Syphilis, malaria rampant 'because of testing problems'

Elimination of killer diseases a long way off because of lack of investment in diagnostics The elimination of killer diseases such as congenital syphilis and malaria is still a long way off, due to the diagnostics landscape in the developing world, researchers from the London School of Hygiene & Tropical Medicine said today. The World Health Organisation has set a global goal for the elimination of congenital syphilis as a public health problem, to be achieved through the reduction of prevalence of syphilis in pregnant women and the prevention of mother-to-child transmission. In relation to malaria, WHO has frequently referred to the ‘moral imperative’ to eliminate the disease. But experts from the London School of Hygiene & Tropical Medicine today told a gathering of science journalists how deficit in investment in diagnostics, access, regulatory control and lack of quality standards for test evaluations are hampering control efforts for these two preventable and treatable diseases. The session was held at the Wellcome Trust headquarters in London as part of the World Conference of Science Journalists 2009. Congenital syphilis can be prevented by a single dose of penicillin delivered before the third trimester – this is one of the most cost-effective interventions available in terms of cost per life-year saved – while an evaluation in Nairobi showed that on-site testing and treatment increased coverage from below 10% to more than 90%. Simple, point-of-care diagnostic tests are now available, yet access varies widely across the region, with the result that the disease still kills more babies than HIV (an estimated 12 million people are infected each year). In sub-Saharan Africa 2 million women with syphilis become pregnant each year. 1.6 million go untreated, with half a million babies dying from the disease. Malaria kills a child every 30 seconds. There were 247 million cases in 2006, causing nearly one million deaths, mostly among African children. Yet malaria is preventable and curable and progress is being made in reducing disease burden. However, one problem is a lack of tools for disease surveillance, which is hampering efforts to monitor this reduction in disease burden. Scientists, including LSHTM Professor of Diagnostics Rosanna Peeling, who is presenting at this session, have worked tirelessly to develop new rapid tests for diagnosing syphilis in the field. These tests are very sensitive and specific, easy to perform and read, do not require complex equipment or electricity, cost next to nothing and provide an accurate result in 20 minutes. But they are still not reaching those who need them. Professor Peeling explains: ‘Ninety nine per cent of women with syphilis are asymptomatic, so early screening is essential. Coverage is low, however, 38% on average in sub-Saharan Africa, and the death toll is catastrophic. We have to make screening and treatment more accessible to those at risk. New point-of-care tests have the potential to make this happen, but without political commitment and funding women and babies will continue to die’. Chris Drakeley, Director of LSHTM’s Malaria Centre, comments: ‘For malaria, much of the focus has been effectively diagnosing disease in a clinical setting, but with a shift in focus to elimination different diagnostics are required. At present, there is a lack of appropriate diagnostic tools to determine whether or not we have reduced malaria transmission, and to monitor progress towards elimination’. He highlights the need for an additional investment focus for developing such tools and improving methods of surveillance across sub-Saharan Africa. David Mabey, Professor of Communicable Diseases at the London School of Hygiene & Tropical Medicine, concludes: ‘These diseases can be prevented with simple, cost-effective interventions but if we do not address the problem of inequity of access, nothing will change. We must encourage pharmaceutical companies to begin seeing the development of quality diagnostics for these diseases as worthy of their time and investment, and Ministries of Health at country level to make greater efforts to ensure that new technologies and treatments both accessible and affordable for the people who need them’. Ends

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