NewsBites: Spotlight on CDC's Parasitic Disease Work

www.cdc.gov/parasites 4th Quarter 2014 What's Inside: Program Updates Malaria Parasites in the U.S. Neglected Tropical Diseases Laboratory Research and Capacity Building Publication Highlights Staff Updates Featured Parasite:Strongyloides Strongyloidiasis is a parasitic disease caused by nematodes, or roundworms, in the genusStrongyloides that can cause upset stomach, diarrhea, loss of appetite, dry cough, throat irritation, and a red rash. Infection can lead to severe and life-threatening disease in individuals whose immune response is impaired. These parasites enter the body through exposed skin, such as bare feet, and are most common in tropical or subtropical climates. There are over 40 species, but only Strongyloides stercoralis commonly infects humans. It is estimated that between 30 and 100 million people worldwide are infected. Upcoming Events World Malaria Day April 25, 2015: Check our website and @CDCGlobal onFacebook and Twitter for featured highlights In Case You Missed It DPDM announced an Funding Opportunity Announcement on reducing the burden of neglected parasitic infections in the United States through evidence-based prevention and control activities. Proposals are due March 13, 2015. The launch of the PMI Strategy 2015-2020 was held in Washington, D.C. on February 25, 2015 On February 25, 2015 the CDC Foundation (CDCF)announced that it has received an initial grant of $29.9 million from the Bill & Melinda Gates Foundation to bring together a consortium of partners, led by DPDM, to eliminate indigenous cases of malaria on the island of Hispaniola by 2020. Learn more:  Read the CDCF Blog by Charles Stokes, President and CEO of CDCF  Read the Blogby Dr. Alan Magill of the Bill & Melinda Gates Foundation Follow the conversation on Twitter at@CDCGlobaland@CDCFound Follow the conversation on Facebook atCDC Globaland CDC Foundation Have a comment you'd like to share? Send an email to DPDM. Welcome to NewsBites A quarterly e-update designed to inform you about CDC's efforts to protect the public from parasitic diseases. Interested in a program update? Use the links to the left under 'What's Inside' to navigate to the full story or scroll below.   Program Updates Dr. Laurence Slutsker, Director, Division of Parasitic Diseases and Malaria (DPDM) Dear Colleagues, The start of 2015 continues to be an exciting time for parasitic diseases. Several neglected tropical diseases (NTDs) are slated for elimination within the next five years, and momentum is increasing towards malaria elimination efforts.  Substantial progress has also occurred on the elimination of lymphatic filariasis (LF) in Haiti, with all 140 communes having received at least three years of annual mass drug administration (MDA); sentinel sites show a 90% decrease in the number of infections between 2000 and 2014. We have also seen massive reductions (> 99.99%) in the burden of Guinea worm disease, with only 126 cases reported globally in 2014 from the four remaining endemic countries. Further, after more than a decade of sustained commitment, the U.S President’s Malaria Initiative (PMI) and global partners have achieved a massive impact on child survival and driven malaria transmission to very low levels in some focus countries. Malaria elimination efforts are focused on key strategic regions. At CDC we are excited to be part of a new collaborative effort, with initial funding from the Bill & Melinda Gates Foundation, to eliminate malaria from Hispaniola. The goal is to create a malaria-free zone across the Caribbean within the next five years, providing an improved environment for local economic development. We also will support a global effort to eliminate malaria from the Greater Mekong Subregion in Southeast Asia, as this is the most effective way to address the threat of artemisinin drug resistance. In addition, we’ll continue to co-implement PMI under a new six-year strategy, with a goal of helping at least five focus countries transition to the pre-elimination phase by 2020.  CDC continues to advance the science to support countries in elimination efforts, by developing innovative new epidemiologic and diagnostic methods, like incorporation of soil-transmitted helminth diagnosis and treatment into the Transmission Assessment Survey for LF, and development of the OV 16 ELISA test for onchocerciasis, which will help detect transmission at low levels. We also continue totest and evaluate new interventions, like promising new malaria vaccines, to add to the mix of available tools to drive down rates of disease.   Continued scale-up of current efforts and addressing key knowledge gaps will be critical to achieve elimination of these serious and sometimes deadly parasitic disease threats. You can continue to read more about these and other key priority activities in this and future editions of NewsBites. Sincerely, Larry Malaria You won't find what you're not looking for Indoor residual spraying (IRS) works! Predicting the future of malaria prevention and control Neglected Tropical Diseases No room for error African ministries of health pledge continued support to control and eliminate NTDs Parasites in the U.S. An ounce of prevention: Lessons for transplants and transfusions  The 4-1-1 on malaria in the United States  Laboratory Research and Capacity Building How long will insecticide last? Protecting our troops Malaria You won't find what you're not looking for Surveillance systems are key to documenting the success of a program and being able to allocate resources where they are most needed. PMI Uganda and in-country partners recently evaluated their national malaria surveillance systems at a few selected health facilities in Gulu and Jinja districts. The evaluation included interviews with key stakeholders at the national, district, and facility levels to determine the usefulness of the surveillance system and data utilization; patient and data flow observations; case management evaluation, including an evaluation and observation of clinical, lab, and pharmacy practices. The evaluation findings were shared with PMI and the Ugandan National Malaria Control Program inform an upcoming operations research project to assess the feasibility of using the “quality improvement collaborative (IC) methodology” to improve malaria data and the quality of reporting. Indoor residual spraying (IRS) works! Anemia and parasitemia (AP) prevalence surveys can be used to assess the impact of indoor residual spraying (IRS). In Ghana, repeated cross-sectional surveys of children under five years old have been conducted since 2010. With these surveys, the national malaria control program was able to assess the impact of two different IRS schedules (one round vs. two rounds per year), as well as the impact of an insecticide change from pyrethroids to organophosphates. Results from the surveys indicated that parasitemia prevalence significantly decreased in 2013 compared to 2012 after switching to organophosphates,similar results were observed for anemia prevalence. The 2014 AP survey recorded similar findings to the 2013 survey. Evidence shows that IRS has had a significant impact on malaria in the Bunkpurugu Yunyoo District, and is recommended to be continued in 2015. Predicting the future of malaria prevention and control What happens when you bring together top thought leaders in global malaria efforts and ask them about the future? That is exactly what the Center for Strategic & International Studies did at their all-day conference “A strategic approach to malaria,” where several DPDM scientists joined other experts to discuss the long-term goal of elimination, drug and insecticide resistance, future technologies, and financing. DPDM contributed to two papers CSIS released in conjunction with the event, US Department of Defense contributions to malaria elimination in the era of artemisinin resistance and  Insecticide resistance and malaria: a threat decades in the making. If you missed it, don’t worry, webcasts of the sessions are still available to watch. Parasites in the U.S. An ounce of prevention: Lessons for transplants and transfusions Organ transplants can save lives but there are not enough donated organs for all the patients in need. Although parasitic infections are relatively uncommon in organ donors, when they occur they can be serious or fatal. DPDM is working with transplant community partners to develop the best approaches to screen for parasitic diseases in organ donors and manage the recipients of organs from donors who test positive. In some cases, this means life-saving organs that would otherwise be discarded can be successfully transplanted into critically ill patients. An example of DPDM’s work is a recent study that summarizes investigations of recipients of organs from donors who tested positive for Strongyloides infection. Screening donors at the time of organ collection means that recipients can be prophylactically treated; none of the recipients developed donor-derived Strongyloides infection. In some cases, the donor’s infection was only identified after the recipient was diagnosed with severe strongyloidiasis, weeks after transplant. The study, published in the American Journal of Transplantation, provides further evidence that adoption of the current American Society of Transplantation’s recommendations by all organ procurement organizations and transplant centers may prevent the morbidity and mortality associated with Strongyloides in solid organ transplant recipients. The 4-1-1 on malaria in the United States DPDM published Malaria Surveillance—United States, 2012 in CDC’sMorbidity and Mortality Weekly Report. Highlights from the summary include 1,687 malaria cases reported in the United States in 2012, a 12% decrease from the 1,925 cases reported in 2011. In addition, for the first time, DPDM is using advanced molecular detection methods on blood samples from cases of malaria diagnosed in the United States in order to detect emerging drug resistance in malaria endemic countries. Nearly all of U.S. malaria cases are still acquired overseas; most travelers who contract malaria either did not take an antimalarial drug for prevention or did not take an appropriate drug or dose. Neglected Tropical Diseases No room for error DPDM is conducting a study to evaluate new diagnostic tests and provide recommendations about the best test to use in onchocerciasis (river blindness) elimination programs. The appropriate diagnostic test provides valuable information to programs, helping them to identify areas where there are very few infections, to determine if a targeted intervention is needed, and to reliably identify if transmission has been stopped. DPDM has trained partners from the Democratic Republic of Congo (DRC) National Program for Onchocerciasis Control, the DRC National Institute for Biomedical Research, the Kinshasa School of Public Health, and the African Field Epidemiology Network to assist with specimen collection and processing for this study funded by the Bill & Melinda Gates Foundation.  African Ministries of Health pledge continued support to control and eliminate NTDs Over 23 African Ministers of Health and Heads of Delegations signedon to the Addis Ababa NTD Commitment of 2014 which included country-led commitments to strengthen neglected tropical disease (NTD) control and elimination at the country-level. The signing was a part of a series of meetings that included the 20th meeting of the Joint Action Forum for Onchocerciasis Control in Africa, the 8th meeting of the Global Alliance for the Elimination of Lymphatic Filariasis, and the 1st meeting of the Global Schistosomiasis Alliance. The signing of the commitment shows continued dedication by African MOHs to the achievement of global elimination and control targets for NTDs. DPDM provided scientific expertise at the meetings to help national NTD programs develop plans that will achieve their NTD control and elimination goals. Laboratory Research and Capacity Building How long will insecticides last? In collaboration with the Navy Entomology Center of Excellence, Camp Blanding Joint Training Center, and Bayer AG, U.S. Navy entomologists detailed to DPDM are evaluating a novel, long-lasting insecticide formulation for use during malaria control efforts. The study includes insecticide treatments of 12”X12” panels made of cement, wood, sheet metal, and mud/dung mixture (common building surfaces used in Sub-Saharan Africa) retrofitted in experimental huts located at Camp Blanding Joint Training Center in Florida. Treated panels are left to “weather” (climatological conditions at the field site are similar to those encountered in Africa) in experimental huts to evaluate how much of the insecticide is remaining. Some of the treated panels are then shipped to CDC at pre-determined intervals (one week, one month, two months, etc.) to evaluate remaining efficacy using World Health Organization cone bioassays. Based on the results of this study, the new insecticide may be further evaluated by WHO for approval as an insecticide for use in IRS programs. Protecting our troops DPDM, in collaboration with a U.S. Navy entomologist on detail to CDC, have developed and are testing a simple colorimetric test to assess insecticide (permethrin) levels on pre-treated military uniforms. A small section of wetted fabric is blotted with a special paper disk about the size of a pencil eraser and then exposed to a color reagent. Color develops on the disk when insecticide remains, and the intensity of the color is proportional to the insecticide concentration on the uniform. Using a smart phone app, the color can be analyzed to calculate the amount of remaining insecticide. This helps determine when uniforms are no longer protective and need to be replaced. Publication Highlights Serological markers for monitoring historical changes in malaria transmission intensity in a highly endemic region of western Kenya, 1994–2009 Monitoring local transmission intensity is essential for planning evidence-based control strategies and evaluating their impact over time. Anti-malarial antibodies have proven useful in areas where transmission has dropped to low sustained levels, however it is unclear if serological markers are also informative in high transmission settings. This paper explores the utility of serological markers in highly endemic settings, finding that they are useful for accurate point estimates of transmission intensity, but not for retrospective analysis of historical changes. PET-PCR method for the molecular detection of malaria parasites in a national malaria surveillance study in Haiti  In other studies, PET-PCR assay was found to be robust and easier to use when compared to currently available real-time PCR methods. This study reviews the use of PET-PCR for molecular detection of malaria parasites in a nationwide malaria community survey in Haiti showing that PET-PCR, while less sensitive, is easier and less expensive, providing an alternative assay for rapid screening of a large number of samples in laboratory settings. Higher rates of misdiagnosis in pediatric patients versus adults hospitalized with imported malaria  Imported adult and pediatric malaria occurs in the United States even though effective antimalarial medications are available. This study retrospectively reviewed clinical information from patients diagnosed with malaria between 2005 and 2012 at a medical center that provides care for a large population with high risk for exposure to malaria. The review found that pediatric patients were misdiagnosed at a higher rate and tended to report more gastrointestinal symptoms than adults at the same facility. Case Report: Evidence of Autochthonous Chagas Disease in Southeastern Texas   In the United States domestically acquired Trypanosoma cruzi is rarely reported. This paper describes five cases from a pilot study of blood donors who tested positive for the parasite. Including these five, there have been a total of 28 published cases of autochthonous vector-borne T. cruzi infection in the United States since 1955. Ocular Toxoplasmosis in the United States: Recent and Remote Infections This article reviews the results of a study testing samples from patients with ocular toxoplasmosis that were submitted to the only Toxoplasma parasite testing reference laboratory in the United States from June 2004 through August 2010. The results of the study indicate that >10% of people with ocular disease developed it soon after acquiring T. gondii infection, a phenomenon previously thought to be uncommon in the general population. These results also suggest that patients identified both clinically and serologically as having had a recent T. gondii infection should be questioned about known risk factors for infection, and about close family members or associates who may have had a common exposure leading to infection. Staff Updates DPDM is restructuring its senior leadership, the following staff were selected for the new roles: o   Eric Gogstad is the Deputy Director for Management and Operations. o   Monica Parise leaves the Parasitic Diseases Branch Chief position and is the Deputy Director for Science and Program. Recruitment is under way for a new chief. o   Namita Joshi is the Deputy Director for Policy and Communications. Dr. Anthony Fiore, who was the Associate Director for Science, has transitioned within CDC to be the Epidemiology Research and Innovations Branch Chief in the Division of Healthcare Quality Promotion. Dr. William (Bill) Hawley is the new Entomology Branch Chief. Dr. Hawley has been with DPDM for over 24 years, most of which were dedicated to the fight against malaria. His most recent assignment (2011–2014) was as country director in Indonesia. We welcome Dr. Hawley back to Atlanta.