Date Published: June 25, 2008
Publisher: Public Library of Science
Author(s): Diana Boraschi, Markos Abebe Alemayehu, Abraham Aseffa, Francesca Chiodi, John Chisi, Gianfranco Del Prete, T. Mark Doherty, Ibrahim Elhassan, Howard Engers, Ben Gyan, Ali M. Harandi, Thomas Kariuki, Fred Kironde, Bourema Kouriba, Jean Langhorne, Tamás Laskay, Donata Medaglini, Ole Olesen, Philip Onyebujoh, Carla Palma, Robert Sauerwein, Elopy Sibanda, Ulrich Steinhoff, Aldo Tagliabue, Andreas Thiel, Mahnaz Vahedi, Marita Troye-Blomberg, Sara Lustigman
Abstract: Author SummaryInfectious diseases remain a major health and socioeconomic problem in many low-income countries, particularly in sub-Saharan Africa. For many years, the three most devastating diseases, HIV/AIDS, malaria, and tuberculosis (TB) have received most of the world’s attention. However, in rural and impoverished urban areas, a number of infectious diseases remain neglected and cause massive suffering. It has been calculated that a group of 13 neglected infectious diseases affects over one billion people, corresponding to a sixth of the world’s population. These diseases include infections with different types of worms and parasites, cholera, and sleeping sickness, and can cause significant mortality and severe disabilities in low-income countries. For most of these diseases, vaccines are either not available, poorly effective, or too expensive. Moreover, these neglected diseases often occur in individuals who are also affected by HIV/AIDS, malaria, or TB, making the problem even more serious and indicating that co-infections are the rule rather than the exception in many geographical areas. To address the importance of combating co-infections, scientists from 14 different countries in Africa and Europe met in Addis Ababa, Ethiopia, on September 9–11, 2007. The message coming from these scientists is that the only possibility for winning the fight against infections in low-income countries is by studying, in the most global way possible, the complex interaction between different infections and conditions of malnourishment. The new scientific and technical tools of the post-genomic era can allow us to reach this goal. However, a concomitant effort in improving education and social conditions will be needed to make the scientific findings effective.
Partial Text: Infectious diseases remain a major health and socioeconomic problem in many low-income countries, particularly in sub-Saharan Africa. Most of the public attention has so far been devoted to the three most devastating diseases, HIV/AIDS, malaria, and tuberculosis (TB). However, in rural and impoverished urban areas of low-income countries, a number of neglected infectious diseases (NIDs) cause massive suffering, although they receive little or no scientific or mass-media attention . By considering all NIDs together, it is obvious that they threaten the health of the poorest to a similar extent as the three major killers –. It has been calculated that a group of 13 NIDs, including Buruli ulcer (Mycobacterium ulcerae), cholera (Vibrio cholerae), cysticercosis, dracunculiasis (Guinea worm), trematodal infections, hydatidosis, leishmaniasis, lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), schistosomiasis, helminthiasis, trachoma (Chlamidia trachomatis), and trypanosomiasis (African sleeping sickness, Chagas disease), affect over one billion people (corresponding to a sixth of the world’s population) . For most of these diseases, vaccines are either unavailable, ineffective, or too expensive. Moreover, NIDs often occur in individuals that are also affected by HIV/AIDS, malaria, or TB, indicating that co-infections are the rule rather than the exception in many geographical areas –. In order to develop effective vaccination and treatment strategies, it is essential to understand how protective immunity to a pathogen can be achieved in individuals co-infected with multiple pathogens.
It is of key importance to focus future research on a detailed understanding of the mechanisms of immunity to pathogens during co-infections between HIV/AIDS, malaria, and TB, and NIDs. This information will be highly relevant for the development of new preventive and therapeutic interventions for use in impoverished areas of disease-endemic countries. Indeed, multiple infections, nutritional status, and level of exposure to microbial/parasitic compounds can alter the reactivity of the immune system in such a way that vaccines may need new/novel formulations. Research priorities should focus on immunological studies in humans, preceded and supported by experimentation on suitable animal models, and should include the following key areas.
Additional research is necessary to understand the mechanisms of immune protection and memory during co-infection with HIV/AIDS, malaria, TB, and NIDs. The AFRIEND consensus meeting identified seven key areas with research gaps, where more attention is needed: