31 million – China 26 million – Brazil 22 million – Bangladesh 16 million – Pakistan 14 million – Middle East: Egypt, Saudi Arabia, Syria, Yemen

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Dengue and Bollywood

Yash Chopra Priyanka Chopra Ranveer Singh

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Dengue/Chik Mosquito Vectors

  • Ae. aegypti
  • Ae. albopictus
  • Yellow Fever Mosquito
  • Best Dengue Mosquito
  • Prefers humans
  • House dwelling
  • Primary vector
  • Asian Tiger Mosquito
  • Nonspecific preference
  • Invasive species
  • Vector in 2001 Hawaii

Outbreak

Aleisha Elliott UTSPH

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U.S. Distribution – Ae. aegypti

Source: Exotic and Invasive Vectors Database 2010

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U.S. Distribution – Ae. albopictus

Source: Exotic and Invasive Vectors Database 2010

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Symptoms

  • Influenza-like symptoms, retro-orbital pain,

severe joint and muscle pain, thrombocytopenia.

  • Dengue Hemorrhagic Fever (DHF)

Dengue Shock Syndrome (DSS)

  • capillary leakage
  • severe bleeding
  • organ failure and death
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Dengue in U.S.

Endemic prior to 1940’s Generally travel- associated cases Texas- Mexico Border 7 outbreaks since 1980 Hawaii 2001 Ae. albopict us Houston 2003- 2005? Florida 2009 - 2010

Vector eradication efforts mid- 1940’s Vector eradication “successful” Efforts stopped 1972

  • Ae. Albopictus

documented 1987 Aleisha Elliott UTSPH

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Kristy Murray DVM PhD BCM Aleisha Elliott MPH UTSPH Emergence of Dengue Fever in Houston

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The National School of Tropical Medicine at Baylor College of Medicine

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www.immunizeUSA.org

Rekha Lakshmanan, MHA The Immunization Partnership

NTDs and You.. Next Steps

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www.immunizeUSA.org

  • Bring AWARENESS to yourself and your peers
  • 4 things you can do:

– START the conversation

  • Have a message- why are NTDs important and why they need to be vaccine

preventable

– EDUCATE yourself and your peers

  • Seek out information. Inform yourselves

– SHARE information

  • Facebook, twitter, blog posts
  • Organizations consider providing literature and information on how to diagnose

and treat

  • Professional associations and coalitions can have NTD outreach project

What can we do?

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www.immunizeUSA.org

– TAKE ACTION

  • Community based activities

– Health fairs – Provider education meetings – Promote with other programs

  • Organization activities

– Quality metrics – Training programs – Grand Rounds focus

  • Policy activities

– Advocate for legislation

» E.g.., surveillance

What can we do?

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www.immunizeUSA.org

Resources- Where to go?

  • Websites:

– Sabin Institute- http://www.sabin.org/programs/vaccine- development – Rice University’s Baker institute- http://bakerinstitute.org/ – CDC- http://www.cdc.gov/globalhealth/ntd/ – HealthMap – http://www.healthmap.org – PLOS (Public Library of Science) NTDs- http://journals.plos.org/plosntds/ – United to Combat NTDs- http://unitingtocombatntds.org/why-ntds

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www.immunizeUSA.org

Resources- Where to go?

  • Twitter:

– Gates Health @gateshealth – Children Without Worms @CWWDirector – Drugs for Neglected Diseases initiative @DNDi – PLOS NTDs @PLOSNTDs – London School of Hygiene & Tropical Medicine Press Office @LSHTMpress – Liverpool School of Tropical Medicine @LSTMnews – The Carter Center @CarterCenter – FHI 360 @fhi360 – Schistosomiasis Control Initiative @sci_ntds

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www.immunizeUSA.org

Rekha Lakshmanan, MHA rlakshmanan@immunizeusa.org

Thank you!

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www.immunizeUSA.org

Q&A with Speakers

  • Questions can be typed into

the question box on the right-hand of your screen.

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www.immunizeUSA.org

Thank you!