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Malaria

Malaria is a life–threatening parasitic disease that is transmitted by mosquitoes. There are four types of human malaria: Plasmodium vivax, P. malariae, P. ovale and P. falciparum. Symptoms usually appear 9–14 days following a bite from an infected mosquito, although this time period varies depending on the species. Often, malaria produces headaches, fever, vomiting and other flu–like symptoms. Malaria kills by destroying red blood cells, causing anemia, and by blocking blood vessels to the brain or other vital organs.

Photo by USP Staff

An estimated 300 million cases of malaria occur each year, and more than one million people die from the disease. During the mid–twentieth century, malaria was virtually eradicated in temperate climates, but it continues to plague many of the tropical and sub–tropical regions of the world. Today, approximately 40% of the world's population is at risk for contracting malaria.

In some areas of the developing world, antimalarial drugs are not available for treatment or those available are not of good quality. The parasites can also become resistant to medicines, rendering available drugs ineffective. In each of these instances, the infection can become life–threatening. Effective, low–cost strategies are available to treat malaria, including insecticide–treated bed nets. Also, chloroquine and sulfadoxine–pyrimethamine, among others, remain reliable medicines, while combination drug therapies, like artemisinin–based combination therapies (ACTs), are helping to improve treatment efficacy and help contain drug resistance.

Credit: Roll Back Malaria, World Health Organization

Tuberculosis

Tuberculosis (TB) is an airborne infection caused by the bacterium Mycobacterium tuberculosis that primarily attacks the lungs. Symptoms associated with TB include night sweats, unexplained weight loss, loss of appetite, fever, chills, lethargy, and prolonged coughing, sometimes including coughing up blood.

Because TB spreads like the common cold, each person infected with TB will infect 10–15 more people each year. Approximately 8.9 million new TB infections occurred globally in 2004; however, people infected with TB bacilli will not necessarily become sick with the disease. The immune system protects the body from the bacilli, and the disease can lie dormant for years. If the immune system is weakened, the chance of becoming ill increases. An estimated 1.7 million people died as a result of TB in 2004.

© Ash Clements @ Ash Clements, Courtesy of Photoshare

Most TB can be cured, but the administration of improper treatment regimens by healthcare workers and the failure to ensure that patients complete the whole course of treatment has led to increasing drug resistance. Introduced by the World Health Organization (WHO) in 1995, the Directly Observed Treatment Short–course (DOTS) strategy combines appropriate diagnosis of TB and registration of each patient. DOTS follows with a standardized multi–drug treatment, using a secure supply of high quality anti–TB drugs, individual patient outcome evaluation to ensure cure, and cohort evaluation to monitor overall program performance. In 2004, 183 countries (including all 22 of the high–burden countries that account for 80% of the world's TB cases) were implementing DOTS in at least part of the country.

Credit: World Health Organization, American Lung Association, TB Alert

Multidrug–Resistant Tuberculosis and Extensively Drug–Resistant Tuberculosis

Multidrug–resistant Tuberculosis (MDR–TB) is a form of TB that has become resistant to two or more of the primary drugs used to treat TB, such as isoniazid and rifampicin. MDR–TB occurs as a result of inadequate treatment practices, unreliable drug supply, or improper use of anti–TB medications. While MDR–TB is treatable, the treatment regimen requires up to two years of drug therapy and is often more than 100 times more expensive to treat than strains of drug–susceptible TB. Furthermore, the cure rate decreases from over 90% for non–resistant strains to 50% for MDR–TB. When MDR–TB becomes resistant to virtually all first– and second–line drugs, it is known as Extensively Drug–resistant TB (XDR–TB). Treatment options for XDR–TB are even more limited.

In 2006, WHO launched the Stop TB Strategy to reduce the incidence, prevalence and death rate trends of TB in all regions through a partnership of planned TB control activities. In addition to the Directly Observed Treatment, Short–course (DOTS) introduced by WHO in 1995, the Stop TB Strategy addresses the specific challenges of MDR–TB, XDR–TB and HIV/TB. One component is to contribute to health system strengthening; in response, USAID is actively expanding efforts to improve system–wide policy, human resources, financing, and management.

USP DQI is assisting the Global Drug Facility (GDF) in its efforts to increase the availability of good quality second–line anti–tuberculosis (TB) medicines at an affordable price. To expedite the process of prequalification with the World Health Organization (WHO)–thereby expanding the pool of viable manufacturers–USP DQI will provide technical assistance to interested companies on the drug dossiers they submit to WHO with their "Expressions of Interest". More Information

HIV/AIDS

© 2004 Courtney Crosson, Courtesy of Photoshare

HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). This virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person's broken skin or mucous membranes. In addition, an infected pregnant woman can pass HIV on to her baby during pregnancy or delivery, as well as through breast–feeding. Some people will develop AIDS as a result of their HIV infection. AIDS is characterized by the weakening of the immune system and development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person's immune system.

AIDS has killed more than 25 million people since its discovery in 1981, making it one of the most destructive epidemics in recorded history. The number of people receiving antiretroviral therapy in low– and middle–income countries has tripled since 2001; yet in 2005, only 10% of Africans and 15% of Asians in need of retroviral therapy were receiving medicine. More than three million people died as a result of AIDS in 2005.

There is growing awareness that HIV prevention efforts must be scaled up and intensified. In order for prevention efforts to get ahead of the epidemic, long–term strategies must be implemented, which include linking HIV prevention with treatment programs, funding research for vaccine development, increasing access to quality antiretroviral drugs, and reducing the social stigma that often accompanies the infection.

Credit: Centers for Disease Control and Prevention, World Health Organization

HIV/TB

© 2006 John Horan, Courtesy of Photoshare

HIV/AIDS and TB are so closely connected that the term "co–epidemic" or "dual epidemic" is often used to describe their relationship. An estimated one–third of the 40 million people living with HIV/AIDS worldwide are also infected with TB. People with HIV are up to 50 times more likely to develop TB in a given year than HIV–negative people. Furthermore, without proper treatment, approximately 90% of those living with HIV die within months of contracting TB.

In order to control TB in HIV–settings, the Directly Observed Treatment, Short–course (DOTS) strategy should be implemented, along with collaborative efforts between those fighting against TB and HIV. HIV–positive people can easily be screened for TB. If infected, prophylactic treatment can be administered to prevent development of the disease; and, if already infected, patients can have an appropriate treatment regimen assigned. Likewise, TB patients can be offered an HIV test. Research shows that TB patients are more likely to accept HIV testing than the general population, meaning that TB programs can have a significant impact by identifying eligible candidates for antiretroviral treatment.

Credit: World Health Organization

Maternal and Child Health

Almost 600,000 women die each year—90% of them in developing countries—from complications due to the natural process of pregnancy and childbirth. More than 10 million children never reach the age of five, many ravaged by diseases that, given accessibility to proper medicines, could be prevented. USP DQI joins other international organizations in addressing the health needs of these special populations. Read more.

Credit: World Health Organization and Prevention of Postpartum Hemorrhage Initiative (POPPHI)

Antimicrobial Resistance

Antimicrobial drug resistance (AMR) has emerged as a major public health issue in recent years. Initially, the problem of AMR was solved by the discovery of new classes of drugs and by modifying existing drugs; unfortunately, the development of new antimicrobial drugs cannot keep pace with the ability of microorganisms to develop resistance. Read more.

Avian Influenza

Since its emergence in Southeast Asia in mid–2003, avian influenza (AI) has spread across Asia, into some countries in Europe and Eurasia, and to Africa. Due to the rapid spread of the virus, there is increasing concern that it could potentially develop into a global human pandemic. The United States Agency for International Development (USAID) and its partners find the greatest concern in South East Asia. Read more.