Eliminating lymphatic filariasis, onchocerciasis, and schistosomiasis from the Americas: breaking a historical legacy of slavery

PJ Lammie, JF Lindo, WE Secor… - PLoS Neglected …, 2007 - journals.plos.org
PJ Lammie, JF Lindo, WE Secor, J Vasquez, SK Ault, ML Eberhard
PLoS Neglected Tropical Diseases, 2007journals.plos.org
The 2007 bicentennial of the enactment of the bill to abolish the transatlantic slave trade in
the British Empire has focused new attention on the historical legacy of slavery and its
human and social consequences. Beyond the societal impact of slavery, which continues to
the present day, the transportation of millions of persons from sub-Saharan Africa to the New
World also resulted in the importation of a number of parasitic diseases to the Americas.
Lymphatic filariasis (LF), schistosomiasis, and onchocerciasis were most likely imported to …
The 2007 bicentennial of the enactment of the bill to abolish the transatlantic slave trade in the British Empire has focused new attention on the historical legacy of slavery and its human and social consequences. Beyond the societal impact of slavery, which continues to the present day, the transportation of millions of persons from sub-Saharan Africa to the New World also resulted in the importation of a number of parasitic diseases to the Americas. Lymphatic filariasis (LF), schistosomiasis, and onchocerciasis were most likely imported to the Americas via the slave trade; the presence of competent vectors (such as mosquitoes, black flies, and snails) allowed transmission and dispersal of the parasites [1–4]. Although parasitologists first speculated more than a century ago that the slave trade was responsible for introduction of these diseases to the New World [3], only recently has convincing evidence supporting this hypothesis been generated. Molecular evaluation of Schistosoma mansoni and Onchocerca volvulus has demonstrated very limited heterogeneity among New World strains, which share a strong affinity with West African strains of these parasites [5, 6]. Poverty and poor living conditions continue to put people at risk of LF, schistosomiasis, and onchocerciasis. On the 200th anniversary of the abolition of the slave trade, a fitting commemoration would be a commitment to the regional eradication of these three diseases that remain as a historical legacy of slavery. Lymphatic filariasis is a mosquito-transmitted infection that is associated with the development of debilitating lymphedema, elephantiasis, and hydrocele. The principal mosquito vector in the Americas, Culex quinquefasciatus, breeds in polluted water and is adapted to urban environments. LF once was widely distributed throughout the region, particularly in areas where the local geography was amenable to plantation-based agriculture and large numbers of slaves were imported. Economic development in the United States and in the Caribbean led to the spontaneous disappearance of LF in some areas and substantial declines in the prevalence of infection in others [7]. Ongoing transmission in the Western Hemisphere, now limited to four countries (Brazil, the Dominican Republic, Haiti, and Guyana), is concentrated in impoverished settings and appears to be a growing problem in urban slums. LF elimination programs based on the mass distribution of antifilarial drugs have been developed in all four countries and have resulted in declines in the prevalence of filarial infection ([8] and unpublished data). However, all four programs are resource challenged and none have achieved full coverage of at-risk populations. Onchocerciasis is well recognized as a cause of blindness and skin disease due to the pathology elicited by death of microfilariae in the tissues. Transmission of onchocerciasis in the Americas is now limited to 13 foci in six countries (Mexico, Guatemala, Columbia, Brazil, Venezuela and Ecuador)[9]. The Onchocerciasis Elimination Program in the Americas is coordinating twice-yearly mass treatment with ivermectin in these foci. Impressive strides have been made in reducing the prevalence of onchocercal disease, and in some foci interruption of transmission has been achieved, leading to the decision to halt mass treatment in one focus in Guatemala. End-game strategies for completing the interruption of transmission in the remaining active foci must now be validated [10].
2007 also marks the centenary of the first description of Schistosoma mansoni, the causative agent of schistosomiasis in the Americas. Schistosomiasis was once widespread throughout the Caribbean and …
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