Sabin Vaccine Institute, Texas Children's Center for Vaccine Development, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Tropical Medicine, Baylor College of Medicine, Houston, USA.
Adv Exp Med Biol. 2013;764:1-12. doi: 10.1007/978-1-4614-4726-9_1.
An estimated 100 million people in the Latin American and Caribbean (LAC) region live on less than US$2 per day, while another 46 million people in the US live below that nation's poverty line. Almost all of the 'bottom 100 million' people suffer from at least one neglected tropical disease (NTD), including one-half of the poorest people in the region infected with hookworms, 10% with Chagas disease, and up to 1-2% with dengue, schistosomiasis, and/or leishmaniasis. In the US, NTDs such as Chagas disease, cysticercosis, toxocariasis, and trichomoniasis are also common among poor populations. These NTDs trap the poorest people in the region in poverty, because of their impact on maternal and child health, and occupational productivity. Through mass drug administration (MDA), several NTDs are on the verge of elimination in the Americas, including lymphatic filariasis, onchocerciasis, trachoma, and possibly leprosy. In addition, schistosomiasis may soon be eliminated in the Caribbean. However, for other NTDs including hookworm infection, Chagas disease, dengue, schistosomiasis, and leishmaniasis, a new generation of 'anti-poverty vaccines' will be required. Several vaccines for dengue are under development by multinational pharmaceutical companies, whereas others are being pursued through non-profit product development partnerships (PDPs), in collaboration with developing country manufacturers in Brazil and Mexico. The Sabin Vaccine Institute PDP is developing a primarily preventive bivalent recombinant human hookworm vaccine, which is about to enter phase 1 clinical testing in Brazil, as well as a new therapeutic Chagas disease vaccine in collaboration with several Mexican institutions. The Chagas disease vaccine would be administered to seropositive patients to delay or prevent the onset of Chagasic cardiomyopathy (secondary prevention). Together, MDA and the development of new anti-poverty vaccines afford an opportunity to implement effective control and elimination strategies for the major NTDs in the Americas.
据估计，拉丁美洲和加勒比地区（LAC）有 1 亿人每天的生活费不足 2 美元，而美国有 4600 万人生活在该国贫困线以下。几乎所有“最底层的 1 亿人”都患有至少一种被忽视的热带病（NTD），其中包括该地区一半的最贫困人口感染钩虫，10%的人感染恰加斯病，多达 1-2%的人感染登革热、血吸虫病和/或利什曼病。在美国，贫困人群中也常见到恰加斯病、囊虫病、弓蛔虫病和滴虫病等 NTD。这些 NTD 对母婴健康和职业生产力产生影响，使该地区最贫困人口陷入贫困。通过大规模药物治疗（MDA），几种 NTD 即将在美洲消除，包括淋巴丝虫病、盘尾丝虫病、沙眼和可能的麻风病。此外，加勒比地区可能很快将消除血吸虫病。然而，对于其他 NTD，包括钩虫感染、恰加斯病、登革热、血吸虫病和利什曼病，需要新一代“抗贫困疫苗”。几家跨国制药公司正在开发几种登革热疫苗，而另一些则通过非营利性产品开发伙伴关系（PDP）与巴西和墨西哥的发展中国家制造商合作进行。萨宾疫苗研究所 PDP 正在开发一种主要用于预防的双价重组人钩虫疫苗，该疫苗即将在巴西进入 1 期临床试验，还与几家墨西哥机构合作开发一种新的恰加斯病疫苗。该恰加斯病疫苗将用于血清阳性患者，以延迟或预防恰加斯心肌病（二级预防）的发生。MDA 和新的抗贫困疫苗的开发为在美洲实施有效的 NTD 控制和消除策略提供了机会。
