Neglected tropical diseases in India

Neglected tropical diseases in India (NTDs) are a group of bacterial, parasitic, viral, and fungal infections that are common in low income countries but receive little funding to address them. Neglected tropical diseases are common in India.

India's population is about 1.3 billion as of 2018, which is the second largest in the world.[1] However, high population does not explain the greater frequently of NTDs in India than in other countries.[1] NTDs in India occur in areas of both urban and rural poverty.[1]

The neglected tropical diseases which especially affect India include ascariasis, hookworm infection, trichuriasis, dengue fever, lymphatic filariasis, trachoma, cysticercosis, leprosy, echinococcosis, visceral leishmaniasis, and rabies.[2]

List
Main article: Neglected tropical diseases

Various organizations will include different diseases under the umbrella term of "neglected tropical diseases," but most diseases listed as such occur in tropical climates, lack global public attention, and have high infection rates. The World Health Organization recognizes 20 NTDs,[3] of which 12 are present in India.

Protozoan

Visceral leishmaniasis (kala-azar)

India has a goal for the elimination of kala-azar.[4] The steps to eliminating the disease include passive and active case detection, early diagnosis and treatment, and vector control integrated into medical treatment.[4][5]

Before the year 2000 there was hope and expectation that India could completely eliminate kala-azar from the country.[6] In those years there were various programs to continue usual treatments and develop new ones.[6] Around year 2000 there were reports that parasites which cause kala-azar had developed drug resistance to pentavalent antimonial, which was the popular drug for treating this disease for the last 50 years.[7][8] The disease spread to become a problem again and now more difficult to treat.[6] In poorer areas of India underreporting of the disease was a problem, allowing the disease to spread.[9] The newer treatments of that time were expensive.[10]

The treatment of kala-azar in India since about year 2000 has been difficult.[11] In 2017 the Indian government had contained kala-azar in certain regions with the goal of providing easy access to medical treatment to completely eliminate it from the country.[12] The intent was that by 2020 the disease should be very uncommon and also should never spread or grow again.[13] Physicians use a drug to treat kala-azar both before and after the patient seems cured, but take care to use a safe amount.[14] The work that health agencies in India have done to reduce kala-azar are learning models for India or any other country to apply to other public health programs to eliminate infectious disease.[15]

African trypanosomiasis

African trypanosomiasis (sleeping sickness) is not a problem in India.[16] Researchers do monitor watching for the disease.[16] In 2005, an Indian farmer became ill following an unusual infection with an Indian species of this parasite called Trypanosoma evansi.[17]

Chagas disease

Chagas disease is not a problem in India.[16] Chagas disease, like African trypanosomiasis, has a Trypanosoma parasite as its cause.[16][17] This parasite is not in India.[16][17]

Worms

Soil-transmitted helminthiasis

Soil-transmitted helminthiasis is a group of various parasitic diseases which differentroundworms cause. The large roundworm causes Ascariasis, the hookworm causes Hookworm infection, and the whipworm causes Trichuriasis. These worms are related and there are strategies for prevention which apply to all of them.[18]The World Health Organization estimated that in 2015, 75% of the children in India who had Soil-transmitted helminthiasis also got treatment.[1][19]

Lymphatic filariasis
Main article: Lymphatic filariasis in India

India has 40% of the world's lymphatic filariasis (LF) cases.[20] For the patient, one of the major costs of treating the disease is having to take a lot of time off work.[20] A year 2000 survey reported that about half of the people in India were at risk of contracting LF.[21] Men and women can get this disease equally, but in the past, there have been barriers to women accessing treatment in the normal way.[22]

In 1955 the Indian government established the National Filaria Control Programme to reduce LF.[23] In 1997 India joined a World Health Assembly resolution to eliminate LF by 2020.[23] In India to achieve this goal healthcare must be very accessible to almost everyone at risk for the disease.[24] In 2015 the Indian government launched a health campaign called Hathipaon Mukt Bharat (Filaria Free India) to encourage public participation in eliminating LF.[25]

Following some missed deadlines in 2015 and before a 2020 target date for eliminating LF, various media outlets discussed how India might meet the goal or what it should happen next if more time is required.[26][27][28]

The Ayurvedic text Sushruta Samhita described lymphatic filariasis.[23]

Echinococcosis

Echinococcosis is a parasitic disease of tapeworms.[29][30][31][32]

Cysticercosis

Taeniasis and cysticercosis are both parasitic diseases caused by tapeworms in the family Taeniidae.

Eliminated - guinea worm

Guinea-worm disease was an NTD in India until the year 2000 when fortunately people in India eradicated the disease.[33] In 2006 India announced the eradication of yaws after going since 2003 with no reported cases of the disease.[34]

Foodbourne trematode infection

Foodbourne trematode infection is not a problem in India.

From 1969-2012 there have only been a few reports of a few people in India getting fasciolosis (foodbourne trematode infection).[35] The disease is endemic among cows, buffalo, sheep, and goats in India.[36] A 2012 paper which reported two human infections urged for attention that human infection might be more prevalent.[37]

Onchocerciasis

Onchocerciasis (river blindness) is not a problem in India.

Onchocerciasis has been found in India in an unusual case.[38]

Schistosomiasis

Schistosomiasis is not a problem in India.

A 2015 report described that while India has no routine reports of schistosomiasis, the disease might be present and unreported.[39] A 1952 paper described the disease present in an Indian village and how WHO investigators treated the disease and tried to identify its source.[40][41] In retrospect, that older paper was unusual, and either this disease is uncommon in India or difficult to detect.[40]

Fungus

Mycetoma
location, cause, and number of cases of mycetoma in India in 2013

Mycetoma is an infection under the skin which in India may have either a fungus or a bacteria as cause.[42][42] In Rajasthan the cause is usually a fungus, but elsewhere in India a bacteria usually causes the disease.[42]

Small health surveys have shown that mycetoma is common in central India.[43]

The disease is difficult to treat.[44] The treatment for fungus will not work on the bacteria and vice versa.[44] When it is a bacteria the treatment period is long.[44]

In 1874 Henry Vandyke Carter, a British surgeon, wrote a book titled On mycetoma, or the fungus disease of India.[45]

Bacteria

Leprosy
Main article: Leprosy in India

From 1983 till 2005 India organized successful programs to eliminate leprosy as a public health problem.[46] While these programs reduced the number of people in India with leprosy from 58 in 10,000 to 1 in 10,000, they did not eliminate leprosy entirely.[46] Completely eliminating the disease is possible in the near future.[47] The National Leprosy Eradication Program is part of the government solution to ending the disease.

Without health intervention, it is possible that leprosy rates could rise and all the progress could be lost.[48]

A 2018 study reported that India does well at detecting leprosy in poor areas, but more often misses cases in places with more money.[49]

A 2019 report described how newly available technology should make detecting and treating leprosy in India more easy.[50]

Trachoma

In December 2017 the health minister of India announced that India was free of trachoma.[51][52] This announcement included a statement that there were no children in India who had an active case of trachoma.[53]

A 2011 paper had speculated that India could eliminate trachoma within 10 years.[54]

Yaws

The Indian government began programs to eliminate yaws in the 1950s.[55] India began its Yaws Eradication Program in 1996 and identified 735 cases at its start.[56] In 2004 the Indian government announced that the health program seemed to have eliminated the disease.[56] Even after yaws seemed to be gone, the government continued monitoring and searching for cases heavily through 2006.[56] Following that, there was a program to investigate rumors of yaws through 2011.[55]

In May 2016 the World Health Organization declared India free of yaws.[57] India was the first country where yaws was endemic and which eliminated it.[58] This success in India led to excite for other countries to also try to eliminate yaws by year 2020 using techniques which India developed.[59]

Buruli ulcer

Buruli ulcer is not a problem in India.

In 2019 physicians identified a case of Buruli ulcer in India, but the patient was from Nigeria where the disease is present.[60]

Viruses

Dengue fever and chikungunya fever

The WHO groups dengue and chikungunya fever together, but these are separate conditions.

Chikungunya is not a problem in India. India did have chikungunya cases before 1973 when the disease was eliminated. In 2005 India got another case of this.[61][62] Checkungunya cases are rising in India [63]

Rabies

Rabies has been a problem in India since ancient times.[64] Rabies often comes from dog bites.[64]

In India there are many stray dogs and many people report being bitten by them.[65] To determine whether someone requires treatment for rabies or only treatment for the bite, the physician should have information about the incidence of rabies in animals in the area.[66] In India about 2% of people who are bitten get a rabies vaccine.[65][67] A 2012 paper argued that there was now enough information about rabies in India to plan to contain and prevent the disease nationally.[68]

For people in India who get rabies the death rate is nearly 100%.[69]

Other

Scabies

Incidence of scabies in India ranges from 13-59% throughout observed areas.[70] Little research exists on how much this condition affects Indian people's work, leisure, and sleep.[70]

Various epidemiological studies exist reporting the number of people in India with scabies in various times and places.[71][72]

Topical Permethrin and oral ivermectin are commonly available in India for treatment.[73][74]

Snakebites
Indian cobra bites are a serious problem.

The envenomation is the danger of the snakebite, and not the bite itself.[75][76] The four snakes in India which account for most bites are the Indian cobra, common krait, Russell's viper, and saw-scaled viper.[77] Besides these four there are various other snakes which bite enough to require an organized medical response.[77]

In May 2018 the World Health Organization declared that responding to snake bites is a global health priority.[78]

Some places in India use traditional folk medicine with plants to treat snakebite.[79]

Designing antivenom is a challenge because different snakes require different antivenom to treat, and there are many types of snakes in India.[80]

97% of snake bites occur in rural areas.[81]

Snakes have a special place in Indian society and culture.[82] Because of this, many people who receive a snakebite treat their illness with less medical urgency than they would some other disease.[82]

A 2010 review of snake bite in India found that there is underreporting of the problem and also insufficient health care treatment available.[83]

A 1954 study tracked snake bites since 1940. This study estimated 300,000-400,000 bites a year with 10% of those being deadly.[84]

Treatment which should be available but which are sometimes hard to get includes a whole blood clotting test and a venom detection kit.[85]

Epidemiology

India and South Asia have about half of the world's cases of kala azar, lymphatic filariasis, and leprosy.[86] The region also has about a third of rabies deaths and a quarter of the South Asia, in addition to one-third of the rabies deaths, one-quarter of the intestinal helminth infections.[86] As of 2014 there was not good information about dengue and Japanese encephalitis, but these diseases are a major burden in India also.[86]

Of the 17 NTDs which the World Health Organization recognized in 2017, 6 of those diseases are common in India.[87] Those 6 diseases are Lymphatic filariasis, kala-azar (Visceral leishmaniasis), Leptospirosis, Rabies, Soil-transmitted helminthiasis, and Dengue fever.[87]

The Global Burden of Disease Study is a regularly updated report which attempts to describe the extent to which each major disease in the world affects individuals with those diseases.[1] This report identifies surprising problems and described them to be unknown among many health professionals.[1] One surprising finding of the 2016 Global Burden of Disease study is that India has the most and worst cases of 11 of the 16 neglected tropical diseases it considered.[1] India has the most cases of all neglected tropical diseases which occur in India.[1]

New cases of NTDs in 2016[1][88][89]
neglected tropical disease Cases in India Total cases globally India's percent
of global total		 India's incidence rank
Ascariasis 222 million 799 million 28% 1
Hookworm infection 102 million 451 million 23% 1
Trichuriasis 68 million 435 million 16% 1
Dengue fever* 53 million 101 million 53% 1
Lymphatic filariasis 8.7 million 29.4 million 29% 1
Trachoma† 1.8 million 3.3 million 53% 1
Cysticercosis 819,538 2.7 million 31% 1
Leprosy 187,730 523,245 36% 1
Echinococcosis 119,320 973,662 12% 1
Visceral leishmaniasis 13,530 30,067 45% 1
Rabies* 4,370 13,340 33% 1
* - only new cases
† - only cases causing visual impairment

Prevention

Elimination of as many of these diseases as possible is a goal.[90]

The government of India collaborates with the World Health Organization in making financial investments in health care for the purpose of reducing and eliminating NTDs in India.[91]

In 2005, the Indian Health Ministry, Bangladeshi Health Ministry, and the Nepali Health Ministry shared a memorandum of understanding to eliminate kala-azar in their shared region by 2015.[92]

A 2015 study reported that India's public health programs were reducing leprosy rates but not quickly enough to eliminate the disease from the region.[93]

In 2017 the Indian government began participating in the World Health Organization's plan to eliminate 10 of the NTDs.[87] The government strategy was to reduce poverty, promote sanitation, do vector control, and provide public health education.[87]

Society and culture

The neglected tropical diseases are diseases of poverty and poverty reduction in society will reduce them.

Some people feel embarrassed to have a disease, but a disease is not anyone's fault.[94] The government of India sometimes has organized health campaigns to teach about diseases so that people feel comfortable coming for medical help when they need it.[94]

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