ASTMH's Annual Meeting: TropMed24 in NOLA
Global Health NOW was honored to join the 4,000+ scientists, researchers, practitioners, and other experts gathered in New Orleans November 13-17 for the annual meeting of the American Society of Tropical Medicine & Hygiene. We love the ASTMH crowd, and enjoyed meeting professionals committed to global health from so many countries and sit in on so many informative sessions. You'll find our latest coverage below, including briefs on mpox, Hansen’s disease, and Rocky Mountain spotted fever, and a walking tour through public health history. —Brian W. Simpson and Dayna Kerecman Myers
November 17, 2024
A Win Against Sleeping Sickness—But More Work Ahead
People queue for sleeping sickness screening in Paanenefla village, Ivory Coast, on October 11, 2019. Issouf Sanogo/AFP via Getty
It’s a great public health success for Africa: Cases of human African trypanosomiasis (HAT, or sleeping sickness) have been reduced by 97% since 2000.
But the mission remains unfinished. Momentum from two decades of work has pushed public health officials to focus on interrupting transmission of the disease. But insufficient infrastucture, weak health care systems, and conflicts have made getting to zero cases extremely difficult.
While the number of cases per year has hovered at less than 1,000 for the last half dozen years, there’s actually good news beneath those numbers, WHO medical officer Gerardo Priotto told attendees of the annual meeting of the American Society of Tropical Medicine & Hygiene on Nov. 17.
The majority of cases are now found by active screening as the areas where HAT exists are being reduced, Priotto said. As new areas are deemed free of cases and cleared, health officials move into locations where active screening hasn’t been done before.
“This is advancing elimination,” Priotto said.
Priorities in the future include expanded use of single-dose oral drug acoziborole, diagnostics, and control of the tsetse fly, which transmits the disease. Other challenges include deciding on which areas need ramped-up efforts and where strategies can be scaled back. —BWS
November 16, 2024
Smallpox to Mpox: Regaining Control
NEW ORLEANS—Are we on the verge of another global mpox outbreak—of the more dangerous clade 1b version? Mpox experts took up this question on a Saturday ASTMH panel, discussing the recent surge in mpox infections and measures needed to subdue the threat.
Where we are now:
- ~70 countries—20 in Africa—have reported lab-confirmed mpox cases.
- We’re seeing the newer clade 1b version spread; it’s been confirmed in about a dozen countries, including DRC, Rwanda, Kenya, Germany, the UK, Thailand, and now, the U.S., with a new case in California reported just this week.
The new strain “comes as a surprise, but it shouldn’t,” said Rosamund Lewis, the WHO’s technical lead for the global mpox response. We don’t know yet if we’re facing another outbreak of a potentially more virulent version, she said. “But the question is, are we in the same place that we were in five or six years ago [with the emergence of clade 2b], and we’re not doing enough about it?”
What’s needed now:
Better testing options: Despite a growth in diagnostic options, stubborn testing challenges persist, including limited availability of point-of-care tests—especially in decentralized settings.
- Most of the DRC’s cases occur in a remote part of the country, where hurdles including inadequate electricity complicate testing.
- Only ~40% of samples are tested in DRC; instead, they’re shipped out, and it takes a week to get the results, noted Congolese microbiologist Jean-Jacques Muyembe.
More vaccines: The DRC’s hopes rely on the vaccine, Muyembe emphasized—and it hasn’t received enough; the DRC also faces challenging logistics to distribute the vaccine to remote stretches of the country.
A child-safe vaccine: There isn’t a vaccine approved for pediatric populations—"a group that historically … is heavily impacted by mpox,” said Christie Hutson, chief of the CDC’s Poxvirus and Rabies branch. —DKM
November 15, 2024
A Walk Through Public Health History in New Orleans
Steeped in music, food, and culture, New Orleans also has a great store of public health history to share from the past three centuries.
Dozens of attendees of the annual meeting of the American Society of Tropical Medicine & Hygiene joined walking tours of the city led by students from the Tulane University School of Public Health and Tropical Medicine. BWS
Our Lady of Guadalupe Church, on the corner of North Rampart Street and Conti, was originally known as The Mortuary Chapel because funerals of yellow fever victims were held there so they could quickly be buried in the adjacent St. Louis Cemetery. Tradition holds the funerals took place outside until it was known that the disease was transmitted by mosquitoes. BWS
New Orleans municipal regulations limited gatherings of enslaved peoples to Sunday afternoons in Congo Square, now a three-acre park on Rampart Street. The drumming and dancing there led to the birth of jazz. BWS
Yellow fever claimed more than 41,000 lives in New Orleans between 1817 and 1905, when the last epidemic of yellow fever in the U.S. occurred. Archbishop Placide Louis Chapelle was one of the victims in 1905. Mosquito larvae were found in the holy water in the St. Louis Cathedral. BWS
November 15, 2024
Internally displaced people sell goods at a market outside a UN base in Birao, Central African Republic. August 10, 2024. Amaury Falt-Brown / AFP via Getty Images
The Hardest to Reach Have the Greatest Need
Nearly half of the population of the Central African Republic is in need of humanitarian assistance. One in five people have been forced to flee their home.
In a country shattered by three decades of conflict, it’s extremely difficult to determine the nutritional and other needs of the population. It’s even harder to gather data in the most remote areas—“ which are, by definition, the areas that most need to be accessed and assessed,” said Richard Allan, founder of the MENTOR initiative which provides technical support in humanitarian emergencies.
Relying on local community health workers (CHWs), the initiative held more than 470,000 consultations with nearly under-5 children across eight subprefactures between 2015 and 2021, Allan said at a Nov. 15, 2024, presentation during the annual meeting of the American Society of Tropical Medicine & Hygiene.
Key takeaways:
- Standard nutritional surveys typically do not extend to the most hard-to-reach areas, so they are likely missing the areas with the highest levels of malnutrition.
- Chances for survival are much lower for children who are both malnourished and have malaria.
- The research found significant differences in malnutrition levels in the areas studied.
- CHWs offer important opportunities to integrate nutritional support with health care in the areas of greatest need.—BWS
November 14, 2024
The National Leprosarium in Carville, Louisiana. Nov. 11, 2011. Z28scrambler / Wikimedia Commons
The Enduring Stigma and Challenge of Hansen’s Disease
When Anne Harmon Brett was growing up, she couldn’t live with her mother and father.
The couple lived in the National Leprosarium in Carville, Louisiana—the only facility in the continental U.S. dedicated to the care of people with Hansen’s disease (leprosy). Brett remembers the Sundays when her parents would slip through a hole in the barbed wire fence so they could picnic with her beside the Mississippi River, some 70 miles from New Orleans.
After the family ate fried chicken, her parents would go back to their residence. Brett and her brother would go back home with the Cajun family who took care of them.
The stigma was so strong that Brett and her family never spoke of Hansen’s disease or leprosy. They simply called it “the disease.”
Though most people think the disease has faded into history, some 200,000 new cases of Hansen’s disease are still reported every year worldwide. And in the U.S., 150 to 200 new cases are reported annually to the CDC or the National Hansen’s Disease Program (NHDP).
The elimination of the ancient skin disease remains a distant goal, according to a Nov. 14, 2024, panel discussion at the annual meeting of the American Society of Tropical Medicine & Hygiene.
Barriers to eliminating transmission include an extraordinarily long period between infection and symptoms that is typically estimated to be five years but can take as long as 20 years, per the WHO. The fact that the Mycobacterium leprae bacterium cannot be cultured in vitro also makes research more difficult.
Stigma against people who have the disease has been a perennial barrier to early detection and reporting.
And treatment for the disease can be an arduous regimen that requires taking daily medications for years, said Barbara Stryjewska, NHDP director of Medical Services.—BWS
November 14, 2024
Aron Villanueva tends to the grave of his grandson Axel Villanueva who died of Rocky Mountain Spotted Fever, in Ejido Padre Kino, Mexico. June 6, 2023. Michael Robinson Chávez/The Washington Post via Getty Images
A Lethal Disease Hidden in Plain Sight in Mexico
It’s among the deadliest of severe infectious diseases. It moves rapidly to damage all tissues and organs. It causes telltale red spots to erupt on the body.
Rocky Mountain Spotted Fever (RMSF) is also bacterial threat that continues to spread in the Americas because of a lack of research and awareness, according to experts at a Nov. 14, 2024, session at the annual meeting of the American Society of Tropical Medicine & Hygiene.
RMSF’s case fatality rate (CFR) in recent years has rivaled that of dengue, yellow fever, and bubonic plague. Its CFR has ranged from 5% in Arizona to nearly 40% in parts of Mexico and above 50% in Sao Paulo, Brazil.
The disease is a significant public health threat in northern Mexico, where nearly 10,000 cases have been documented in the last 15 years, said Gerardo Álvarez-Hernández, of the University of Sonora.
“The disease in Mexico is a social and public health problem unfairly affecting vulnerable individuals and communities,” said Álvarez-Hernández.
The bacterium Rickettsia rickettsii spreads via several tick species that feed on stray dogs and infect humans. The lack of control of both the ticks and stray dogs means lead to outbreaks among vulnerable populations, disproportionately affecting people living in poverty, per a July 2024 PLOS Neglected Tropical Diseases article by Gerardo Álvarez-Hernández and colleagues.
Death can be avoided if the patient is treated early with the antibiotic doxycycline.—BWS
November 14, 2024
Employees transfer barrels of artemisinin at a pharmaceutical company in southern China on Aug. 27, 2024. Huang Xiaobang/Xinhua via Getty Images
Rising Resistance Threatens a Key Malaria Drug
In yet another ominous sign for malaria treatment’s prospects, the malaria parasite is acquiring partial resistance to a key medication used to care for children experiencing severe malaria, according to a study published today in JAMA and presented at the annual meeting of the American Society of Tropical Medicine & Hygiene.
Major findings:
- The study, led by Ugandan researchers Ruth Namazzi and Robert Opoka from Makerere University in Kampala, found partial resistance to the malaria drug artemisinin in 11 of 100 children treated for severe malaria.
- They found that 10 patients “cured” of severe malaria experienced a resurgence of the same strain of the parasite within 28 days of the original infection—which implies the first treatment didn’t fully eliminate the parasite, said study coauthor Chandy John.
- They also noted that it took more than 72 hours to clear the parasites in two children—a duration that the WHO defines as early treatment failure.
The Quote: “We need studies to confirm whether other places are finding these elevated rates of artemisinin partial resistance,” John said. “We’ll need to see what happens over the next couple of years to see just how bad this problem is in Africa.”
Brian W. Simpson, Global Health NOW
November 13, 2024
Monique Wasunna Delivers Stirring Call to Decolonize Science
NEW ORLEANS—Monique Wasunna, the Africa ambassador for the Drugs for Neglected Diseases Initiative, delivered a moving appeal to for the decolonization of science in a keynote address kicking off ASTMH’s annual meeting.
Wasunna recounted the dark history of colonial-era media research conducted in Africa with no benefit to the locals, often without any ethical guidelines. And the COVID-19 response, which saw rich countries hoard vaccines while Africa went without, revealed another form of imperialism, she added, asking: “What is the point of making scientific discoveries if the people it will benefit do not have access to them?”
Despite these hurdles, an Africa-led research renaissance has taken root and strengthened steadily over the course of the last several decades, Wasunna noted, reflecting on her career on the frontlines of many groundbreaking success stories. —Dayna Kerecman Myers
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Busy street life in downtown New Orleans, November 8, 2019. Getty