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188 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES *** Annex 4. Linkages between neglected tropical diseases and water, sanitation and hygiene Neglected Tropical Disease (NTD) Dengue Dracunculiasis (guinea-worm disease) Foodborne trematodiases Lymphatic filariasis Schistosomiasis Soil-transmitted helminthiases (ascariasis, hookworm, trichuriasis) Trachoma Linkage with water, sanitation and hygiene (WASH) Drinking-water storage in and around the household can create breeding places for the vector mosquitoes. Access (for example: remote wells), availability (for example: rainwater harvesting to bridge brief periods of drought) and reliability (for example: where piped water services are not guaranteed 24/7) are determining factors for household water storage. Safe storage requires adequate containers as well as practices such as closing containers and regular cleaning. Worms are transmitted through ingestion of water fl eas in contaminated water. WASH control measures include water source protection, treatment of contaminated water sources with insecticide (temephos) and water fi ltration. Success towards eliminating this disease over the past 25 years includes how a focus on drinking-water quality can make a major contribution to an integrated public-health programme. Where the infection has been seen to rebound, mostly in areas of humanitarian crises where the delivery of health services is interrupted, reliance on water fi ltering practices has provided a certain level of resilience. The eggs of liver, lung and intestinal fl ukes are released with faeces into open water and are ingested by aquatic snails. Human infection occurs when secondary intermediate hosts (fi sh, crustaceans, molluscs or aquatic plants) are eaten raw. Required interventions are prevention of faecal contamination of freshwater bodies due to lack of sanitation or poor hygiene behaviour, and improving cooking habits. Transmission: The Culex vectors prefer breeding in organically polluted water as well as in faecal matter found in poorly-constructed pit latrines. Necessary interventions include construction, maintenance and management (including pit emptying and disposal) of improved latrines, maintaining sewers, phasing out open sewerage systems, infrastructure upgrading and mosquito proofi ng of existing systems for wastewater management. Morbidity management: access to suffi cient clean water is needed to practise hygiene behaviours such as limbwashing in order to reduce the severity of disease symptoms. Infection via eggs of worms in human faeces and urine deposited in water where emerging larvae enter freshwater snails. After development in snail, larvae forms emerge in water and penetrate skin during contact with infested water. Control measures include snail control, improved sanitation and health education and reduced contact with surface water. This is probably the most researched disease in terms of environmental management interventions, including the provision of sanitation facilities to prevent contamination of open waters, hydraulic infrastructures and water management to eliminate snail intermediate hosts, and the provision of safe recreational waters such as swimming pools, and efforts to induce behavioural change both in terms of proper use of sanitation and avoiding contact with contaminated water. The lessons learned indicate that none of these measures by itself will lead to sustained success – just like case detection and treatment programmes will remain without an end-point as long as the environment and social risk factors are not tackled. Dealing with the environmental factors effectively is often economically not feasible, while lasting behavioural change has proved hard to achieve. Yet, applying a combination of measures in an intersectoral context has shown to produce lasting results in specifi c settings. Eggs ingested through contaminated vegetables or water, or directly bychildren placing soil in mouth; hookworm larvae penetrate skin when walking barefoot on contaminated soil (no direct person-to-person transmission). Prevention requires improved sanitation and hygiene (hand-washing). Of all the NTDs, this group of infections will benefi t the most from the elimination of open defecation and safe management of excreta, and reduced transmission risks will translate into improved nutritional status, increased productivity, enhanced learning capacity and reduced costs for the health sector. The other area where WASH can contribute to the reduction of helminthiases is in the promotion of safe use of wastewater in agriculture and aquaculture. An increasingly important practice around urban centres in water-scarce parts of the world, WHO guidance on safe use practices aims to protect agricultural workers, peri-urban communities involved in wastewater-supported agriculture and the consumers of their produce.2 Transmission occurs between infected persons through fl ies. Full implementation of the SAFE strategy for trachoma control (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) is required to achieve elimination. The SAFE strategy offers the most comprehensive WASH-NTDs framework and fi rmly embeds the need for environmental and promotive health measures alongside medical interventions. WASH interventions are crucial for the delivery of the F and E aspects of the SAFE strategy, through improved sanitation in order to reduce fl y numbers and transmission of infection from person to person; and through hygiene by promoting washing of children’s faces as well as improving overall personal hygiene (such as laundry). All hygiene behaviours require increased access to a reliable and suffi cient supply of water and soap.
*** ANNEXES 189 Annex 5. Medicines for controlling neglected tropical diseases donated by the pharmaceutical industry Pharmaceutical company Medicine Donation Bayer Nifurtimox Up to 300 000 tablets of 120 mg and 20 000 tablets of 30 mg per year during 2014–2019 for human African trypanosomiasis: donation made through WHO Nifurtimox Suramin Up to 1 million tablets of 120 mg including paediatric formulations in 30 mg tablets during 2012–2017 for second-line treatment of Chagas disease; donation made through WHO Up to 10 000 1 g vials per year until November 2017 for human African trypanosomiasis; donation made through WHO Eisai Diethylcarbamazine Up to 2.2 billion tablets until 2020 for lymphatic fi lariasis; donation made through WHO Gilead Sciences AmBisome Up to 445 000 vials during 2012–2016 for visceral leishmaniasis in South-East Asia and East Africa; donation made through WHO GlaxoSmithKline Albendazole Unlimited supply for as long as needed for lymphatic fi lariasis and up to 400 million tablets during 2012–2016 for soil-transmitted helminthiases; donation made through WHO Johnson & Johnson Mebendazole Up to 200 million tablets per year during 2012–2016 for soil-transmitted helminthiases control programmes for school-age children; donation made through WHO Merck & Co., Inc. Ivermectin Unlimited supply for as long as needed; donation made directly to countries for lymphatic fi lariasis and onchocerciasis Merck KGaA Praziquantel Up to 250 million tablets per year for an unlimited period for schistosomiasis; donation made through WHO Novartis Multidrug therapy (rifampicin, clofazimine and dapsone in blister packs) and loose capsules of clofazimine Triclabendazole Unlimited supply for as long as needed for leprosy and its complications; donation made through WHO Unlimited supply for fascioliasis and paragonimiasis; donation made through WHO Pfizer Azithromycin Unlimited quantity for blinding trachoma until at least 2020 Sanofi Efl ornithine Unlimited quantity until 2020 for human African trypanosomiasis; donation made through WHO Melarsoprol Pentamidine Unlimited quantity until 2020 for human African trypanosomiasis; donation made through WHO Unlimited quantity until 2020 for human African trypanosomiasis; donation made through WHO
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