Neglected Illnesses

<br>Buddha Basnyat, MD

Aug. 13, 2012, 5:45 p.m. Published in Magazine Issue: Vol.: 06 No.-06 Aug. 10-2012 (Shrawan 26,2069)<br>

TB, HIV, and malaria are well-recognized illnesses that have a great deal of funding as compared to illnesses like typhoid, typhus and leptospirosis. But the latter three cause a lot of problems in Nepal. In general these organisms ( typhoid, typhus and leptospirosis) usually cause more problems in  the summer than winter probably because they are able to better survive and flourish in the hot, humid, rainy weather. One of the reasons that these three illnesses are neglected is also probably because these illnesses are not often seen in the Western world unlike TB and HIV which are sometimes present together in the West. So this may be a case of “out of sight, out of mind”.  Malaria has been present for centuries especially in Africa and therefore has been in the limelight. Today we will focus on typhoid, the king of neglected illnesses.

Recently the prestigious medical journal “Nature” published the genomic sequence (decoding) of the organism which caused plague ( Black Death) in the middle ages. The bacteria  was reconstructed from the medieval plague victims. Genome sequencing of many organisms has happened rapidly, but has this“basic science” enhancement of our knowledge helped us in a practical sense?

Ten years ago genomic sequencing of the typhoid bacteria  was carried out. Many scientists at that time wrote ecstatically about how this sequencing would lead to revolutionary changes in typhoid fever treatment.  Sadly ten years hence we have made no obvious progress in taking care of our typhoid patients. The academic thrill of discovery did not translate to more effective patientoutcome.

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. And because diseases like typhoid have no spokesperson or lobby groups andare considered biblical diseases  generally confined to the developing world population, there is clearly no incentive  to take advantage of the sequencing to, for example, makecost-effective, accurate diagnostic tools to help with patient care.

Compare typhoid  fever with HIV disease whichcontinues 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.

So it was indeed  good news when  a new organization called  the Coalition against Typhoid ( CaT) pledged to help deal with this neglected disease. At the core of CaT’s mission is a responsibility to provide a voice for the communities impacted by typhoid fever, to better define and increase awareness of the burden of typhoid at the global, regional and national levels, and to foster use of existing vaccines. CaT does not have a substantial operating budget but relies upon the collective, cooperative activities of its members to support its work plan.
Of course if we had clean drinking water and improved sanitation and plumbing, typhoid would disappear; but tremendous political will is required for this. In the meantime we need to increase awareness andhave more effective diagnosis and treatment even to inhibit transmission of this common illness.

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