Progressing research on neglected tropical diseases during a global pandemic

News | Published on 29 Jan 2021

On World Neglected Tropical Disease Day, researchers from the Kirby Institute highlight the progress made in NTD research in a year like no other.

2020 was a year in which the world came to understand how devastating an infectious disease can be to the health and wellbeing of entire communities.

As the pandemic continues around the world, researchers from the Neglected Tropical Disease Research Group at UNSW’s Kirby Institute are making sure that their world-leading work on neglected tropical diseases (NTDs) continues to have impact.

NTDs include a range of infectious conditions, and impact more than one billion people worldwide, mainly in low-income countries. They affect the poorest and most vulnerable in society and perpetuate the cycle of poverty.

“These diseases impair the growth and health of children, which can lead to missing school and result in adults who have poor health, are less educated and less able to find appropriate employment,” says Associate Professor Susana Vaz Nery, Group Leader for NTD Research Group at the Kirby Institute.

“This is because they cause significant morbidity. In our region, important NTDs include worms that cause anaemia and impair childhood development; trachoma that leads to blindness; scabies that causes relentless itching, leading to serious bacterial infections where the skin is broken; and lymphatic filariasis that generates severe and disabling swelling of the limbs, breasts, or genitals.”

In many countries where NTDs are endemic, governments have implemented swift and effective restrictive measures to prevent the spread of COVID-19. But an unintended consequence of this is that public health programs to combat NTDs have been scaled back or stopped completely.

Mathematical models used to predict the short- and long-term impact of the pandemic on NTDs, suggest it may take years to make up for the progress lost unless programs are resumed. Diseases may resurge, cases may go undiagnosed, and people may not be able to access treatment or care for long-term complications of these diseases.

“This makes our research, which is about optimising and enhancing NTD control, more important than ever,” says A/Prof Vaz Nery. “In a context of competing health priorities and increased strain on resources, our research is about ensuring that we’re rolling out programs as effectively and efficiently as we possibly can.”

How the Kirby Institute is tackling neglected tropical diseases in our region

For over a decade, the Kirby Institute has been expanding its work on Neglected Tropical Disease, and last year formed a Neglected Tropical Diseases Research Group (NTDRG), under the leadership of A/Prof Susana Vaz Nery. The group includes Drs Lucia Romani, Clare Dyer and Adam Bartlett; Carleigh Cowling and Aisling Byrne; and PhD students Phoebe Kisavi, Paul delos Trinos and Brandon Le.

The group has been working with collaborators in Australia and overseas on innovative programs and interventions aimed to control and eliminate several NTDs.

“These projects are not straightforward at the best of times, as they take place in remote settings with limited resources, but we are proud to have maintained momentum during the pandemic thanks to strong collaborations between the NTDRG and our national and international collaborators,” says A/Prof Vaz Nery.

Intestinal worm control in Vietnam

Soil-transmitted helminths, more commonly known as "intestinal worms", are the most common NTD globally. They are transmitted by worm eggs and larvae present in human faeces, which contaminate the environment in areas where sanitation is poor. A/Prof Vaz Nery is conducting a trial in the Dak Lak province in Vietnam to find out whether giving intestinal worm medication to everyone living in a community is more effective than giving the medication just to children at primary school in reducing intestinal worm infections in school children.

“Vietnam has kept strong control over COVID-19, so were able to proceed with the trial at the end of last year to collect over 8,000 stool samples and provide 20,000 children with these effective treatments”, says A/Prof Vaz Nery.

Children receiving deworming pill in Vietnam as part of the CoDe trial aiming to optimise current deworming strategiesChildren receiving deworming pill in Vietnam as part of the CoDe trial aiming to optimise current deworming strategies

Scabies control in the Pacific

Research led by Dr Lucia Romani in Fiji and the Solomon Islands, in collaboration with the Murdoch Children's Research Institute, has shown that administration of oral ivermectin to entire communities (the strategy known as “mass drug administration”) can have a very substantial impact on reduction of scabies. Ongoing collaborative research is investigating how best to use ivermectin mass drug administration to treat entire populations for scabies and is focussing on the possibility of using a single dose of ivermectin, rather than the two doses a week apart in the current regimen.

Dr Lucia Romani with the community engagement team in Choiseul, Solomon IslandsDr Lucia Romani with the community engagement team in Choiseul, Solomon Islands

Ivermectin to improve control of intestinal worms and scabies

A/Prof Vaz Nery believes that ivermectin may also help control intestinal worms and is leading research to understand exactly what role ivermectin could have in strategies to eliminate these worms.

In collaboration with partners at the Murdoch Children’s Research Group, Kirby Institute researchers are investigating the impact of different ivermectin doses on worms. In 2019, they collected stool samples from over 800 people in 20 villages of the Western Province in the Solomon Islands, just before drug administration.

In Timor-Leste, in collaboration with the Menzies School of Health Research and the Ministry of Health of Timor-Leste, the Kirby Institute is conducting an assessment of the impact of a national NTD control program that included ivermectin on scabies and intestinal worms, recruiting over 1,000 children in six schools.

The completion of that collection in both countries is expected early this year. If ivermectin proves effective at controlling intestinal worms, it opens up the possibility of treating multiple NTDs through the one program, improving quality of life and saving significant amounts of money on program rollout.

Primary school children undergoing clinical skin examinations in Timor-LestePrimary school children undergoing clinical skin examinations in Timor-Leste

Trachoma surveillance in Australia and the Pacific

Australia is the only high-income country with endemic trachoma, caused by infection of the eye the bacterium chlamydia. It affects those living in remote and very remote Indigenous communities in central and northern Australia. Australia is committed to eliminate trachoma as a public health problem in Australia in the next few years.

The Kirby Institute coordinates data collection and reporting on the evaluation of trachoma control strategies in Australia and produces an annual report for the Department of Health. According to the latest report, trachoma prevalence in endemic areas was 4.5% is 2019.

Kirby Institute researchers are also collaborating with the Ministries of Health in the Republic of Nauru and the Solomon Islands to investigate whether trachoma is still endemic in these countries.

Australian Trachoma Surveillance Report 2018Find out more about trachoma statistics in the Australian Trachoma Surveillance Report 2018.

Impact of Covid 19 on NTDs

It is vital that we understand the impact of COVID-19 on NTD program implementation, so that we can adapt and strengthen these interventions within the context of a global pandemic.

The Kirby Institute is commencing a review of how COVID-19 has impacted NTD control programs in the Asia-Pacific Region. “This review will evaluate lessons and experiences from different countries, not only on the delays caused by the pandemic but also on the solutions found by countries to be able to resume program implementation in a pandemic safe-way,” says A/Prof Vaz Nery.