• Control of Poverty Related and Neglected Tropical Diseases (PRNTD)

Overview

“…the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition…” (WHO constitution entered into force 7th of April 1948)

The international medical community has focused a lot of attention on response to emergencies, epidemics and infectious diseases in humanitarian settings. Nevertheless, in order to reach equity in care, major efforts are required to prevent epidemics and to manage those diseases which have long-term effects on the life of people impacting the quality of their lives.

Non-acute infections and chronic disorders are often neglected in humanitarian settings, mostly because they do not require an immediate response, and they are usually characterized by a complex management structure. Neglected Tropical Diseases (NTDs), and particularly schistosomiasis, are a clear example of complex diseases, poorly managed and lacking attention both in terms of technological and structural innovation.

Prevention and the integration of health care services are crucial for the timely and effective management of complex diseases. Prevention can reduce high medical costs, and the integration of services into existing health care can promote sustainability.

Our research group focuses on operational and implementation research studies aimed at identifying solutions for prevention and management of diseases of poverty, with a main emphasis on NTDs and schistosomiasis. The majority of our studies are conducted in Madagascar, where a high burden of schistosomiasis exists. Additional studies are conducted in Sub-Saharan Africa with a major focus on West-Africa.

In collaboration with the International Teaching and Capacity Building Unit, higher education and capacity building activities are coordinated by the Fusco group.

Research Projects

Female Genital Schistosomiasis in rural Madagascar: improving community understanding and promoting integration into primary health care services - FIRM-UP

Female Genital Schistosomiasis in rural Madagascar: improving community understanding and promoting integration into primary health care services - FIRM-UP

Neglected Tropical Diseases (NTDs) are a group of communicable diseases that occur in tropical and subtropical environments.  Very commonly, NTDs tend to develop in chronic manifestations thing that make their management complex. Female Genital Schistosomiasis (FGS) is a common chronic evolution of schistosomiasis, one of the most common NTDs, caused by the presence of S. haematobium eggs in genital tissues. The diagnosis is mostly done by visual inspection of characteristic lesions (sandy patches) on the cervix and vaginal wall. These techniques are normally offered at hospital level, but the implementation of colposcopy at primary health care level is possible if the infrastructures allow and if appropriated training to the practitioners is offered. Current laboratory techniques are inadequate for the diagnosis of the disease. Among the affected countries, Madagascar is one of the countries with the highest prevalence of schistosomiasis worldwide. FIRM-UP (Female Genital Schistosomiasis irural Madagascar: improving community understanding and promoting integration into primary health care services - FIRM-UP) aims at investigating the operational gaps laying behind FGS in order to identify solutions for a better management of it.

 

Partners:

University of Fianarantsoa, University of Antananarivo, Centre d’Infectiologie Charles Merieux (CICM), University of Mahajanga, University of Düsseldorf, Klinikum Esslingen, IS-Global Barcelona

@BNITM Dewi Ismajani Puradiredja – Eva Lorenz

Funding:

Coalition for Operational Research on NTDs (CORNTD)

Duration:

April 2020-December 2021

African COVID -19Vaccine Hesitancy – ACHES

African COVID -19Vaccine Hesitancy – ACHES

Vaccine hesitancy is defined by the WHO’s Strategic Advisory Group of Experts on Immunization as a ’delay in acceptance or refusal of vaccination despite availability of vaccination services’. This varies in form and intensity based on when and where it occurs and what vaccine is involved. Several prophylactic vaccines against COVID-19 are currently available. As the world is beginning the rollout the first approved vaccines, little is known about people’s potential acceptance of a COVID-19 vaccine in most of the African countries. ACHES (African COVID -19Vaccine Hesitancy) is an observational study aimed at measuring COVID-19 vaccine hesitancy in five west African countries and exploring causes behind the hesitancy with the main objective of informing guidelines for the proficient roll-out of the vaccines in the region.

 

Partners:

Institut de Recherche en Sciences de la Santé (IRSS/CNRST)- Burkina Faso, Santé Plus- Guinea, Faculté de Médecine et d’Odonto - stomatologie (FMOS) & University Clinical Research Center (UCRC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB) - Mali, Université Cheikh Anta Diop de Dakar (UCAD)- Senegal and University of Sierra Leone, College of Medical and Allied Health Sciences (COMAHS)- Sierra Leone.

@BNITM Dewi Ismajani Puradiredja –Ricardo Strauss-Ralf Krumkamp

Funding:

Global Health Protection Programme (GHPP) via the German ministry of health (BMG)

Duration:

March 2021-August 2022

 

Fast and reliable easy-to-use-diagnostics for eliminating Bilharzia in young children and mothers – freeBILy

Fast and reliable easy-to-use-diagnostics for eliminating Bilharzia in young children and mothers – freeBILy

Schistosomiasis is a tropical neglected disease caused by the infection of Schistosoma spp parasite. The disease is endemic in contexts of poverty since mainly spread due to poor hygiene and sanitation conditions. Mass drug administration (MDA) of praziquantel is one of the main control measures against human schistosomiasis. Although pregnant women, infants and children under the age of 5 in high endemic areas should be considered for MDA, they are usually not treated without diagnosis. Diagnostic tools identifying infections at primary health care centre level could therefore help to integrate this vulnerable group into control programmes. freeBILy (Fast and reliable easy-to-use-diagnostics for eliminating Bilharzia in young children and mothers) is an international multi-centre consortium focused on improving schistosomiasis diagnostics. The BNITM is sponsor of the phase III randomized control trial in Madagascar. There the study aims to determine the effectiveness of a Test-Based-Schistosomiasis-Treatment strategy for pregnant women and their infants and children up until the age of 2.

 

Partners:

University of Fianarantsoa, University of Antananarivo, Centre d’Infectiologie Charles Merieux (CICM), University of Leiden, University of Tübingen, Center of Medical Research Lambaréné (CERMEL), IS-Global Barcelona

@BNITM Dewi Ismajani Puradiredja – Eva Lorenz - Anna Jäger

Funding:

European-Developing Countries Clinical Trial Partnership (EDCTP)

Duration:

February 2018-December 2023

 

 

Improved diagnostics for schistosomiasis and epidemiology -SCHISDIMA

Improved diagnostics for schistosomiasis and epidemiology -SCHISDIMA

Diagnostic tools adapted for poor resources settings are often lacking, especially for diseases of poverty such as schistosomiasis. For this reason, schistosomiasis is often empirically diagnosed since to date no point of care strategy for its diagnosis has been implemented in endemic countries.  Since 2008, a point-of-care diagnostic test (POC-CCA) detecting Schistosoma derived circulating cathodic antigen (CCA) in urine is commercially available. The project SCHISDIMA (Improved diagnostics for schistosomiasis and epidemiology) aims at defining sensitivity and specificity of the POC-CCA in different epidemiological groups in Madagascar, where schistosomiasis is highly endemic and no data regarding the performances of the test are available.

 

Partners:

University of Fianarantsoa, University of Antananarivo, Centre d’Infectiologie Charles Merieux (CICM), University of Leiden.

@BNITM Eva Lorenz - Anna Jäger

Funding:

German Center for Infection Research (DZIF)

Duration:

June 2018-April 2021 -CLOSED

Novel approaches for the management of chronic forms of schistosomiasis: the identification of adapted tools through the Madagascan example - NAMASTE

Novel approaches for the management of chronic forms of schistosomiasis: the identification of adapted tools through the Madagascan example - NAMASTE

Among the neglected tropical diseases (NTDs), schistosomiasis ranks top in terms of disability-adjusted life years (3.3 million DALYs), with more than 230 million people infected and 600 million being at risk of infection. More than 90 % of those requiring treatment for schistosomiasis live in Africa, where both intestinal and urinary forms of the disease occur. The main public health impact of Schistosoma infections is associated with chronic evolutions of the infections leading i.e. to hepatic inflammation that progresses to advanced hepatic disease or to urogenital conditions such as Female Genital Schistosomiasis (FGS) impacting on the fertility and on the predisposition to other gynecological disorders as consequences of S. mansoni and S. haematobium infections respectively.

NAMASTE (Novel approaches for the management of chronic forms of schistosomiasis: the identification of adapted tools through the Madagascan example) has the overall objective of improving the management of chronic forms of schistosomiasis identifying adapted strategies for the detection of the disease in poor resources settings and novel diagnostic and prognostic biomarkers for the disease.

 

Partners:

University of Fianarantsoa, University of Antananarivo, Centre d’Infectiologie Charles Merieux (CICM)

@BNITM Lidia Bosurgi - Dewi Ismajani Puradiredja - Eva Lorenz - Anna Jäger

Funding:

German Center for Infection Research (DZIF)

Duration:

January 2021-December 2025

Reducing schistosomiasis through aquaculture interventions in Madagascar: a pilot study - RESAMP

Reducing schistosomiasis through aquaculture interventions in Madagascar: a pilot study - RESAMP

Schistosomiasis is listed as one of the Neglected Tropical Diseases, which is a group of communicable diseases frequent in tropical and subtropical environment. The most effective treatment for schistosomiasis is Praziquantel, but it is not always available to the affected population and does not prevent reinfection. The management of the different forms of chronic manifestation of the disease is different and requires different medical expertise and diagnostic tools. The scientific community recognizes that the only way to win the fight against this disease would be through a combination of treatment, diagnosis, awareness raising and prevention of infection risks. According to the WHO (Resolution WHA70.16), this prevention of the risk of infection should include the control of snails, the intermediate hosts of the disease. RESAMP is a pilot project aiming at assessing the feasibility to implement an aquaculture intervention in rice fields in Madagascar as a potential infection control measure to reduce the transmission of schistosomiasis.

 

Partners:

University of Fianarantsoa, University of Antananarivo, Centre d’Infectiologie Charles Merieux (CICM), APDRA-Pisciculture paysanne (France), Hamburg University of Applied Sciences

@BNITM Dewi Ismajani Puradiredja – Ralf Krumkamp

 

Funding:

German Alliance for Global Health Research (GLOHRA) via the German federal ministry of education and research (BMBF)

Duration:

September 2021-March 2023

Capacity building projects

Global Health and NTDs: an innovative educational approach to meet the endgame target in Madagascar - EduMad

Global Health and NTDs: an innovative educational approach to meet the endgame target in Madagascar - EduMad

Education at all levels of health care is crucial for the proper management of complex diseases, such as the parasitic neglected tropical disease (NTD) schistosomiasis. Madagascar is one of the countries with the highest prevalence, yet gaps in both NTD and Global Health training have been identified. EduMad is a capacity building project contributing to building NTD research and clinical capacities in Madagascar by training about 100 health professionals using an innovative educational approach. (LINK TO THE FELLOWSHIP APPLICATION)

 

Partners:

https://www.univ-fianar.mg/University of Fianarantsoa

@BNITM Dewi Ismajani Puradiredja - Eva Mertens - Ricardo Strauss (iTCB)

Funding:

Else Kröner-Fresenius-Stiftung

Duration:

November 2020-May 2022

Improving biosafety and biosecurity measures for the COVID-19 diagnostic in Madagascar – IBBM

Improving biosafety and biosecurity measures for the COVID-19 diagnostic in Madagascar – IBBM

IBBM is a project aimed at improving the local diagnostic COVID-19 diagnostic capacity of the CHU of Mahajanga. Mahajanga is located on the west-northern coast of Madagascar at more than 2 days travel distance from the capital city Antananarivo. There the most of the diagnostic activities are centralized in the capital and in order to better respond to the pandemic, a decentralized diagnostic frame is crucial. A diagnostic laboratory has been established but biosafety and biosecurity measures must be brought to higher quality standards. The overall objective of IBBM is to improve the biosafety and biosecurity measures at the COVID-19 diagnostic unit of the CHU of Mahajanga.

Partners: University of Mahajanga

@BNITM Dewi Ismajani Puradiredja-Eva Mertens-Ricardo Strauss (iTCB)

Funding:

Federal Foreign Office (BfAA)

Duration:

October 2020-September 2021

Higher education

LAB-SPHERE

Well-functioning and sustainable laboratory services are key components of strong health systems and crucial for improving public health and research capacities of countries. This is a tropEd accredited 2-week intensive course offered annually since 2019 aimed at describing the role of laboratory systems in strengthening health services and research capacity with a special focus on low and middle-income countries (LMICs). The emphasis is on explaining the structure and functions of laboratory systems and their effective and efficient management. Moreover, areas where laboratory systems overlap and/or complement health systems are being considered. The course uses interactive, simulation-based exercises, as well as laboratory- and computer-based practical sessions to complement the theoretical content. (LINK to the application)

Partners:

@BNITM iTCB

Duration:

Rolling every year in September

Dissemination and awareness activities

NTD series

Neglected Tropical Diseases (NTDs) are a group of diseases that cause substantial illness primarily among the world’s poorest populations. Lacking a strong political voice, people affected by these tropical diseases have a low profile and status in public health priorities. Awareness-raising initiatives play a crucial role in mobilizing greater attention, action and investment in the fight against NTDs. The NTD series is an initiative aimed at fueling partnerships and promoting awareness on NTDs through multi sectoral communication. It includes a series of webinars conducted as specialist facilitated debates. The main target sectors are the academia and the non-governmental organizations working on different aspects of global health. The group has the urgent priority to address the humanitarian aspects of NTDs, showing and discovering together how research can positively impact on humanitarian disasters. 

 

Calendar 2021:

-      Chagas – Coordinator: Valentina Marchese/Cattedra Unesco on the world Chagas day 14th of April

-      Clinical and operational research on NTDs in endemic areas - Coordinator: Valentina Mangano/UniPi  – on the international day of the tropics 29th of June

-      The ONE HEALTH approach in the fight against NTDs. - Coordinator:  Stefania Varani/UniBo– on the WORLD DEVELOPMENT and INFORMATION DAY 24th of October

-      Public health strategies for integrating NTDs into health care programmes - Coordinator: Diritti al cuore ONLUS– on the universal health coverage day 12th of December

-      NTD day Coordinator: Daniela Fusco/BNITM – on the world NTD day 30th of January 

Publications

Partnership for Research on Ebola VACcination (PREVAC): protocol of a randomized, double-blind, placebo-controlled phase 2 clinical trial evaluating three vaccine strategies against Ebola in healthy volunteers in four West African countries.
Badio M, Lhomme E, Kieh M, Beavogui AH, Kennedy SB, Doumbia S, Leigh B, Sow SO, Diallo A, Fusco D, Kirchoff M, Termote M, Vatrinet R, Wentworth D, Esperou H, Lane HC, Pierson J, Watson-Jones D, Roy C, D'Ortenzio E, Greenwood B, Chêne G, Richert L, Neaton JD, Yazdanpanah Y; PREVAC study team.
Trials. 2021 Jan 23;22(1):86. doi: 10.1186/s13063-021-05035-9. PMID: 33485369; PMCID: PMC7823170.

Identification of BRCA1/2 p.Ser1613Gly, p.Pro871Leu, p.Lys1183Arg, p.Glu1038Gly, p.Ser1140Gly, p.Ala2466Val, p.His2440Arg variants in women under 45 years old with breast nodules suspected of having breast cancer in Burkina Faso.
Sagna T, Bonora E, Ouedraogo MNL, Fusco D, Zoure AA, Bisseye C, Djigma F, Kafando JG, Zongo N, Douamba Z, Obiri-Yeboah D, Turchetti D, Pietra V, Lompo OM, Ouedraogo C, Seri M, Simpore J.
Biomol Concepts. 2019 Jun 11;10(1):120-127. doi: 10.1515/bmc-2019-0015. PMID: 31203256.

Defining System Requirements for Simplified Blood Culture to Enable Widespread Use in Resource-Limited Settings.
Dailey PJ, Osborn J, Ashley EA, Baron EJ, Dance DAB, Fusco D, Fanello C, Manabe YC, Mokomane M, Newton PN, Tessema B, Isaacs C, Dittrich S.
Diagnostics (Basel). 2019 Jan 11;9(1):10. doi: 10.3390/diagnostics9010010. PMID: 30641976; PMCID: PMC6468589.

The RET51/FKBP52 complex and its involvement in Parkinson disease.
Fusco D, Vargiolu M, Vidone M, Mariani E, Pennisi LF, Bonora E, Capellari S, Dirnberger D, Baumeister R, Martinelli P, Romeo G.
Hum Mol Genet. 2010 Jul 15;19(14):2804-16. doi: 10.1093/hmg/ddq181. Epub 2010 May 4. PMID: 20442138.

The tyrosine kinase receptor RET interacts in vivo with aryl hydrocarbon receptor-interacting protein to alter survivin availability.
Vargiolu M, Fusco D, Kurelac I, Dirnberger D, Baumeister R, Morra I, Melcarne A, Rimondini R, Romeo G, Bonora E.
J Clin Endocrinol Metab. 2009 Jul;94(7):2571-8. doi: 10.1210/jc.2008-1980. Epub 2009 Apr 14. PMID: 19366855.

Expression of the heat shock gene clpL of Streptococcus thermophilus is induced by both heat and cold shock.
Varcamonti M, Arsenijevic S, Martirani L, Fusco D, Naclerio G, De Felice M
Microb Cell Fact. 2006 Feb 15;5:6. doi: 10.1186/1475-2859-5-6. PMID: 16480499; PMCID: PMC1409795.

The pro-fusion domain of herpes simplex virus glycoprotein D (gD) interacts with the gD N terminus and is displaced by soluble forms of viral receptors
Fusco D, Forghieri C, Campadelli-Fiume G.
Proc Natl Acad Sci U S A. 2005 Jun 28;102(26):9323-8. doi: 10.1073/pnas.0503907102. Epub 2005 Jun 21. PMID: 15972328; PMCID: PMC1166633.

The soluble ectodomain of herpes simplex virus gD contains a membrane-proximal pro-fusion domain and suffices to mediate virus entry.
Cocchi F., Fusco D.*, Menotti L., Gianni T., Eisenberg JR, Cohen G., Campadelli -Fiume G.
Proc Natl Acad Sci U S A. 2004 May 11;101(19):7445-50. doi: 10.1073/pnas.0401883101. Epub 2004 May 3. PMID: 15123804; PMCID: PMC409938.

Contact

Daniela Fusco, PhD

Phone: +49 40 42818-243
Fax: +49 40 42818-512
E-Mail: fusco@bnitm.de


Technical staff

PhD students

Post docs

Natalie Fischer

Medical students

Daniel Schad
Paule Donven
Maude Lingscheid
Leonard Gunga
Jean-Marc Kutz
Konstantin Kühn
Jule Hameister
Jean-François Siani

Master students

Johanna Saalfrank
Pia Rausche