16-22 May 2014 #707

Still neglected

Dhanvantari by Buddha Basnyat, MD

The term ‘neglected illnesses’ refers to diseases in the developing world that remain scourges without remedies in sight, even though the academic understanding has improved.

Some years ago the medical journal Nature published the genomic sequence of the organism which caused the plague (Black Death) in Europe in the middle ages. The bacteria was reconstructed from the remains of buried victims. Genome sequencing of many organisms has happened rapidly, but has this ‘basic science’ enhancement of our knowledge helped us in a practical sense? Not really.

About 12 years ago the genomic sequencing of the typhoid bacteria (see pic) was carried out. Many scientists at that time wrote ecstatically about how this would lead to revolutionary changes in typhoid fever treatment. Sadly, more than a decade later we have made no obvious progress in taking care of typhoid patients. The academic thrill of discovery did not translate to more effective patient outcome.

Because typhoid can affect anyone in Nepal (from highly-placed officials to high-altitude climbers to school children) we all continue to suffer from the lack of prompt, proper diagnosis and treatment for this ubiquitous disease despite a huge gain in theoretical knowledge. What happened?

After the laboratory scientists sequenced the typhoid bacteria they moved on to other ‘virgin territories’ in sequencing.  The problem is that diseases like typhoid, typhus, rabies, hepatitis E, and snake bites really do not have a spokesperson or lobby groups, and are truly considered biblical diseases generally confined to the developing world.There is, for example, no financial incentive to take advantage of the typhoid bacterial sequencing to make cost-effective, accurate diagnostic tools to help with patient care in typhoid fever.

Compare typhoid fever with HIV/AIDS which continues to make important gains in prevention and treatment. This favorable bias towards diseases like HIV is obvious in the funding pattern of the US National Institute of Health (NIH) and even the Bill and Melinda Gates Foundation. Of course, if we had clean drinking water and improved sanitation and plumbing, typhoid would disappear, but that would require tremendous political will.

With summer we are already seeing outbreaks of a host of diseases such as hepatitis which has already started causing problems in Biratnagar. It has been reported as hepatitis A or E, but available rapid diagnostic tests are not always reliable and many cases of hepatitis E may be missed. Sophisticated tests like PCR (polymerase chain reaction) are generally expensive and unavailable in Nepal, so a proper diagnosis is often not made, hampering proper management of the case.

Another neglected problem rampant in the Tarai are snakebites. Year after year there continues to be a shortage of life-saving anti-snake venom, which means more farmers and their families are going to fall victims.

Rabies is not a seasonal disease and is generally present in the same intensity the year around. But thankfully at least for dog bite victim, the Health Ministry administers the expensive anti rabies vaccine for free. Often rabies affects children and even a small puncture wound by a rabid dog’s teeth may potentially cause rabies. So it is crucial to obtain the vaccine and importantly also to clean the dog bite wound with soap and water and iodine very carefully as the rabies virus tends to stay at the bite site.

Targeted assistance from charities like the Bill and Melinda Gates Foundation would focus attention on disease that have been neglected for too long because they afflict mainly the poor in poor countries.

Read also:

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A milestone article

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