Division of Parasitic Diseases and Malaria (DPDM)
2017 DPDM SNAPSHOT
- Conducted more than 6,700 diagnostic tests for parasitic diseases and responded to more than 6,300 hotline inquiries, providing advice on diagnosis and treatment to healthcare providers, blood banks, and other essential healthcare facilities, as well as advice on preventing malaria among travelers to improve diagnosis and treatment of parasitic diseases.
- Managed the release of otherwise unavailable, life-saving medications for 150 patients in the United States with parasitic infections.
- Led or assisted with 14 investigations of parasitic infections associated with organ transplantation involving 20 organ recipients.
- Provided, through the U.S. President’s Malaria Initiative (PMI), technical expertise to benefit 480 million people at risk of malaria across sub-Saharan Africa and in communities in the greater Mekong sub-region, including on vector control, appropriate diagnosis and treatment, surveillance, and monitoring and evaluation.
- Received 88.5% of all visits to the CGH website to DPDM pages, as according to web metrics, visitors sought information on topics such as the treatment of malaria, lifecycles of various parasites, or other parasitic diseases.
Year In Review
Providing expert technical advice to providers in the U.S. and around the world on parasitic diseases
DPDM staff provided expert technical advice on the prevention, diagnosis, and treatment of parasitic diseases through its 24-hour hotlines, responding to more than 6,300 inquiries in 2017. DPDM also facilitated the release of otherwise unavailable life-saving medications for 150 patients in the United States with parasitic infections including Chagas disease (71) and severe malaria (41).
Developing novel approaches to vector surveillance
In response to the Zika virus outbreak, DPDM’s Integrated Vector Management team developed a field-friendly tool for monitoring mosquito populations based on CDC’s open source program, Epi Info™ 7. The tablet- based app will save time, improve data quality, and help vector control programs standardize information across geographical areas for better comparisons. In 2017, the team conducted targeted hands-on training on the new app to 138 surveillance and vector control staff in Haiti, Sierra Leone, Dominican Republic, and Trinidad & Tobago. Staff conducted additional international hands-on trainings in Sierra Leone, where participants represented 12 West African countries, and again in Thailand.
Refining preventive chemotherapy for lymphatic filariasis
DPDM has a long history of fighting lymphatic filariasis (LF), a debilitating neglected tropical disease (NTD) spread by the bites of mosquitoes. Over the past several years, DPDM staff have provided key technical assistance to the Ministry of Public Health and Population in Haiti to ensure proper monitoring of a study to determine the frequency, type, and severity of adverse reactions following triple-drug LF therapy, compared to the standard two-drug therapy. In October 2017, WHO revised recommendations for preventive chemotherapy of LF, changing the recommendation to a three-drug regimen based on the results of this and other completed studies in Fiji, India, Indonesia, and Papua New Guinea. In 2017, DPDM staff also continued to support the implementation of triple-drug LF therapy to help achieve the elimination of LF in American Samoa.
Proving that malaria interventions work in sub-Saharan Africa
In September 2017, DPDM staff led the publication of a special supplement in the American Journal of Tropical Medicine and Hygiene, “Evaluating the Impact of Malaria Control Interventions in Sub-Saharan Africa,” which demonstrated that over the last decade global malaria control efforts have saved millions of children’s lives in the areas most affected by malaria. In nine novel articles, the authors, including those from PMI and other partner agencies, presented real-world evidence of declining trends in malaria infection and illness as well as improved child survival across sub-Saharan Africa. For example, the authors noted that between 2000–2015 malaria deaths declined by 60 percent, and almost seven million lives were saved.
Decreasing malaria deaths in sub-Saharan Africa
Integrating elimination efforts across diseases
In 2015, CDC, the Nigeria National Malaria Elimination Programme (NMEP), the Nigeria Field Epidemiology and Laboratory Program (NFELTP), and the National Stop Transmission of Polio (NSTOP) program initiated the NSTOP/ Malaria Frontline Project to improve malaria control in Nigeria by strengthening the capacity of the public health system to reduce malaria, as well as to improve the prevention, detection, and response to epidemics and other high-impact diseases. The project builds on the experience gained from polio eradication efforts and the Ebola response to strengthen capacity at the facility, local government area, and state levels to analyze and use malaria surveillance data for decision making. In 2017, the Malaria Frontline Project provided training, onsite mentorship, and technical support to more than 5,000 local government health officials across Kano and Zamfara States. Now community healthcare workers can carefully monitor the stocks of malaria prevention and treatment supplies and trends in local illness cases diagnosed and treated in each of the health facilities. They are also able to use data to spot early trends and to target emergency supplies and outreach efforts at the time and place they are most needed.
Partnering to eradicate Guinea worm disease
In January 2017, WHO redesignated the Parasitic Diseases Branch in DPDM as a PAHO/WHO Collaborating Centre (WHOCC) for Dracunculiasis Eradication, continuing CDC’s longstanding commitment to eradicating Guinea worm disease (GWD) globally. One of DPDM’s critical contributions to the global program is aiding in the proper diagnosis of GWD from suspect cases. In 2017 DPDM staff examined 111 individual worm specimens received from humans and animals with suspected GWD.
Innovating diagnosis of NTDs
Since 2012, DPDM laboratories have been working on the development of antibody-based testing for post- elimination surveillance for the eye disease trachoma, an NTD, with a focus on the Chlamydia trachomatis antigen, Pgp3. Historically the only primary method for diagnosis was physical examination of the eye and/or examination of stained conjunctival scrapings of the eye. By the end of 2017, DPDM-developed tests had been evaluated by laboratories in three African countries, and more than 60,000 blood samples from 29 districts in 11 countries had been tested using the new test.
Increasing provider awareness of parasitic diseases in the United States
DPDM is committed to raising awareness of five neglected parasitic infections in the United States, including Chagas disease. In September 2017, DPDM staff participated in an all-day continuing medical education (CME) symposium, “Chagas disease in the United States: Improving Patient Diagnosis and Treatment,” held at Einstein College of Medicine in the Bronx, NY. The symposium, supported by DPDM’s neglected parasitic infections cooperative agreement, included discussion of the epidemiology and clinical aspects of Chagas disease and how to diagnose and manage patients with Chagas disease in the United States. More than 100 health care providers were trained on general clinical management, approaches to managing chagasic cardiac disease, and the results of a trial that assessed the impact of treatment on patients with early chagasic cardiac disease.
- Bhattarai A, Kachur SP. Evaluating the Impact of Malaria Control Interventions in sub-Saharan Africa. American Journal of Tropical Medicine and Hygiene. 2017; 97(3) Suppl.
- Gutman J, Kovacs S, Darsey G, et al. Safety, Tolerability, and Efficacy of Repeated Doses of Dihydroartemisinin-piperaquine for Prevention and Treatment of Malaria: A Systematic Review and Meta-Analysis. Lancet. 2017; 17(2):184–193. doi.org/10.1016/S1473-3099(16)30378-4.
- Gwyn SE, Xiang L, Kandel RP, et al. Prevalence of Chlamydia trachomatis-Specific Antibodies before and after Mass Drug Administration for Trachoma in Community-Wide Surveys of Four Communities in Nepal. American Journal of Tropical Medicine and Hygiene. doi:10.4269/ ajtmh.17-0102.
- Halsey ES, Venkatesan M, Plucinski MM, et al. Capacity Development through the US President’s Malaria Initiative–Supported Antimalarial Resistance Monitoring in Africa Network. Emerging Infectious Diseases. 2017; 23(13). doi:10.3201/eid2313.170366.
- Karanja DMS, Awino EK, Wiegand RE, et al. Cluster Randomized Trial Comparing School- Based Mass Drug Administration Schedules in Areas of Western Kenya with Moderate Initial Prevalence of Schistosoma mansoni Infections. PLoS Neglected Tropical Diseases. 2017; 11(10):e0006033. doi.org/10.1371/journal. pntd.0006033.
- Messenger LA, Shililu J, Irish S, et al. Insecticide Resistance in Anopheles arabiensis from Ethiopia (2012–2016): A Nationwide Study2115-2. for Insecticide Resistance Monitoring. Malaria Journal. 2017; 16(469). doi:10.1186/s12936-017-
- Rogier E, Plucinski M, Lucchi N, et al. Bead- Based Immunoassay allows sub-Picogram Detection of Histidine-Rich Protein 2 from Plasmodium falciparum and Estimates Reliability of Malaria Rapid Diagnostic Tests. PLoS ONE. 2017; 12(2):e0172139. doi:10.1371/journal. pone.0172139.
- Tan KR, Henderson SJ, Williamson J, et al. Long Term Health Outcomes among Returned Peace Corps Volunteers after Malaria Prophylaxis, 1995–2014. Travel Medicine and Infectious Diseases. 2017; 17:50–55. doi.org/10.1016/j.tmaid.2017.05.003.
DPDM protects the health of Americans, including active and retired military personnel, travelers returning to the United States, and those living abroad, as well as the global community, from parasitic diseases. We:
- Provide life-saving diagnostic, consultative, and epidemiologic and entomologic services and training.
- Prevent, track, and treat parasitic diseases in the United States.
- Prevent, control, and eliminate NTDs and malaria, including co-implementing PMI with USAID.
- Conducting innovative research to accelerate control and elimination of malaria and NTDs worldwide.
Protecting Americans: Working with healthcare providers to deliver life-saving diagnosis and treatment of parasitic diseases in the United States, and to disseminate up-to-date, data-driven guidelines and recommendations for public health partners and the public.
Eliminating the Global Burden of Malaria and NTDs: Reducing the global deaths, illnesses, and risks of malaria and NTDs by providing scientific support to ensure data-driven, effective disease control and elimination programs.
Advancing Research: Conducting research to develop tools and approaches to better detect, prevent, and control parasitic diseases, mitigate drug and insecticide resistance, and accelerate progress towards elimination.