American Journal of Tropical Medicine and Hygiene
May 2014; 90 (5)
http://www.ajtmh.org/content/current

Special Section on Neglected Parasitic Infections
Neglected Parasitic Infections in the United States: Needs and Opportunities
Monica E. Parise*, Peter J. Hotez and Laurence Slutsker
Author Affiliations
Division of Parasitic Diseases and Malaria, Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
Initial text
Parasitic infections are a major global health burden. The impact of debilitating diseases caused by parasites is greatest among those who struggle to meet their daily basic needs and access basic health care services in low-income countries. However, persons who have or are at risk for parasitic infections are present in every income and social strata, and residents of the United States and other developed nations are not unaffected. For some persons living in the United States, these parasitic infections are acquired in their own immediate environment; for example, exposure to feces from domestic dogs or cats puts children at risk for toxocariasis and toxoplasmosis. For others, chronic parasitic infections acquired years ago in other areas of the world can manifest with severe illness later in life, such as neurocysticercosis leading to adult–onset epilepsy or Chagas disease leading to severe cardiomyopathy requiring heart transplant. We know much less than we should about the health and economic burden and impact of parasitic diseases in developed countries, including the United States (Table 1).1
This issue of the American Journal of Tropical Medicine and Hygiene features brief reviews of five parasitic infections that remain a significant health problem in the United States: Chagas disease, cysticercosis, toxocariasis, toxoplasmosis, and trichomoniasis.2–6 These five diseases, which are among those that Centers for Disease Control and Prevention (CDC) refers to as neglected parasitic infections (NPIs) in the United States, have different epidemiologic profiles and modes of transmission and require tailored prevention and control strategies…
Early Phase Clinical Trials with Human Immunodeficiency Virus-1 and Malaria Vectored Vaccines in The Gambia: Frontline Challenges in Study Design and Implementation
Muhammed O. Afolabi*, Jane U. Adetifa, Egeruan B. Imoukhuede, Nicola K. Viebig, Beate Kampmann and Kalifa Bojang
Author Affiliations
Vaccinology Theme, Medical Research Council Unit, The Gambia; The Jenner Institute, University of Oxford, United Kingdom; European Vaccine Initiative, Germany; Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia Abstract.
Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and malaria are among the most important infectious diseases in developing countries. Existing control strategies are unlikely to curtail these diseases in the absence of efficacious vaccines. Testing of HIV and malaria vaccines candidates start with early phase trials that are increasingly being conducted in developing countries where the burden of the diseases is high. Unique challenges, which affect planning and implementation of vaccine trials according to internationally accepted standards have thus been identified. In this review, we highlight specific challenges encountered during two early phase trials of novel HIV-1 and malaria vectored vaccine candidates conducted in The Gambia and how some of these issues were pragmatically addressed. We hope our experience will be useful for key study personnel involved in day-to-day running of similar clinical trials. It may also guide future design and implementation of vaccine trials in resource-constrained settings.