ABSTRACT

The objective of this manuscript is to provide selective examples of the work of the Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Centre for Research and Training in Parasite Epidemiology and Control which contribute to the WHO goal of eliminating neglected tropical diseases by 2030. This PAHO/WHO CC specifically aligns its activities with the Sustainable Development Goals and with the goals outlined in the WHO Road Map for Neglected Tropical Diseases 2021-2030. Its role is to contribute to advancing global action on NTDs, primarily through policy development and knowledge translation. Three important projects have recently been completed: 1. Finalizing the Monitoring and Evaluation Framework for the NTD Road Map (published May 2021; this PAHO/WHO CC was a member of the working group); 2. Developing new guidelines for the preventive chemotherapy of Taenia solium taeniasis (published September 2021; this PAHO/WHO CC was co-Chair; and 3. Formulating a policy brief on deworming for adolescent girls and women of reproductive age (published January 2022; this PAHO/WHO CC is co-lead). These projects are the result of the integration of expertise and experience from multiple partners, including from PAHO and WHO (where both organizations provided key leadership), this PAHO/WHO CC, government ministries, civil society organizations and universities, among others. In conclusion, this PAHO/WHO CC contributes timely guidance to country-led evidence-informed public health policy, to cost-effective program implementation and to the identification of priority research topics – all focused, ultimately, on eliminating NTD-attributable morbidity by 2030.

Keywords
Parasitic diseases; health surveillance system; women; poverty; child

RESUMEN

El objetivo de este artículo es proporcionar ejemplos seleccionados de la labor del centro colaborador de investigación y capacitación en epidemiología y control de parásitos de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), que contribuye al objetivo de la OMS de eliminar las enfermedades tropicales desatendidas para el 2030. Este centro colaborador de la OPS/OMS alinea sus actividades específicamente con los Objetivos de Desarrollo Sostenible y con los objetivos descritos en la Hoja de ruta sobre enfermedades tropicales desatendidas 2021-2030 de la OMS. Su función es contribuir al avance de las medidas mundiales sobre las enfermedades tropicales desatendidas, principalmente mediante la elaboración de políticas y la traducción de conocimiento. Recientemente se han completado tres proyectos importantes: 1) finalización del marco de seguimiento y evaluación de la Hoja de ruta sobre enfermedades tropicales desatendidas (publicado en mayo del 2021; este centro colaborador de la OPS/OMS formó parte del grupo de trabajo); 2) elaboración de nuevas directrices para la quimioterapia preventiva de la teniasis por Taenia solium (publicado en septiembre del 2021; este centro colaborador fue copresidente); y 3) formulación de un informe de políticas sobre la desparasitación de las adolescentes y las mujeres en edad reproductiva (publicado en enero del 2022; este centro colaborador fue coautor). Estos proyectos son el resultado de la integración del conocimiento y la experiencia de múltiples asociados, como la OPS y la OMS (ambas organizaciones ofrecieron un liderazgo clave), este centro colaborador de la OPS/OMS, así como varios ministerios gubernamentales, organizaciones de la sociedad civil y universidades, entre otros. En conclusión, este centro colaborador de la OPS/OMS ofrece orientaciones oportunas para las políticas de salud pública basadas en la evidencia lideradas por los países, la ejecución de programas costo-efectivos y la determinación de los temas de investigación prioritarios, todo ello destinado, en última instancia, a eliminar la morbilidad atribuible a las enfermedades tropicales desatendidas para el 2030.

Keywords
Parasitic diseases; health surveillance system; women; poverty; child

RESUMO

O objetivo deste manuscrito é fornecer exemplos seletivos do trabalho do Centro Colaborador de Pesquisa e Treinamento em Epidemiologia e Controle de Parasitos da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) que contribuem para a meta da OMS de eliminar até 2030 as doenças tropicais negligenciadas. Este CC da OPAS/OMS alinha especificamente suas atividades com os Objetivos de Desenvolvimento Sustentável e com as metas delineadas no Roteiro da OMS para Doenças Tropicais Negligenciadas 2021-2030. Seu papel é contribuir para o avanço da ação global contra doenças tropicais negligenciadas, principalmente por meio do desenvolvimento de políticas e da tradução de conhecimentos. Três importantes projetos foram concluídos recentemente: 1. Finalização da Estrutura de Monitoramento e Avaliação do Roteiro para as DTN (publicada em maio de 2021 – este CC da OPAS/OMS foi membro do grupo de trabalho); 2. Desenvolvimento de novas diretrizes para a quimioprofilaxia da teníase por Taenia solium (publicado em setembro de 2021 – este CC da OPAS/OMS foi copresidente); e 3. Formulação de orientação para políticas de desparasitação para adolescentes e mulheres em idade reprodutiva (publicado em janeiro de 2022 – este CC da OPAS/OMS foi cogestor). Esses projetos são o resultado da integração de conhecimentos e experiência de múltiplos parceiros, incluindo a OPAS e a OMS (onde ambas as organizações forneceram liderança essencial), este CC da OPAS/OMS, ministérios governamentais, organizações da sociedade civil e universidades, entre outros. Em suma, este CC da OPAS/OMS contribui com orientações oportunas para uma política de saúde pública liderada pelos países e informada com base em evidências, para a implementação de programas com boa relação custo-benefício e para a identificação de tópicos prioritários de pesquisa – todos focados, em última análise, na eliminação da morbidade atribuível às DTN até 2030.

Palavras-chave
Doenças parasitárias; sistema de vigilância sanitária; mulheres; pobreza; criança

The Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Centre for Research and Training in Parasite Epidemiology and Control at McGill University in Montreal, Canada (CAN-88) was established in 2015 to provide technical support to the Pan American Health Organization (PAHO) and the World Health Organization (WHO) in the area of the neglected tropical diseases (NTDs) (referred to as Neglected Infectious Diseases (NIDs) in the Region of the Americas) – and primarily in the soil-transmitted helminthiases (STHs) (¹1. McGill University. School of Population and Global Health: Epidemiology, Biostatistics and Occupational Health.[Internet] Montreal: McGill.[cited 14 April 2022]. Available from http://www.mcgill.ca/epi-biostat-occh/.
http://www.mcgill.ca/epi-biostat-occh/... ). This CC is notable for its expertise in epidemiology and biostatistics. Its work has been informed by a long-standing research partnership with colleagues in the Amazon region of Peru. Its workplan focuses on three major activities: 1. Training and research relevant to parasite prevention and control; 2. Knowledge dissemination - Publications and documents of the Department of Control of Neglected Tropical Diseases, at the request of PAHO/WHO; and 3. Development of policies and strategies to control STHs in women of reproductive age.

The NTDs are a cluster of 20 communicable diseases which affect between 1 and 2 billion people living mostly in tropical and sub-tropical countries of the world, including all countries of Latin America and the Caribbean (²2. World Health Organization. Neglected tropical diseases. [Internet]Geneva: WHO. [cited 14 April 2022]. Available from: https:/www.who.int/health-topics/neglected-tropical-diseases#tab=tab_1.
https:/www.who.int/health-topics/neglect... ) (Table 1). Most of these diseases are life-threatening (e.g. dengue); many are zoonotic (e.g. echinococcosis); some are acute (e.g. snakebite envenoming); some are chronic (e.g. lymphatic filariasis); some can be acquired congenitally (e.g. Chagas disease); many create mental anguish and stigma (e.g. leprosy); and all are diseases of poverty. Impoverished people living in NTD-endemic areas not only commonly suffer from multiple diseases at the same time but, because malnutrition and other comorbidities are too often also present, they are at risk of developing health deficits which can extend over their entire lifespan (³3. Ezeamama AE, Bustunduy AL, Nkwata AK, Martinez L, Pabalan N, Boivin MJ, et al. Cognitive deficits and educational loss in children with schistosome infection - a systematic review and meta-analysis. PLoS Negl Trop Dis. 2018;12(1):e0005524. Available from: https://doi.org/10.1371/journal.pntd.0005524.
https://doi.org/10.1371/journal.pntd.000... ,⁴4. King CH, Dangerfield-Cha M. The unacknowledged impact of chronic schistosomiasis. Chronic Illn. 2008;4(1):65-79. Available from: https://doi.org/10.1177/1742395307084407.
https://doi.org/10.1177/1742395307084407... ).

These diseases have been called ‘neglected’ because they typically affect impoverished populations; they are not considered as public health priorities; their occurrence, and attributable morbidity, are underreported; and they fail to attract adequate funding or research attention (⁵5. Molyneux DH, Asamoa-Bah A, Fenwick A, Savioli L, Hotez P. The history of the neglected tropical disease movement. Trans R Soc Trop Med Hyg. 2021;115(2):169-175. Available from: https://doi.org/10.1093/trstmh/trab015.
https://doi.org/10.1093/trstmh/trab015... ). Global advocacy efforts are beginning to remedy this neglect (⁵5. Molyneux DH, Asamoa-Bah A, Fenwick A, Savioli L, Hotez P. The history of the neglected tropical disease movement. Trans R Soc Trop Med Hyg. 2021;115(2):169-175. Available from: https://doi.org/10.1093/trstmh/trab015.
https://doi.org/10.1093/trstmh/trab015... ,⁶6. Horton R. Neglected tropical diseases: ending the neglect of populations. Lancet. 2022;399(10323):411. Available from: https://doi.org/10.1016/s0140-6736(22)00161-1.
https://doi.org/10.1016/s0140-6736(22)00... ). A turning point was likely the January 2012 London Declaration where key advocates from donor organizations, non-governmental organizations, academia, endemic countries and the pharmaceutical industry came together to redress the considerable and overt inequity resulting from NTDs suffered by ‘the bottom billion’ (⁷7. Uniting to Combat Neglected Tropical Diseases. London Declaration on Neglected Tropical Diseases. London: Uniting to Combat NTDs; 2012. Available from: https://unitingtocombatntds.org/wp-content/uploads/2017/11/london_declaration_on_ntds.pdf Accessed 19 April 2022.
https://unitingtocombatntds.org/wp-conte... ,⁸8. Hotez PJ, Fenwick A, Savioli L, Molyneux DH. Rescuing the bottom billion through control of neglected tropical diseases. Lancet. 2009;373(9674):1570-5. Available from: https://doi.org/10.1016/s0140-6736(09)60233-6.
https://doi.org/10.1016/s0140-6736(09)60... ). At the following 2013 World Health Assembly, Resolution 66.12 was adopted, which aimed at supporting Member States in meeting targets set in 2015 and 2020 for the prevention, control, elimination and eradication of NTDs (⁹9. World Health Organization. Neglected tropical diseases [Resolution 66.12]. 66th World Health Assembly; 27 May 2013. Geneva: WHO; 2013. Available from: https://apps.who.int/iris/bitstream/handle/10665/150163/A66_R12-en.pdf
https://apps.who.int/iris/bitstream/hand... ). In 2016, PAHO developed a robust elimination plan of action for NTDs and, importantly, included consideration of programming post-elimination (¹⁰10. Pan American Health Organization. Plan of action for the elimination of neglected infectious diseases and post-elimination actions 2016-2022. Washington, DC: PAHO; 2016. Available from: https:///www.paho.org/hq/dmdocuments/2016/CD55-15-e.pdf
https:///www.paho.org/hq/dmdocuments/201... ). This was followed, in 2019, by a comprehensive policy on communicable disease elimination focusing on integration and sustainability (¹¹11. Pan American Health Organization. PAHO disease elimination initiative: a policy for an integrated sustainable approach to communicable diseases in the Americas. Washington, DC: PAHO; 2019. Available from: https://iris.paho.org/handle/10665.2/51388
https://iris.paho.org/handle/10665.2/513... ).

NTDs are now explicitly included in Sustainable Development Goal (SDG) 3: Ensure healthy lives and promote well-being for all at all ages; Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, waterborne diseases and other communicable diseases (¹²12. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development [A/70/L.1]. United Nations General Assembly, 70th Session; 21 October 2015. New York City: UN; 2015. Available from: https://www.un.org/en/development/desa/population/migration/generalassembly/docs/globalcompact/A_RES_70_1_E.pdf
https://www.un.org/en/development/desa/p... ). The indicator designated for tracking the progress of action in reducing the disease burden of NTDs is: the number of people requiring intervention against NTDs. This indicator encompasses both curative aspects of interventions and preventive approaches which aim to reduce NTD-attributable morbidity and mortality. More recently, in 2021, WHO set out a new Road Map for NTDs – to end the neglect by 2030 (¹³13. World Health Organization. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021-2030: overview. Geneva: WHO, 2020. Available from: https://apps.who.int/iris/handle/10665/332094
https://apps.who.int/iris/handle/10665/3... ). In celebrating World Day for NTDs in January 2022, PAHO encouraged governments to ensure timely treatment for persons suffering from NTDs (¹⁴14. Pan American Health Organization. Neglected tropical diseases: PAHO calls for an end to delays in treatment in the Americas. Geneva: PAHO; 2022 [cited 14 April 2022]. Available from: https://www.paho.org/en/news/28-1-2022-neglected-tropical-diseases-paho-calls-end-delays-treatment-americas#:~:text=Leprosy%2C%20dengue%2C%20leishmaniasis%2C%20schistosomiasis,200%20million%20people%20at%20risk.
https://www.paho.org/en/news/28-1-2022-n... ).

The PAHO/WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control (CAN-88) has been actively engaged in contributing to the NTD elimination goals of PAHO and WHO. Activities include participation in webinars, in working groups, in expert advisory groups, and in research projects. Documents and video recordings are shared within the PAHO and WHO communities, in addition to being made accessible in the public domain. The following is a description of three recent contributions of the Collaborating Centre.

CONTRIBUTION 1: ON THE NTD ROAD TO 2030: MONITORING, EVALUATION AND RESEARCH

With the renewal of the NTD Road Map in 2021, it became essential to rethink how progress toward the new goals would be monitored and evaluated. New emphasis was placed on measuring impact, holistic and integrated programming, and country ownership. A comprehensive framework was developed with input from several centres and experts, including the PAHO/WHO CC on Research and Training in Parasite Epidemiology and Control (as a member of the Working Group on Monitoring, Evaluation and Research of the WHO Strategic and Technical Advisory Group for NTDs) (¹⁵15. World Health Organization. Ending the neglect to attain the Sustainable Development Goals. A framework for monitoring and evaluating progress of the road map for neglected tropical diseases 2021-2030. Geneva: WHO; 2021 [cited 14 April 2022]. Available from: https://apps.who.int/iris/handle/10665/341313.
https://apps.who.int/iris/handle/10665/3... ). Unique to this framework was the inclusion of qualitative monitoring, in addition to the more traditional quantitative-focused monitoring. The quantitative monitoring component is based on progress obtained from 70 core and disease-specific goal-driven indicators, and the qualitative component is based on an assessment of gaps and challenges encountered in meeting the goals (Figure 1).

The core indicators include a set of 4 overarching indicators, 10 cross-cutting indicators and 22 disease-specific indicators. An additional 34 disease-specific indicators ensure that a comprehensive and timely reporting would assist with any key disease-specific attributes. To also ensure that reporting would be standardized, an NTD Compendium of Indicators was drawn up, with definitions and details on data collection, including specification of reporting tools and projected timelines (¹⁶16. Pan American Health Organization. NTD Indicator Compendium. Washington, DC:PAHO; 2021 [cited 14 April 2022]. Available from: file:///C:/Users/Utilisateur/Documents/WHO%20CC/WG%20MER/NTDIndicatorCompendium%20(1).pdf.
file:///C:/Users/Utilisateur/Documents/W... ).

The qualitative monitoring component aims to supplement the quantitative monitoring by identifying gaps or barriers to implementation so that timely solutions can be found and delays in achieving program milestones can be minimized. The Gap Assessment Tool is currently being developed to provide standardized assessment criteria for monitoring all 20 NTDs, in addition to criteria for 11 pan-disease dimensions (e.g. advocacy and logistics, diagnostics).

As the periodic quantitative and qualitative assessments will inform both progress achieved and challenges remaining, research priorities can be identified, and strategic funding opportunities and research partnerships initiated. In this way, research results can more directly inform subsequent program implementation and overall progress towards the NTD road map goals.

CONTRIBUTION 2: PUTTING TAENIA SOLIUM TAENIASIS ON THE MAP

Among the NTDs, Taenia solium taeniasis can certainly still be regarded as neglected. This is because the disease caused by its larval form, the cysticercus (i.e. cysticercosis), and the disease named for its most important pathologic manifestation (i.e. neurocysticercosis), attract much more attention. Yet, by eliminating Taenia solium taeniasis, cysticercosis would quickly disappear. Prevention and control efforts for taeniasis are therefore critical to the elimination of both diseases. Because taeniasis is a zoonotic parasite disease, a One Health approach is required. In 2019, PAHO launched a manual and virtual course, in Spanish, on taeniasis and cysticercosis control highlighting the One Health approach and emphasizing interventions which could be applied to the human population, the animal population and the environment (¹⁷17. Organización Panamericana de la Salud. Curso virtual de la teniasis y la cisticercosis causadas por Taenia solium. Washington, DC: OPS; 2022. Available from : https://www.campusvirtualsp.org/es/node/25841
https://www.campusvirtualsp.org/es/node/... ,¹⁸18. Organización Panamericana de la Salud. Pautas operativas para las actividades de control de la teniasis y la cistercosis causadas por Taenia solium. Contribución al control de Taenia solium en América Latina y el Caribe. Washington DC: OPS; 2019. Available from: https://iris.paho.org/handle/10665.2/51660
https://iris.paho.org/handle/10665.2/516... ).

One of the essential elements in the control of T. solium taeniasis is preventive chemotherapy (PC) of at-risk human populations. In order to consolidate research and practice evidence to date, and to provide up-to-date guidance on the use of PC drugs, PAHO initiated the process of developing a guideline specifically for the use of these drugs in humans (¹⁹19. Pan American Health Organization. Guideline for Preventive Chemotherapy for the control of Taenia solium taeniasis. Washington DC: PAHO; 2021. Available from: https://doi.org/10.37774/9789275123720
https://doi.org/10.37774/9789275123720... ). The PAHO/WHO CC for Research and Training in Parasite Epidemiology and Control participated in this process. Table 2 provides the consensus recommendations which were published in 2021.

Several benefits accrue during the process of developing a guideline. First among these is typically the completion of a timely systematic review and, if warranted, a meta-analysis. This was the case here (²⁰20. Haby MM, Sosa Leon LA, Luciañez A, Nicholls RS, Reveiz L, Donadeu M. Systematic review of the effectiveness of selected drugs for preventive chemotherapy for Taenia solium taeniasis. PLoS Negl Trop Dis. 2020;14(1):e0007873. Available from: https://doi.org/10.1371/journal.pntd.0007873
https://doi.org/10.1371/journal.pntd.000... ). In addition, the Guideline Development Group benefited not only from having advice and input from experts around the globe (e.g. researchers, methodologists, veterinarians, clinicians, program managers) but also from experts in the guideline development process itself. This resulted in a rigorous and comprehensive final product. Lastly, a robust listing of research gaps and challenges was made to draw attention to existing inadequacies in terms of diagnostics, PC implementation and delivery issues, efficacy and safety concerns, and assessment procedures. In this way, the research community at large could be engaged and the evidence base for subsequent guideline updates expanded.

CONTRIBUTION 3: PICKING UP THE PACE FOR THE GLOBAL ELIMINATION OF STH MORBIDITY

The soil-transmitted helminthiases (STHs) (i.e. ascariasis, hookworm disease and trichuriasis) are the most prevalent of the NTDs, occurring in over 100 countries worldwide, including Latin America and the Caribbean (Figure 2) (Table 3) and carry the largest disease burden in terms of disability-adjusted life years lost (DALYs) (²¹21. Montresor A, Mupfasoni D, Mikhailov A, Mwinzi P, Luciañez A, Jamsheed M, et al. The global progress of soil-transmitted helminthiases control in 2020 and World Health Organization targets for 2030. PLoS Negl Trop Dis. 2020;14(8):e0008505. Available from: https://doi.org/10.1371/journal.pntd.0008505
https://doi.org/10.1371/journal.pntd.000... ,²²22. Molyneux DH, Savioli L, Engels D. Neglected tropical diseases: progress towards addressing the chronic pandemic. Lancet. 2017;389(10066):312-325. Available from: https://doi.org/10.1016/s0140-6736(16)30171-4
https://doi.org/10.1016/s0140-6736(16)30... ). This cluster of intestinal helminth diseases has long been a focus of public health action for PAHO; and many countries in Latin America and the Caribbean have national deworming days, and even weeks (²³23. Saboyá MI, Catalá L, Nicholls RS, Ault SK. Update on the mapping of prevalence and intensity of infection for soil-transmitted helminth infections in Latin America and the Caribbean: a call for action. PLoS Negl Trop Dis. 2013;7(9):e2419. Available from: https://doi.org/10.1371/journal.pntd.0002419
https://doi.org/10.1371/journal.pntd.000... ,²⁴24. Flisser A, Valdespino JL, García-García L, Guzmán C, Aguirre MT, Manon ML, et al. Using National Health Weeks to deliver deworming to children: lessons from Mexico. J Epidemiol Community Health. 2008; 62(4):314-7. Available from: https://doi.org/10.1136/jech.2007.066423
https://doi.org/10.1136/jech.2007.066423... ).

Since 2001, with Member States at the World Health Assembly (WHA) endorsing WHA

Resolution 54.19, deworming programs have been implemented, focusing initially on school-age children, to effectively use the infrastructure provided by schools in endemic countries (²⁵25. World Heath Organization. Schistosomiasis and soil-transmitted helminth infections [Resolution 54.19]. 54th World Health Assembly; 22 May 2001. Geneva: WHO; 2001. Available from: https://apps.who.int/gb/archive/pdf_files/WHA54/ea54r19.pdf
https://apps.who.int/gb/archive/pdf_file... ,²⁶26. Bundy DAP, Schultz L, Sarr B, Banham L, Colenso P, Drake L. The school as a platform for addressing health in middle childhood and adolescence. In: Bundy DAP, Silva ND, Horton S, Jamison DT, Patton GC, editors. Child and Adolescent Health and Development. 3rd ed. Washington, DC: The International Bank for Reconstruction and Development / The World Bank; 2017. Available from: https://doi.org/10.1596/978-1-4648-0423-6_ch20
https://doi.org/10.1596/978-1-4648-0423-... ). Donations of albendazole from GlaxoSmithKline and of mebendazole from Johnson & Johnson were key to scaling up these programs with the goal of reaching 600 000 000 school-age children, per year, worldwide (²¹21. Montresor A, Mupfasoni D, Mikhailov A, Mwinzi P, Luciañez A, Jamsheed M, et al. The global progress of soil-transmitted helminthiases control in 2020 and World Health Organization targets for 2030. PLoS Negl Trop Dis. 2020;14(8):e0008505. Available from: https://doi.org/10.1371/journal.pntd.0008505
https://doi.org/10.1371/journal.pntd.000... ,²⁷27. Lin WM, Addiss DA. Sustainable access to deworming drugs in a changing landscape. Lancet Infect Dis. 2018;18(12):e395-398. Available from: https://doi.org/10.1016/s1473-3099(18)30351-7
https://doi.org/10.1016/s1473-3099(18)30... ). Guidance subsequently followed for extending deworming treatment to preschool-age children and, indeed, to all at-risk groups (²⁸28. Crompton DWT, World Health Organization. Preventive chemotherapy in human helminthiasis: coordinated use of anthelminthic drugs in control interventions: a manual for health professionals and programme managers. Geneva: WHO; 2006. Available from: https://apps.who.int/iris/handle/10665/43545
https://apps.who.int/iris/handle/10665/4... ,²⁹29. World Health Organization. Guideline: preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups. Geneva: WHO; 2017. Available from: https://apps.who.int/iris/handle/10665/258983
https://apps.who.int/iris/handle/10665/2... ).

This PAHO/WHO Collaborating Centre has been engaged in supporting the implementation of school-based deworming programs and in building up the scientific knowledge base on the impact of STH infections on health. For example, a partnership with the Dirección Regional de Salud in Loreto, Peru ensured that a monitoring and surveillance component was embedded into its school-based deworming program (³⁰30. Rodriguez Ferruci H, Razuri H, Casapia M, Rahme E, Silva H, Ault S, et al. Governance, organization, accountability and sustainability of a region-wide school-based deworming program in Loreto, Peru. Acta Trop. 2016;159:219-26. Available from: https://doi.org/10.1016/j.actatropica.2016.04.001
https://doi.org/10.1016/j.actatropica.20... ). With increasing acceptance, experience and success of deworming programs for children, the case for providing deworming treatment for women of reproductive age became stronger (³¹31. Gyorkos TW, Montresor A, Belizario V, Biggs BA, Bradley M, Brooker SJ, et al. The right to deworming: the case for girls and women of reproductive age. PLoS Negl Trop Dis. 2018;12(11):e0006740. Available from: https://doi.org/10.1371/journal.pntd.0006740
https://doi.org/10.1371/journal.pntd.000... , ³²32. World Health Organization. (2018). Reaching girls and women of reproductive age with deworming: report of the Advisory Group on deworming in girls and women of reproductive age, Rockefeller Foundation Bellagio Center, Bellagio, Italy 28–30 June 2017. World Health Organization. Available from: https://apps.who.int/iris/handle/10665/259962.
https://apps.who.int/iris/handle/10665/2... ). In the Americas, it was estimated that over 47 000 000 women of reproductive age, including over 500 000 pregnant women, were in need of PC for STH (³³33. Mupfasoni D, Mikhailov A, Mbabazi P, King J, Gyorkos TW, Montresor A. Estimation of the number of women of reproductive age in need of preventive chemotherapy for soil- transmitted helminth (STH) infections. PLoS Negl Trop Dis. 2018; 12(2): e0006269. Available from: https://doi.org/10.1371/journal.pntd.0006269
https://doi.org/10.1371/journal.pntd.000... ). Because of the concern about deworming during pregnancy, a systematic review of the effects of exposure to albendazole and mebendazole during pregnancy was undertaken. This review established that there was no additional adverse risk related to deworming, to either the mother or the baby, even when the deworming treatment was inadvertently administered during the first trimester (³⁴34. Gyorkos TW, St-Denis K. Systematic review of exposure to mebendazole or albendazole during pregnancy on adverse birth outcomes, with particular reference to exposure in the first trimester. Int J Parasitol. 2019;49(7):541-554. Available from: https://doi.org/10.1016/j.ijpara.2019.02.005
https://doi.org/10.1016/j.ijpara.2019.02... ). To assist program managers in implementing deworming programs for women of reproductive age, a screening tool to rule out women who were likely to be in their first trimester was developed so that these women could be identified and treatment offered to them at a later time (³⁵35. St-Denis K, Blouin B, Rahme E, Casapia M, Montresor A, Mupfasoni D, et al. Ruling out early trimester pregnancy when implementing community-based deworming. PLoS Negl Trop Dis. 2020; 14(1):e0007901. Available from: https://doi.org/10.1371/journal.pntd.0007901
https://doi.org/10.1371/journal.pntd.000... ).

COLLABORATIONS WITH OTHER ORGANIZATIONS

One of the important aspects of being a PAHO/WHO Collaborating Centre is the opportunity of interacting with other Collaborating Centres within the PAHO network and around the world so that relevant activities and lessons learned can be shared. In 2021, PAHO invited Collaborating Centres in the region to participate in a live poster webinar describing their contributions to the SDGs (³⁶36. Pan American Health Organization. PAHO/WHO Collaborating Centres Regional Webinar: engaging our partners to achieve the SDGs together. Washington, DC: PAHO; 2021. Available from: https://iris.paho.org/handle/10665.2/54870
https://iris.paho.org/handle/10665.2/548... ). Globally, there are seven Collaborating Centres with an STH focus. These CCs have recently formed a network to advance mutual goals. Other collaborations also offer meaningful exchanges. The PAHO/WHO CC for Research and Training on Parasite Epidemiology and Control is an international co-applicant on a 5-year European-based Centre of Excellence for NTD with the aim of sharing technical expertise in parasite epidemiology (2021-2026). It is also a founding member of the Canadian Network for Neglected Tropical Diseases, where contributions made by Canadian researchers in the field of NTD research have been highlighted, even though many of these diseases are not endemic to Canada (³⁷37. Gyorkos TW, Carabin H, Phillip M, Benedict L, Davis A, Hatcher Roberts J, et al. Canadian contributions to research on Neglected Tropical Diseases. PLoS Negl Trop Dis. 2021;15(7):e0009476. Available from: https://doi.org/10.1371/journal.pntd.0009476
https://doi.org/10.1371/journal.pntd.000... ). Further guidance has been provided to organizations which include deworming in its programming (e.g., for adolescent girls and women of reproductive age) and contribute to policy and practice review through participation in the STH Advisory Committee of the STH Coalition, supported by Children Without Worms (³⁸38. Nutrition International. Frequently asked questions: preventive chemotherapy (deworming) for soil-transmitted helminth infections among adolescents and women of reproductive age. Ottawa: Nutrition International; 2021 [cited date]. Available from: https://www.nutritionintl.org/learning-resource/frequently-asked-questions-preventive-chemotherapy-deworming-for-soil-transmitted-helminth-infections-among-adolescents-and-women-of-reproductive-age/
https://www.nutritionintl.org/learning-r... ,³⁹39. Freeman MC, Akogun O, Belizario V Jr, Brooker SJ, Gyorkos TW, Imtiaz R, et al. Challenges and opportunities for control and elimination of soil-transmitted helminth infection beyond 2020. PLoS Negl Trop Dis. 2019;13(4):e0007201. Available from: https://doi.org/10.1371/journal.pntd.0007201
https://doi.org/10.1371/journal.pntd.000... ). As part of the global campaign to reduce the disease burden caused by STHs, knowledge dissemination is important, and access to continuing support, essential (⁴⁰40. World Health Organization. 2030 targets for soil-transmitted helminthiases control programmes. Geneva: WHO; 2020. Available from: https://apps.who.int/iris/handle/10665/330611
https://apps.who.int/iris/handle/10665/3... ,⁴¹41. World Health Organization. Deworming for adolescent girls and women of reproductive age: policy brief. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/9789240037670
https://www.who.int/publications/i/item/... ).

CONCLUSIONS

The PAHO/WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control actively contributes to the goals of the NTD Road Map 2021-2030 and achievement of the SDGs. Increasing activities with a variety of partners, both in the Americas and globally, is evidence of robust knowledge exchange among people dedicated to eliminating the disease burden caused by STHs and NTDs by 2030.

Disclaimer.

The authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the Revista Panamericana de Salud Pública / Pan American Journal of Public Health and/or those of the Pan American Health Organization.

Acknowledgements.

The support of the Department of Epidemiology, Biostatistics and Occupational Health in the School of Population and Global Health at McGill University, the host institution for this PAHO/WHO Collaborating Centre, and the Centre for Outcomes Research and Evaluation (CORE) at the Research Institute of the McGill University Health Centre, is gratefully acknowledged.

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