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May 2014

Neglected Tropical Skin Diseases: Their Global Elimination Through Integrated Mass Drug Administration?

Author Affiliations
  • 1Sabin Vaccine Institute & Texas Children’s Hospital Center for Vaccine Development, Section of Pediatric Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
  • 2National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
  • 3Department of Dermatology, Baylor College of Medicine, Houston, Texas
JAMA Dermatol. 2014;150(5):481-482. doi:10.1001/jamadermatol.2013.8759

In 2005, the concept of a combination of essential medicines—the “rapid-impact” package—was proposed to simultaneously target 7 high-prevalence neglected tropical diseases (NTDs) in sub-Saharan Africa through programs of annual mass drug administration.1 The approach relied on the observation that the major NTDs affecting the poorest people in sub-Saharan Africa, led by hookworm infection, ascariasis, schistosomiasis, trichuriasis, trachoma, lymphatic filariasis (LF), and onchocerciasis, have similarities in terms of their abilities to cause long-term disabilities and ultimately poverty by influencing worker productivity in the tropics and child development, as well as having effects on girls and women, especially during pregnancy. Moreover, these NTDs overlap geographically and therefore can be treated at roughly the same time through once-annual administration of an integrated package containing albendazole (or mebendazole), ivermectin, praziquantel, and azithromycin.1 Together, these medicines could be administered for less than US $1 annually, making this approach highly cost-effective.

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1 Comment for this article
Colin Crawford, MRCP | Retired
It is surprising that Professor Hotez and colleagues (1) do not mention leprosy, which is a neglected tropical disease, in their discussion of skin disorders. Moreover, mass treatment campaigns, using dapsone monotherapy in northern Nigeria (2) and the ex-French territories of west and central Africa were undertaken in the 1960s. In 1967, I surveyed the village of Igabi in northern Nigeria and found that the prevalence of the disease had decreased from 67 per 1000 to 2 per 1000 after 15 years of dapsone monotherapy (3). There were no bacteriological positive patients and so transmission had ceased. Together, with other evidence, it has been possible to conclude that leprosy could be eradicated.

1. Hotez PJ, Velasquez RM, Wolf JE. Neglected tropical skin diseases. Their global elimination through integrated mass drug administration? JAMA 2014; 150 (5): 481-4822.

2. Ross CM. leprosy control programme in in Northern Nigeria. In: Cochrane RG, Davey TF .Eds. Leprosy in theory and practice. Bristol: John Wright. 1964: 595-599.

3. Crawford CL. The effect of out-patient dapsone in an area of endemic leprosy. Lepr Rev 1969; 40 (3): 159-163.

4. Crawford CL. Towards the eradication of leprosy. In: Berhardt LV ed. Adv Med Biol New York: Nova Sci Publ 2012; 56: 117-127.