FACT SHEET Infectious Disease Interventions The Basics Infectious diseases cause millions of deaths each year, largely in developing countries.1 They also disable millions of people, diminishing their quality of life, decreasing productivity and creating financial hardship. Many prevention and treatment measures are effective and inexpensive and yet remain unavailable to those most in need. Interventions aim to reduce the burden of disease and can be targeted toward individuals or populations. They may involve reduction of environmental risk factors, campaigns to encourage healthy behaviors, or provision of preventive or curative medical care.2 Prevention !
Insecticide-treated bed nets (ITNs) protect against several tropical diseases, including malaria, lymphatic filariasis, Chagas disease and leishmaniasis, by preventing bites from insects that carry parasites.3 In Africa, ITNs have been shown to decrease all-cause child mortality by 18 percent.4 Tuberculosis and malaria interventions7-15 Intervention
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Vaccination is among the most cost-effective interventions, especially in low-income countries.2 The World Health Organization recommends all children be immunized against diphtheria, Haemophilus influenzae type b, hepatitis B, human papillomavirus, measles, pneumonia, polio, rotavirus, tetanus, tuberculosis (severe childhood form), and whooping cough.5
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Since 2000, vaccines delivered through the GAVI Alliance, an innovative finance organization, have prevented the deaths of more than five million people.6 New vaccines that can prevent many cases of diarrhea and pneumonia, the two biggest causes of child mortality, were released in 2006 and 2009 respectively. A new meningococcal vaccine was rolled out in 2010. These vaccines were the first to become available in developing countries at the same time as in developed countries. Improved access to clean water and sanitation facilities can prevent waterborne diseases, diseases spread through the fecal-oral route, and diseases transmitted by vectors that depend on water as part of their lifecycle. Handwashing reduces the risk of diarrheal disease by up to 47 percent.16 Universal access to indoor plumbing and sanitation could reduce the global burden of diarrheal disease by nearly 70 percent.17
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Directly-observed therapy, short-course (DOTS) is a highly cost-effective strategy for tuberculosis treatment. A six-month course of four medications administered using DOTS cures more than 90 percent of patients.18 Longer treatment with more expensive and less easily tolerated medication is necessary for multidrug- and extensively drug-resistant TB (MDR- and XDR-TB); cure rates range between 60 and 83 percent, but are lower in people living with HIV.19 Drug resistance has rendered some traditional anti-malarial medications ineffective in many parts of Africa and Asia. Artemisinin-based combination therapies (ACTs) contain a combination of artesunate or artemether and another drug to treat malaria. The exclusive use of ACTs, rather than a single anti-malarial drug, will slow the development of further drug resistance.20 A package of four drugs can be used to treat seven neglected diseases: roundworm (ascariasis), hookworm, whipworm (trichuriasis), elephantiasis (lymphatic filariasis), river blindness (onchocerciasis), snail fever (schistosomiasis), and blinding trachoma. The package costs just US $0.50 per person treated, including program and delivery costs.21
NOVEMBER 2011
References 1. World Health Organization. Global burden of disease report: 2004 update; 2008. 2. Laxminarayan R, Chow J, Shahid-Salles S. Intervention cost-effectiveness. In: Jamison D, Breman JG, Measham A, Alleyne G, Claeson M, Evans D, et al., edi tors. Disease Control Priorities in Developing Countries. 2 ed. New York: Oxford University Press; 2006. 3. World Health Organization. Insecticide-treated mosquito nets: a WHO position statement; 2007. 4. Menéndez C, D’Alessandro U, O ter Kuile F. Reducing the burden of malaria in pregnancy by preventive strategies. Lancet Infec Dis. 2007; 7: 126-35. 5. World Health Organization. Recommended routine immunization--summary of WHO position papers. 2010. Available from: http://www.who.int/ immunization/policy/Immunization_routine_table1.pdf 6. GAVI Alliance. The GAVI Alliance; 2011. 7. Breman JG, Alilio MS, White NJ. Defining and defeating the intolerable burden of malaria III: progress and perspectives. Am J Trop Med Hyg. 2007; 77(Suppl 6): vi-xi. 8. Breman J, Alilio M, Mills A. Conquering the intolerable burden of malaria: what’s new, what’s needed: a summary. American Journal of Tropical Medicine & Hygiene. 2004; 71: 1-15. 9. Maartens G, Wilkinson RJ. Tuberculosis. Lancet. 2007; 370: 2030-43. 10. Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH. A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg. 2007; 77(Suppl 6): 119-27. 11. Aponte John J SD, Egan Andrea, et al. Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomized, placebo-controlled trials. Lancet. 2009; 374: 1533-42. 12. Malaria Vaccine Initiative. The RTS,S malaria vaccine candidate. 2011. Available from: http://www.malariavaccine.org/files/April82011MVI_RTSScandidate.pdf 13. World Health Organization. Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resourceconstrained settings; 2011. 14. Evans CA. GeneXpert--A game-changer for tuberculosis control? PLoS Medicine. 2011; 8(7): e1001064. 15. Roll Back Malaria Partnership. Global malaria action plan; 2008. 16. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhea risk in the community: a systematic review. Lancet Infec Dis. 2003; 3: 275-81. 17. Hutton G, Haller L. Evaluation of the Costs and Benefits of Water and Sanitation Improvements at the Global Level. Geneva: World Health Organization; 2004. 18. Stop TB Partnership. The global plan to stop TB 2011-2015. Geneva: Stop TB Partnership; 2010. 19. Gandhi N, Nunn P, Dheda K, Schaaf H, Zignol M, van Soolingen D, et al. Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis. The Lancet. 2010; (375): 1830-43. 20. World Health Organization. Guidelines for the treatment of malaria, second edition; 2010. 21. Molyneux P, Hotez J, Fenwick A. Rapid-impact interventions: how a policy of integrated control for Africa’s neglected tropical diseases could benefit the poor. PLoS Medicine. 2005; 2(No 11 e336).
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