Cystic echinococcosis in Peru: workshop and funding opportunities
Cystic echinococcosis workshop in Lima on 16-19 October 2018
Ahead of a ground-breaking cystic echinococcosis workshop in Lima on 16-19 October 2018, the ISNTD speaks to Dr. César Gavidia Chucán (Faculty of Veterinary Medicine at the Universidad Nacional Mayor de San Marcos, Peru) and Dr. Victor Del Rio Vilas (Lecturer in Infectious Disease Epidemiology at the University of Surrey) about current research gaps in CE and how the upcoming workshop will accelerate both the advocacy as well as the research agenda to tackle this disease. This workshop is funded by the Researcher Links scheme offered within the Newton Fund, the British Council and the Peruvian Council for Science and Technology (CONCYTEC).
When: 16 to 19 October
Where: Lima, Peru
Who can attend: Early Career Researchers, i.e. with less than 10 years post PhD (or, if no PhD, similar research experience)
Number of awards: Up to 10
Application deadline: 1 August
What is Cystic echinococcosis (CE) and what is its public health impact in Latin American countries including Peru?
Cystic echinococcosis (CE) is a parasitic disease caused when humans ingest eggs from the Echinococcus granulosus tapeworm. Dogs which are fed contaminated meat will also become infected and can pass on infection through fecal contamination of soil, water or vegetables or through close contact. This condition is endemic in Peru as well as many other Latin American countries and scientists both in the UK and Peru are joining forces to tackle this disease.
CE or hydatidosis is a parasitic zoonosis caused by a cestode of the family Taeniidae, species Echinococcus granulosus. It is endemic in a number of countries in South America. In the period 2009 to 2014, and for the five countries (Argentina, Brazil, Chile, Peru, and Uruguay) that constitute the South American Initiative for the Control and Elimination of CE (the Initiative), nearly 5000 new CE cases were diagnosed annually, with an average case fatality rate of 2.9%, and an average hospital stay of 10.6 days. The burden is significant. Furthermore, 15% of the new cases were children aged 15 and less, indicating ongoing transmission. In Peru, more than 2000 new cases were reported in 2015 alone.
It is estimated that 5-10% of people in endemic areas are carrying cysts in the liver without symptoms, using abdominal ultrasound as the screening test. Also chest x-rays suggest that approximately 2-4% of similar people have pulmonar cysts.
What are some of the main challenges in the control of CE and what are the main current research gaps?
One of the main challenges is to standardize diagnostic tests in the region, for instance a Copro-ELISA test and Copro-PCR. Countries use different protocols and some of them are not well standardized, so infection rates are not comparable. We have standardized an in-house Copro-ELISA method at the beginning of this year and just submitted it for evaluation in a peer reviewed journal. If accepted then we will extend its application for the region.
Another challenge might be the continuous treatment of dogs with praziquantel; it sometimes is hard to maintain this in the field, owners might not always comply, the handling of dogs can be difficult, etc. However, praziquantel is the most effective drug against the adult stage; looking for other strategy in dogs could be also important, such as the vaccine. Vaccination is still under investigation in a couple of research groups in the world and also in our Peruvian group.
What has been some of your recent research in the field of CE and associated issues?
As part of the Initiative’s efforts towards the control of the disease in the region, we have contributed to the compilation of epidemiological data on the condition across the different countries. This led to the publication of the first epidemiological report for the region for the period 2009-2014, and subsequent annual reports. This data was also used to produce an advocacy paper, and to inform the current Action Plan for the Control of NTDs by the Pan American Health Organization (PAHO/WHO). In addition, again as part of the Initiative, we conducted the first inter-laboratory proficiency exercise in the Region where we observed large variability in the lab’s SOPs, and test results.
Other main research interests include the afore-mentioned copro ELISA test, as well as looking for some proteins as vaccine candidates and the study of the immune response in experimentally infected dogs. Also, we are working on the chemotherapy of infected sheep (natural intermediate host); we have been testing oxfendazole as the option for reducing the proportion of viable protoscolices in sheep and reduce finally the parasite burden in the environment.
What international collaborations have been initiated between Peru and the UK?
Collaboration between Peru and the UK is starting out in this field - to the best of our knowledge this is the first time a joint grant has been obtained specifically for CE. We have also had an ongoing collaboration with a researcher, Dr. Phillip Craig, from Salford University, who used to help us with the analysis of dog fecal samples. Dr. Craig had a copro ELISA test standardized years ago.
How will the upcoming workshop help to accelerate capacity building and partnership building in the field of CE?
The purpose of the workshop is to review the evidence from 5 pilot projects, assessing the impact of different interventions (e.g. vaccination of sheep, MDA in dogs) jointly conducted by Peruvian animal health and public health authorities. Moreover we will also review the current and future surveillance and disease control plans. Attendees will present their CE work, or related. The discussion with officials attending the workshop will provide an optimal platform for the identification of capacity and partnership building opportunities. The workshop will focus on methodologies towards the best use of evidence to inform policy. On this note, we also expect to identify future research opportunities in cross-cutting disciplines such as epidemiology, modelling, and economic evaluations among others.
What are the main partnerships or innovations which you would like to see develop in the near future in terms of accelerating the CE control agenda?
We hope to establish partnerships towards the analyses of the pilots data, its interpretation and translation into policy, as well as helping to characterise the most efficient surveillance design. These analyses will then feed operational indicators to measure progress against the objectives of the Regional Action Plan for the Control of NTDs 2016-2022, that includes CE.
For more information please contact:
Dr. Victor Del Rio Vilas
University of Surrey
Dr. Cesar Gavidia
Universidad Nacional Mayor de San Marcos, Peru