Neglected tropical diseases

Renewed medicine donation to sustain global fight against liver infection

23 July 2018 | Geneva –– The World Health Organization (WHO) and Novartis have signed an agreement that allows countries endemic for fascioliasis to continue receiving the donation of triclabendazole1 for the treatment of the disease.

Fascioliasis is a neglected tropical disease caused by parasitic flatworms (trematodes or leaf-shaped worms) that mainly affect the liver.

©HCC. Liver fluke

Today’s agreement shows WHO’s continued engagement and willingness to work with partners across sectors to provide better access to free treatment to hundreds of thousands of mainly poor people,” said Dr Ren Minghui, WHO Assistant Director-General for Communicable Diseases. “While timely treatment is the quickest way to cure infected individuals and prevents the development of advanced morbidity, other measures should also be considered to reduce transmission rates among humans”.

WHO estimates that at least 2.4 million people are infected in more than 70 countries worldwide, with several millions at risk. No continent is free from fascioliasis, and it is likely that where animal cases are reported, human cases also exist. Areas known for of high transmission include highlands of South America, the Nile valley, the Caspian sea basin and countries in east Asia and south-east Asia.

Novartis looks forward to its continued partnership with WHO to reduce the burden of fascioliasis around the world through access to effective treatment,” said Patrice Matchaba, Group Head of Global Health and Corporate Responsibility. “The extension of our donation through 2022 is a testament to our company’s long-term commitment to reimagine the fight against neglected tropical diseases”.

Under the current agreement, Novartis has agreed to donate up to 600 000 quality assured tablets (250 mg ) annually for treatment of fascioliasis for a period of four years (2019-2022). Novartis has been donating the medicine through WHO since 2005 and an estimated two million people have benefitted from free treatment.

Triclabendazole, the only medicine recommended by WHO for treatment of fascioliasis, is active against both immature and adult parasites and cure rates are high. In case of treatment failure, the dosage may be increased as per WHO recommendations.2

The donation will enable many countries to continue preventive treatment through large-scale programmes, particularly in communities where cases are clustered,” said Dr Antonio Montresor, Medical Officer, WHO Department of Control of Neglected Tropical Diseases. “The availability of the medicine in peripheral health centres increases access to treatment, particularly to children of school age who have both the highest prevalence and intensity of infection”.

Life cycle

Fascioliasis is acquired when people ingest aquatic vegetables to which the larval forms of the parasite are attached. The two species of trematodes that cause fascioliasis (Fasciola hepatica and F. gigantica) are leaf-shaped worms, large enough to be visible to the naked eye.

The life cycle of the disease is quite complex as it involves a final host (where the adult worm lives), an intermediate host (where the larval stages of the worm develop) and a carrier (entailing suitable aquatic plants).

The process starts when infected animals defecate in fresh-water sources. Since the worm lives in the bile ducts of such animals, its eggs are evacuated in faeces and hatch into larvae that lodge in a particular type of water snail (the intermediate host).

Once in the snail, the larvae reproduce and eventually release more larvae into the water. These larvae swim to nearby aquatic or semi-aquatic plants, where they attach to the leaves and stems and form small cysts.

When the plants with the small cysts attached are ingested, they act as carriers of the infection. Watercress and water-mint are effective plants for transmitting fascioliasis.

Sustainability of control beyond medicine

Significant long-term progress can be achieved through the promotion of disease awareness and education as well as the cultivation of vegetables in water which is free of faecal pollution. Thorough cooking of vegetables before consumption is also important.

Veterinary public health measures which imply treating domestic animals and other environmental measures such as control of snails and appropriate drainage of grazing lands can support long-term control.

Requesting triclabendazole

Information on how eligible countries can obtain donation of triclabendazole can be found here.

1Triclabendazole is marketed by Novartis as Egaten®
2The WHO-recommended regimen is 10 mg/kg body weight administered as a single dose in both clinical practice and preventive chemotherapy interventions. Where treatment failure occurs, the dosage may be increased to 20 mg/kg body weight in two divided doses administered 12–24 hours apart.

Ashok Moloo
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