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Critical R&D and innovation
needs for NTDs
Dr Dirk Engels, Director, NTD
Vector Control in recent years has been focused on malaria:
LLIN IRS
Global burden of vector-borne diseases
Vector Disease Estimated or reported
annual cases
Estimated
annual deaths
Estimated
annual DALYs
Mosquitoes Malaria 212 000 000 429 000 55 111 000
Dengue 96 000 000 9 110 1 892 200
Lymphatic filariasis 38 464 000 NA 2 075 000
Chikungunya (Americas) 693 000 (suspected, 2015) NA NA
Zika virus disease (Americas) 500 000 (suspected, 2016) NA NA
Yellow fever (Africa) 130 000 500 31 000
Japanese encephalitis 42 500 9250 431 552
West Nile fever 2 588 111 NA
Blackflies Onchocerciasis 15 531 500 NA 1 135 700
Sandflies (Muco) cutaneous leishmaniasis 3 895 000 NA 41 500
Visceral leishmaniasis 60 800 62 500 1 377 400
Triatomine bugs Chagas disease 6 653 000 10 600 236 100
Ticks Borreliosis (Lyme disease) 532 125 NA 10.5
Tick-borne encephalitis (North Eurasia) 10 000 – 12 000 NA 167.8 / 100 000
Tsetse flies Human African trypanosomiasis 10 700 6 900 202 400
Snails Schistosomiasis 207 000 000 200 000 2 613 300
Various Other: Rift Valley fever, O'nyong nyong virus, Mayaro virus, Crimean-Congo haemorrhagic fever,
rickettsial diseases, plague (limited data)
• 390M cases of dengue/year
• Zika has spread to 62 countries since 2015
• Recent yellow fever outbreak with 4,140 cases & 388 deaths in Angola & DCR.
Outbreak ongoing in Brazil
• Chikungunya first described in Tanzania in 1952, but now in 60 countries
• Which Aedes-borne disease will be next?
1
0
Dengue
risk
The rise in Aedes-borne diseases
Aedes-borne diseases are increasingly urban diseases
Zika
yellow fever
Severe dengue
chikungunya
Aedes aegypti
Rationale for a Global Vector Control Response
… above all, the spread of Zika, the resurgence of dengue, and the emerging
threat of Chikungunya are the price being paid for a massive policy failure that
dropped the ball on mosquito control in the 1970s.
Margaret Chan, Director-General World Health Organization
World Health Assembly, May 2016
Recognition that something broader and more fundamental is needed, beyond existing regional and
global (disease-specific) vector control strategies
Expanding on (and preserving) successes against malaria, Chagas disease, lymphatic filariasis,
onchocerciasis, and visceral leishmaniasis, for maximal impact on all vector-borne diseases
Need for optimization - re-alignment across multiple vectors, diseases, sectors and partners
Power of innovation, with multiple novel tools, technologies and approaches on the horizon
Re-building of capacity and capability to implement vector control addressing specific conditions and
challenges
Time is ripe to link vector control to development: alignment with Sustainable Development Goals
Overview
Vision, Aim and Goals
Goals Milestones Targets
2020 2025 2030
Reduce mortality due to vector-
borne diseases globally relative to
2016
At least 30% At least 50% At least 75%
Reduce case incidence due to
vector-borne diseases globally
relative to 2016
At least 25% At least 40% At least 60%
Prevent epidemics of vector-borne
diseases*
In all countries
without transmission
in 2016
In all
countries
* Rapid detection of outbreaks and curtailment before spread beyond country.
• Vision: A world free of human suffering from vector-borne diseases.
• Aim: Reduce the burden and threat of vector-borne diseases through
effective locally adapted and sustainable vector control.
WHO response to enhance Innovation in Vector Control
Established in 2012, six meetings held
The objectives of VCAG are:
1. To conduct an initial review of concept and determine data required to
validate the product class, claim or variation and (b).
2. To advise on the process to generate the required data
3. To assess the evidence for new vector control tools / approaches
4. To develop or refine the Target Product Profiles;
5. To establish public health value and support formulation of a WHO policy &
use recommendation
Vector Control Advisory Group (GMP and NTD)
Summary of achievements
14
New or variant classes of
tools (some with
multiple products)
included in VCAG
program
(2013-2016)
Review and
guidance for
tools in VCAG
program
• 6th VCAG Meeting
April 2017
• Risk Assessments for 2
products
• New tools for Zika
Guidelines
• LLINs for pyrethroid resistance;
• Vector traps for surveillance and
control (in progress);
• Vector control trial design
manual (in progress)
• Policy pathways for new vector
control tools
Overview of New Products (by product class)
New Product - Variation Generic Exemplar Prototype product
ITN against IR Vector (extend ITN) Pyr + mix/comb LLIN PermaNet 3, Interceptor G2
Treated walls against IR vector (extend IRS) IRS/wall linings for IR pop No claim reviewed
Peri-focal residual spraying (extend IRS) Outdoor RS PFS formulation, Bayer
Insecticide-treated curtain (extend ITN) Fully screened house FSH pyrethroid netting
New Product Class – (chemical) Generic Exemplar Prototype product
Attract and kill baits Attractive Toxic Sugar Bait Bait station
Spatial repellents Passive emanator metofluthrin or transfluthrin
ITM for specific risk groups ITM Blanket, Clothes
Vector traps Adulticidal Oviposition traps ALOT, IN2TRAP, AGO, TNK
Lethal house lures Eave tubes Eave tubes
Systemic insecticide Rodent bait Imidacloprid based bait
New Product Class – (biological) Generic Exemplar Prototype product
Microbial control in adult vectors Bacterial infection wMel Wolbachia in Ae. aegypti
Pop. reduction through genetic manipulation GMM, self limiting OX513A Ae. aegypti (RIDL)
GMM, gene-drive CRISP/Cas9 in An. gambiae
Pop. alteration of malaria vector mosquitoes GMM, gene-drive CRISP/Cas9 anti-parasite
SIT & incompatible insect technique (IIT) Radiation + bacterial infection Sterilized Aedes spp. + Wolbachia
Step 3 Approved Step 3 underway
Overview of New Products (by use)
New Products for Anopheles; Malaria Generic Exemplar Prototype product
ITN against IR Vector (extend ITN) Pyr + mix/comb LLIN PermaNet 3, Interceptor G2
Attract and kill baits Attractive Toxic Sugar Bait Bait station
Lethal house lures Eave tubes Eave tubes
Pop. alteration of malaria vector mosquitoes GMM, gene-drive CRISP/Cas9 anti-parasite
GMM, gene-drive CRISP/Cas9 in An. gambiae
Step 3 Approved Step 3 underway
New Product Class for Aedes; Arboviral diseases Generic Exemplar Prototype product
Vector traps Adulticidal Oviposition traps ALOT, IN2TRAP, AGO, TNK
Microbial control in adult vectors Bacterial infection wMel Wolbachia in Ae. aegypti
Pop. reduction through genetic manipulation GMM, self limiting OX513A Ae. aegypti (RIDL)
SIT & incompatible insect technique (IIT) Radiation + bacterial infection Sterilized Aedes spp. + Wolbachia
Peri-focal residual spraying (extend IRS) Outdoor RS PFS formulation, Bayer
Overview of New Products
New Product Class – for Anopheles and Aedes Generic Exemplar Prototype product
Spatial repellents Passive emanator metofluthrin or transfluthrin
Treated walls against IR vector (extend IRS) IRS/wall linings for IR pop No claim reviewed
Insecticide-treated curtain (extend ITN) Fully screened house FSH pyrethroid netting
ITM for specific risk groups ITM Blanket, Clothes
Step 3 Approved Step 3 underway
New Product Class – for NTD (leishmaniasis and
plague) transmitted by sandflies and fleas
Generic Exemplar Prototype product
Systemic insecticide Rodent bait Imidacloprid based bait
Conclusion: need for innovation in approach & tools
• More holistic approach and country leadership in vector-borne disease
prevention and control efforts is critical
• Policies and activities should be multi-sectorial and should always be
evidence-based
• Emphasis on locally adapted, "multi-vector" and community-based
approaches – involvement of municipalities and local governments
• Adoption of novel tools is key (once thoroughly validated for operational
use)
• Aim is to ensure all countries can achieve success, irrespective of their
current disease burden/risk, capacities and resources
Thank you

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Dirk Engels-Enfermedades transmitidas por vectores

  • 1. Critical R&D and innovation needs for NTDs Dr Dirk Engels, Director, NTD
  • 2. Vector Control in recent years has been focused on malaria: LLIN IRS
  • 3. Global burden of vector-borne diseases Vector Disease Estimated or reported annual cases Estimated annual deaths Estimated annual DALYs Mosquitoes Malaria 212 000 000 429 000 55 111 000 Dengue 96 000 000 9 110 1 892 200 Lymphatic filariasis 38 464 000 NA 2 075 000 Chikungunya (Americas) 693 000 (suspected, 2015) NA NA Zika virus disease (Americas) 500 000 (suspected, 2016) NA NA Yellow fever (Africa) 130 000 500 31 000 Japanese encephalitis 42 500 9250 431 552 West Nile fever 2 588 111 NA Blackflies Onchocerciasis 15 531 500 NA 1 135 700 Sandflies (Muco) cutaneous leishmaniasis 3 895 000 NA 41 500 Visceral leishmaniasis 60 800 62 500 1 377 400 Triatomine bugs Chagas disease 6 653 000 10 600 236 100 Ticks Borreliosis (Lyme disease) 532 125 NA 10.5 Tick-borne encephalitis (North Eurasia) 10 000 – 12 000 NA 167.8 / 100 000 Tsetse flies Human African trypanosomiasis 10 700 6 900 202 400 Snails Schistosomiasis 207 000 000 200 000 2 613 300 Various Other: Rift Valley fever, O'nyong nyong virus, Mayaro virus, Crimean-Congo haemorrhagic fever, rickettsial diseases, plague (limited data)
  • 4. • 390M cases of dengue/year • Zika has spread to 62 countries since 2015 • Recent yellow fever outbreak with 4,140 cases & 388 deaths in Angola & DCR. Outbreak ongoing in Brazil • Chikungunya first described in Tanzania in 1952, but now in 60 countries • Which Aedes-borne disease will be next? 1 0 Dengue risk The rise in Aedes-borne diseases
  • 5. Aedes-borne diseases are increasingly urban diseases Zika yellow fever Severe dengue chikungunya Aedes aegypti
  • 6. Rationale for a Global Vector Control Response … above all, the spread of Zika, the resurgence of dengue, and the emerging threat of Chikungunya are the price being paid for a massive policy failure that dropped the ball on mosquito control in the 1970s. Margaret Chan, Director-General World Health Organization World Health Assembly, May 2016 Recognition that something broader and more fundamental is needed, beyond existing regional and global (disease-specific) vector control strategies Expanding on (and preserving) successes against malaria, Chagas disease, lymphatic filariasis, onchocerciasis, and visceral leishmaniasis, for maximal impact on all vector-borne diseases Need for optimization - re-alignment across multiple vectors, diseases, sectors and partners Power of innovation, with multiple novel tools, technologies and approaches on the horizon Re-building of capacity and capability to implement vector control addressing specific conditions and challenges Time is ripe to link vector control to development: alignment with Sustainable Development Goals
  • 8. Vision, Aim and Goals Goals Milestones Targets 2020 2025 2030 Reduce mortality due to vector- borne diseases globally relative to 2016 At least 30% At least 50% At least 75% Reduce case incidence due to vector-borne diseases globally relative to 2016 At least 25% At least 40% At least 60% Prevent epidemics of vector-borne diseases* In all countries without transmission in 2016 In all countries * Rapid detection of outbreaks and curtailment before spread beyond country. • Vision: A world free of human suffering from vector-borne diseases. • Aim: Reduce the burden and threat of vector-borne diseases through effective locally adapted and sustainable vector control.
  • 9. WHO response to enhance Innovation in Vector Control Established in 2012, six meetings held The objectives of VCAG are: 1. To conduct an initial review of concept and determine data required to validate the product class, claim or variation and (b). 2. To advise on the process to generate the required data 3. To assess the evidence for new vector control tools / approaches 4. To develop or refine the Target Product Profiles; 5. To establish public health value and support formulation of a WHO policy & use recommendation Vector Control Advisory Group (GMP and NTD)
  • 10. Summary of achievements 14 New or variant classes of tools (some with multiple products) included in VCAG program (2013-2016) Review and guidance for tools in VCAG program • 6th VCAG Meeting April 2017 • Risk Assessments for 2 products • New tools for Zika Guidelines • LLINs for pyrethroid resistance; • Vector traps for surveillance and control (in progress); • Vector control trial design manual (in progress) • Policy pathways for new vector control tools
  • 11. Overview of New Products (by product class) New Product - Variation Generic Exemplar Prototype product ITN against IR Vector (extend ITN) Pyr + mix/comb LLIN PermaNet 3, Interceptor G2 Treated walls against IR vector (extend IRS) IRS/wall linings for IR pop No claim reviewed Peri-focal residual spraying (extend IRS) Outdoor RS PFS formulation, Bayer Insecticide-treated curtain (extend ITN) Fully screened house FSH pyrethroid netting New Product Class – (chemical) Generic Exemplar Prototype product Attract and kill baits Attractive Toxic Sugar Bait Bait station Spatial repellents Passive emanator metofluthrin or transfluthrin ITM for specific risk groups ITM Blanket, Clothes Vector traps Adulticidal Oviposition traps ALOT, IN2TRAP, AGO, TNK Lethal house lures Eave tubes Eave tubes Systemic insecticide Rodent bait Imidacloprid based bait New Product Class – (biological) Generic Exemplar Prototype product Microbial control in adult vectors Bacterial infection wMel Wolbachia in Ae. aegypti Pop. reduction through genetic manipulation GMM, self limiting OX513A Ae. aegypti (RIDL) GMM, gene-drive CRISP/Cas9 in An. gambiae Pop. alteration of malaria vector mosquitoes GMM, gene-drive CRISP/Cas9 anti-parasite SIT & incompatible insect technique (IIT) Radiation + bacterial infection Sterilized Aedes spp. + Wolbachia Step 3 Approved Step 3 underway
  • 12. Overview of New Products (by use) New Products for Anopheles; Malaria Generic Exemplar Prototype product ITN against IR Vector (extend ITN) Pyr + mix/comb LLIN PermaNet 3, Interceptor G2 Attract and kill baits Attractive Toxic Sugar Bait Bait station Lethal house lures Eave tubes Eave tubes Pop. alteration of malaria vector mosquitoes GMM, gene-drive CRISP/Cas9 anti-parasite GMM, gene-drive CRISP/Cas9 in An. gambiae Step 3 Approved Step 3 underway New Product Class for Aedes; Arboviral diseases Generic Exemplar Prototype product Vector traps Adulticidal Oviposition traps ALOT, IN2TRAP, AGO, TNK Microbial control in adult vectors Bacterial infection wMel Wolbachia in Ae. aegypti Pop. reduction through genetic manipulation GMM, self limiting OX513A Ae. aegypti (RIDL) SIT & incompatible insect technique (IIT) Radiation + bacterial infection Sterilized Aedes spp. + Wolbachia Peri-focal residual spraying (extend IRS) Outdoor RS PFS formulation, Bayer
  • 13. Overview of New Products New Product Class – for Anopheles and Aedes Generic Exemplar Prototype product Spatial repellents Passive emanator metofluthrin or transfluthrin Treated walls against IR vector (extend IRS) IRS/wall linings for IR pop No claim reviewed Insecticide-treated curtain (extend ITN) Fully screened house FSH pyrethroid netting ITM for specific risk groups ITM Blanket, Clothes Step 3 Approved Step 3 underway New Product Class – for NTD (leishmaniasis and plague) transmitted by sandflies and fleas Generic Exemplar Prototype product Systemic insecticide Rodent bait Imidacloprid based bait
  • 14. Conclusion: need for innovation in approach & tools • More holistic approach and country leadership in vector-borne disease prevention and control efforts is critical • Policies and activities should be multi-sectorial and should always be evidence-based • Emphasis on locally adapted, "multi-vector" and community-based approaches – involvement of municipalities and local governments • Adoption of novel tools is key (once thoroughly validated for operational use) • Aim is to ensure all countries can achieve success, irrespective of their current disease burden/risk, capacities and resources

Editor's Notes

  1. This response calls for improved public health entomology capacity, a well-defined national research agenda, better coordination within and between sectors, strengthened monitoring systems, availability and use of novel interventions with proven public health value, and community involvement in vector control.