Specific chemotherapy of Chagas disease: relevance, current limitations and new approaches.

Despite economic and medical advances, acute rheumatic fever and consequent rheumatic heart disease remain a major public health burden in low and middle-income countries, and a designated priority for the World Health Organisation. The clinical consequences are major and enduring, particularly for women of child-bearing age, and access to diagnosis, preventive therapy and transcatheter or surgical interventions remains a challenge. Herein, we provide a summary of key aspects of the condition, with particular focus on epidemiology, pathogenesis and immune mechanisms, diagnosis and clinical manifestations, contemporary management and preventive strategies.

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Acute rheumatic fever and rheumatic heart disease

Health research priority setting processes assist researchers and policymakers in effectively targeting research that has the greatest potential public health benefit. Many different approaches to health research prioritization exist, but there is no agreement on what might constitute best practice. Moreover, because of the many different contexts for which priorities can be set, attempting to produce one best practice is in fact not appropriate, as the optimal approach varies per exercise. Therefore, following a literature review and an analysis of health research priority setting exercises that were organized or coordinated by the World Health Organization since 2005, we propose a checklist for health research priority setting that allows for informed choices on different approaches and outlines nine common themes of good practice. It is intended to provide generic assistance for planning health research prioritization processes. The checklist explains what needs to be clarified in order to establish the context for which priorities are set; it reviews available approaches to health research priority setting; it offers discussions on stakeholder participation and information gathering; it sets out options for use of criteria and different methods for deciding upon priorities; and it emphasizes the importance of well-planned implementation, evaluation and transparency.

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A checklist for health research priority setting: nine common themes of good practice

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60393-5.pdf

New vaccines for tuberculosis

A disproportionate burden of helminthiases in human populations occurs in marginalised, low-income, and resource-constrained regions of the world, with over 1 billion people in developing areas of sub-Saharan Africa, Asia, and the Americas infected with one or more helminth species. The morbidity caused by such infections imposes a substantial burden of disease, contributing to a vicious circle of infection, poverty, decreased productivity, and inadequate socioeconomic development. Furthermore, helminth infection accentuates the morbidity of malaria and HIV/AIDS, and impairs vaccine efficacy. Polyparasitism is the norm in these populations, and infections tend to be persistent. Hence, there is a great need to reduce morbidity caused by helminth infections. However, major deficiencies exist in diagnostics and interventions, including vector control, drugs, and vaccines. Overcoming these deficiencies is hampered by major gaps in knowledge of helminth biology and transmission dynamics, platforms from which to help develop such tools. The Disease Reference Group on Helminths Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps. In this review, we provide an overview of the forces driving the persistence of helminthiases as a public health problem despite the many control initiatives that have been put in place; identify the main obstacles that impede progress towards their control and elimination; and discuss recent advances, opportunities, and challenges for the understanding of the biology, epidemiology, and control of these infections. The helminth infections that will be discussed include: onchocerciasis, lymphatic filariasis, soil-transmitted helminthiases, schistosomiasis, food-borne trematodiases, and taeniasis/cysticercosis.

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A research agenda for helminth diseases of humans: the problem of helminthiases.

The need for new pharmaceutical tools to prevent and treat neglected diseases is widely accepted [1]. The creation of a vaccine for HIV/AIDS, more effective diagnostics for tuberculosis (TB), and better treatments for leishmaniasis and sleeping sickness would greatly improve health in the developing world in line with the United Nations Millennium Development Goals. However, funders wishing to invest in this vitally important area currently face an information gap.

There is little consensus on what constitutes a neglected disease or what new products are required [2]. Health research funding figures have been published by the Council on Health Research for Development and the Global Forum for Health Research [3,4], but these do not disaggregate product-related research and development (R&D) or neglected disease investments.

Specific R&D investment data are available for some neglected diseases—including annual surveys of HIV/AIDS and TB funding since 2000 and 2005, respectively [5,6], and a one-off survey of malaria R&D funding published in 2005 [7]—but these cannot readily be compared since each survey uses different methodologies and covers different diseases, products, donors, and countries. For most neglected diseases, there is simply no information.

In order to address these information deficits, the Bill & Melinda Gates Foundation commissioned the George Institute for International Health to conduct five sequential annual surveys of global investment into R&D of new pharmaceutical products to prevent, manage, or cure diseases of the developing world. This article summarises key data from the first G-FINDER report (http://www.thegeorgeinstitute.org/prpppubs).

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Nicole Jameson

Papers

Neglected Disease Research and Development: How Much Are We Really Spending?