The facets of TDR research from drug discovery to implementation

First meeting in the Americas region

Implementation research: syphilis diagnostics

Riverside home in an indigenous community along Brazil’s Amazon River, near the site of TDR supported syphilis diagnostics trials.

Yet another field trip took JCB participants to the Manaus region of the Amazonas, where two TDR-supported projects are being carried out to test syphilis diagnostics and antimalarial drugs in remote rural communities. Traveling by boat down the Amazon River, group members visited two indigenous communities where research had begun on the use and effectiveness of rapid syphilis diagnostics among pregnant women. The research project has incorporated the use of a validated rapid syphilis test into the prenatal care of women living in 30 communities along the river. The communities along this stretch of the Amazon in northern Brazil are located at some distance from one another, with little access to health clinics.

The research is examining whether the rapid test, which works without electricity, can perform well even in the high temperatures and humidity that are characteristic of the Amazonas region. The study also explores how to help trained lay workers make appropriate use of the tests, as well as stock and administer medicines to those diagnosed with infections.

Dr Adele Schwartz Benzaken, director and president of the Foundation Alfredo da Matta, who made a presentation on the work at the JCB session and then led the subsequent field trip, described how the research aims to reduce the incidence of congenital syphilis in Brazil. Between 1998 and 2007, 41 000 Brazilian babies were born with congenital syphilis, she said. Some are born prematurely, and many die soon after birth or carry life-long disabilities. In women diagnosed, however, a single dose of penicillin at a cost of under US$ 0.50 can cure the infection. A guide evaluating rapid syphilis tests was published by TDR in 2006.

Schistosomiasis: developing new tools for populations still at risk

Brazil has the largest number of cases of intestinal schistosomiasis in the Americas, with up to 6 million people infected. However, Brazil also was one of the first countries in the region to launch a nation-wide schistosomiasis control programme, guided by research sponsored by both government and scientific institutions, including TDR. Despite the success of schistosomiasis control in many parts of the country, there remains a need to develop new tools to identify and treat populations still at risk. Brazilian scientists have recently taken part in multi-country and multi-centre trials, supported and managed by TDR to assess more sensitive diagnostic tools for use in low transmission areas. TDR has also recently supported the evaluation of the safety and efficacy of an appropriate praziquantel dose to advise policy on the treatment of school children for schistosomiasis (see TDR Research Briefs p. 4). During the 11th International Symposium on Schistosomiasis, on 22 August, TDR was recognized for its contribution to schistosomiasis research at the official commemoration of the centenary of the discovery of Schistosoma mansoni in Brazil by Professor Manuel Piraja da Silva.

Dengue virus: improving case classification and vector control

More than 200 000 people became sick with dengue fever in Brazil this past summer, with over 100 resulting deaths. The disease causes mild, flu-like symptoms with a rash and acute muscle pain, but the more severe dengue haemorrhagic fever type often kills young people. Aedes aegypti mosquitoes transmit dengue, so vector control is the most important measure, given that there is no treatment other than hydration and/or transfusion.

TDR is supporting research on dengue clinical classification and guidelines validation. It is also supporting research that explores new methods of vector control, targeting the most productive breeding sites with insecticide-treated curtains and water container covers, and examining the interrelationships between economic, biological and social factors in dengue transmission. A paper on dengue outbreak detection, including studies from Brazil, has recently been published in Tropical Medicine and International Health. For an interesting article on the 2008 dengue outbreak in Brazil, read an editorial in the FASEB Journal.