Development of the tungiasis treatment guideline

Universidad de las Américas (UDLA), Quito, Ecuador

Dr. Calvopiña holds the following academic degrees: Medical Doctor (Quito-Ecuador); Master’s in sciences, London School of Hygiene and Tropical Medicine (UK); Ph.D., Kochi-Japan.

He is a physician teaching and researching on tropical diseases interested mainly in Neglected Tropical Diseases (NTDs) in Ecuador. Collaborating with several national and international institutions, he has published dozens of papers (ORCID 0000-0002-0286-0747). Recently he published a paper on tungiasis doi:10.4269/ajtmh.21-0207. He strongly believes that Tungiasis, known by the locals as “nigua” is underreported in the tropics of the Coastal and Amazon regions.

KEMRI-Wellcome Trust, Kenya and Nuffield Department of Medicine, University of Oxford, UK

Dr. Elson holds the following academic degrees: BSc Zoology/Parasitology-Imperial College, London, UK; PhD-Liverpool School of Tropical Medicine, Liverpool, UK; MPH & Tropical Medicine-James Cook University, Townsville, Australia.

Each of her degrees contributes to her foundation in public health and tropical medicine and is directly relevant to the tungiasis guideline. Since 2012 she has been living in a community in coastal Kenya where the prevalence of tungiasis was 17% among school children and she started a community-based project to control it. By 2016, the prevalence has been reduced to less than 1%. She has established collaborations with scientists working in multiple disciplines: entomologists, disease ecologists, molecular biologists, clinicians, and civil engineers at multiple institutions in Kenya and Europe. Through joint projects on tungiasis, she has developed experience in the development and implementation of public health interventions, clinical trials, and epidemiological research on tungiasis in Kenya.

The projects have included risk factor studies; a clinical trial for neem and coconut oil; the development of and trialing of a low-cost house floor to prevent infection; a national prevalence survey; investigating clinical, cognitive, and psychosocial aspects of the disease and the ecology of the parasite. In the past, she contributed to the development of Kenya’s national policy and guidelines for jigger prevention and control.

Institute of Microbiology, Infectious Diseases and Immunology, Charité – University Medicine, Berlin, Germany

Prof. Feldmeier holds the following academic degrees: M.D., Ph.D., and Diploma of Tropical Medicine and International Health (Sorbonne University, Paris, France).

Prof. Feldmeier has worked on Neglected Tropical Diseases (NTDs) for 42 years. His research on various NTDs is published in more than 180 articles in international peer-reviewed journals. Since 2002, he has concentrated on the understanding of parasitic skin diseases and pathogens that cause the diseases. He has investigated the epidemiology, ecology, pathogenesis, rapid assessment, treatment, prevention, and control of tungiasis, and published the results in more than 30 articles.

He has developed a new treatment rationale for tungiasis based on the occlusion of the rear abdominal cone with dimeticone oils.

International Centre of Insect Physiology and Ecology (ICIPE)

Dr. Fillinger holds the following academic degrees: MSc; and Doctorate in natural sciences from the University of Heidelberg, Germany, whilst working as Entomologist for the German Mosquito Control Association. 

She joined ICIPE in 2000. Ulrike is a passionate disease ecologist who strives to understand the ecological causes of disease patterns and the ecological consequences of infectious diseases. She enjoys working trans-disciplinary and has strong collaborations with ecologists, geographers, epidemiologists, parasitologists, medical practitioners, veterinarians, microbiologists, social scientists, health economists, and civil engineers. Her current research portfolio includes projects on integrated vector management for malaria control, the development of novel behavior-modulating mosquito control tools, community-based One Health approaches for the combined prevention of arthropod-borne human and animal diseases, the impact of land use changes on health, the association between housing and health, and several projects investigating the disease ecology of tungiasis, and explored novel treatment and prevention options for this highly neglected parasitic skin disease. Dr. Fillinger is a member of the WHO/NTD expert committee to develop a framework for tungiasis elimination.

Hospital Universitario de Móstoles, Madrid, España; Universidad Rey Juan Carlos. Madrid, España; Fundación Lucha contra las Infecciones, Badalona, Barcelona, España.

Dr. Galvan holds the following academic degrees: Graduate in medicine and surgery; Specialist in Surgical Medical Dermatology and Venereology; International Diploma in Leprology; Currently, she is pursuing her Ph.D., on infectious neglected and emergent diseases with skin manifestations.

She founded DerMalawi, a community-based Integrated Dermatological Health project in 2015 in Nkhotakota, Malawi (Africa), and led it from 2015 until January 2022.

She has focused her research program on Neglected Skin tropical diseases and emergent infectious diseases with skin manifestations. She is the current vice-chair of the International Alliance for the Control of Scabies (IACS). She has been a volunteer doctor in the conflicts of Madrid 11M 2004, Tsunami 2004, and in the Saharan refugee camps in Tindouf.

She has been a professor in training courses for medical and pharmaceutical personnel and nursing students in the Sahrawi refugee camps of Tindouf and Malawi, Nkhotakota health area. She has collaborated as an expert with the World Health Organization (WHO) and the Pan American Health Organization (PAHO) in the development of the roadmap for the control of Ectoparasitosis in the Americas region. She is a collaborating member of the WHO Working Group on the Clinical Management of mpox.

Professor at Universidade Federal do Ceará, Fortaleza, Brazil.

Prof. Heukelbach holds the following academic degrees: MD, DTMPH, MScIH, PhD.

Prof. Heukelbach is a medical doctor and Professor of Epidemiology/Public Health at a leading university in Brazil. From 2006-2019, he has been Adjunct Professor at James Cook University in Australia. He holds a Diploma in Tropical Medicine and Hygiene, a Master’s Degree in International Health, and a Ph.D. degree in Pharmacology. His Academic research focuses on the epidemiology and sustainable control of Neglected Tropical Diseases and poverty-related diseases, mainly in sub-Saharan Africa and South America (with a focus on Brazil), within the One Health Approach.

He has ample field experience and is recognized as an internationally renowned expert on tungiasis and other ectoparasitoses, with many projects implemented. His academic track record includes the publication of more than 300 papers and book chapters. Jorg is a peer reviewer for more than 80 scientific journals, including top leading journals. He is also a member of editorial boards and editor of scientific journals and books.

Retired from steady employments. Prof.em. Infectious Diseases and Public Health.

Prof. Krantz is a Swedish MD; and has a Diploma certificate in Tropical Medicine and Tropical Parasitology from Bernhard Nocht Institut für Schiffs- und Tropenkrankheiten, Hamburg, Germany; Her two PhDs are from the University of Göteborg and Karolinska Institutet (“Whooping cough: some epidemiological method problems”) and Faculty of Medicine, Lund University (“Ethics and public health interventions: four cases”).
Former positions: 1988-1996 reader in epidemiology and biostatistics at the Nordic School of Public Health; Acting Director of Skaraborg Institute for Research and Development, 1997-2012; Approved associate professor in Infectious disease epidemiology, Karolinska institutet, 1993; Professor in Infectious Diseases and Public Health at Dpt of Public Health, Clinical Medicine and Epidemiology, Umeå university, Sweden, 2002-2008.

Since 1990 she has been involved in research projects in East Africa. Participated in tungiasis research, mainly as an evaluator and reviewer, since 2010. Author of the chapter “Infectious diseases. In Machin D, Day S, Green S (eds). Textbook of Clinical Trials (2nd ed). John Wiley & Sons Ltd, 2006”.

Scientist, Bruyère Research Institute; Assistant Professor, School of Epidemiology and Public Health, University of Ottawa; Senior Research Fellow at the WHO Collaborating Centre for Knowledge Translation, Technology Assessment for Health Equity; Principal Investigator, The Threads Lab, https://www.thethreadslab.org/

Dr. Krentel holds the following academic degrees: BA in Art and English, Washington and Lee University (USA); MSc in Public Health in Developing Countries, London School of Hygiene and Tropical Medicine (UK); and PhD, London School of Hygiene and Tropical Medicine (UK).

For 20+ years, she has been a researcher and consultant in public health working in over 14 countries across the African, Southeast Asian, Western Pacific, and the Americas regions. Her research includes methods to facilitate community engagement, understanding and measurement of acceptability, use of implementation research to support health systems, and translation of research results into programmatic action. She is currently interested in those who have been left behind by neglected tropical disease programs (never treated) and ensuring they are reached.

Former staff of the Ministry of Health of Mozambique; WHO consultant

Dr. Marilia Massangaie holds the following academic degrees: Medical Doctor and Master in Field and Laboratory Epidemiology.

With about 13 years of experience in management and technique in Public Health programs in Mozambique, she is currently a consultant to the World Health Organization for the Surveillance of Acute Flaccid Paralysis in Manica Province for the response to the Polio outbreak in Mozambique. As Head of the Department of Disease Prevention and Control, where she supervised a team of 10 doctors and health officials across the country, she was responsible for implementing strategies for the control and elimination of Communicable and Non-Communicable Diseases including Neglected Tropical Diseases (NTDs). 

She also worked with other health departments and partners to achieve the World Health Organization's goals for controlling and eliminating these diseases. In this capacity, she led several surveys on soil-transmitted helminthiasis and schistosomiasis in endemic districts and conducted successful Mass Drug Administration (MDA) activities and evaluations for monitoring and impact of interventions. She also supported the implementation of outreach interventions and managing cervical and breast cancer, with this exercise it was possible to prove the reduction in the burden of these diseases in the country.

Health Directorate of Vaupés Department in Colombia: Focal point on vector-borne diseases, zoonosis, and neglected infectious diseases

Hollman Miller holds the following academic degrees: a Bachelor’s in Biology; specialization in epidemiology; specialization in medical entomology, and an MSc in Microbiology of Tropical Diseases.
Hollman Miller has 26 years of experience in vector-borne and neglected disease control in indigenous communities of the Colombian Amazon. He has extensive experience in community processes for the prevention and control of vector-borne diseases, zoonoses, and neglected infectious diseases and is a researcher in parasitic and infectious diseases in the Colombian Amazon.

He described the occurrence of ocular trachoma for the first time in Colombia and is an expert and reference in the Amazon in the approach to prevention, control, and treatment of tungiasis and other ectoparasites prevalent in indigenous populations.

County Government of Vihiga; Department of Health Services for 12 years

Mr. Nandoya holds the following academic degrees: A diploma in Youth health and development work at the University of Nairobi;and a BSc in Community Health and Development at Great Lakes University of Kisumu. Currently, he is undertaking MSc in Health Management.

He worked during his internship with Ahadi Kenya Trust, REDCROSS and KEMRI organizations within Vihiga county to eradicate the jigger flea. Among this population are children who are unable to walk to school, write properly or even participate in learning activities to the same level as their uninfected peers. Their inabilities become a source of ridicule and scorn among their peers, both in and out of school. Given the challenges that people suffering from Tungiasis are faced with, including the inability to walk and fear of social stigma, they are unable to participate in the democratic processes of the country. Most people whose families are jigger infested prefer to stay home and hide rather than seek medical attention. Most families in the constituency live in utter poverty and rely on small-scale farming for their livelihood. Due to their low social-economic status, pins and other unsterilized equipment could be shared for jigger removal, leading to the spread of HIV and other communicable diseases.

The strategies in which he has supported the fight against tungiasis include community mobilization, participation, and sensitization; carrying out surgical removal of embedded jigger fleas and disinfection of the skin lesions among individuals infected with the parasite within Vihiga; carrying out spraying and dusting of houses infested with jigger fleas in Vihiga County; and conducting behavior change communication (BCC) campaigns for jigger prevention, control, among other health promotion messages targeting residents of Vihiga County.

Kenya Medical Research Institute (KEMRI)

Dr. Nyangacha holds the following academic degrees: PhD. in Applied Parasitology from the University of Nairobi and an Msc. in Medical Parasitology and Entomology from Jomo Kenyatta University of Agriculture and Technology. 

Dr. Nyangacha is a medical parasitologist/entomologist with expertise in infectious diseases research. She has authored several publications in peer-reviewed journals on malaria and tungiasis. She is a senior research scientist in KEMRI, with over 15 years of experience as a principal investigator and a co-principal investigator in several projects. Her focus has been studies on new antimalarial agents and more recently to support community-based and public health tungiasis control measures. Her Ph.D. thesis titled “Prevalence of tungiasis and associated bacterial pathogens from lesions of patients in Western Kenya” aimed to provide clinical data that would help in the treatment of tungiasis. The study confirmed multidrug-resistant bacteria in the lesions of patients presenting with tungiasis thereby contributing to scientific evidence of sepsis reported in observational studies.

Health Directorate of Vaupés Department in Colombia: support health professional

Karen Perilla holds a bachelor’s degree in Professional Nurse from Universidad Popular del Cesar.
She is a professional nurse and indigenous leader with experience in the clinical and intercultural approach and management of Tungiasis and neglected infectious diseases (NIDs), in the different indigenous populations of the department of Vaupés, Colombia.

Center for Bioethics, School of Medicine, Clínica Alemana, Universidad del Desarrollo; Director of the WHO Collaborating Center for Bioethics at Clínica Alemana, Universidad del Desarrollo.

Dr. Sofia Salas is a Chilean medical doctor with more than 25 years of experience as a member of ethics research committees (ERCs) in Chile. During these years, she has been involved in the review of national and international regulations related to clinical research. She was a member of the advisory commission on ethics in research for the Chilean Ministry of Health (2014-2022), where she was responsible for contributing to developing ethics research capacity at the national level. 

She has attended different meetings, especially at the Global Forum on Ethics in Research, and took formal courses on research ethics at the NIH and FLACSO, Argentine. This long-lasting interest and commitment to the development and strengthening of research ethics capacity led her to become a national and regional expert in the field. During the COVID-19 pandemic, she was invited to collaborate with different international experts on research ethics. Through these networks, she participates in the Maternal Health on COVID-19 coalition (Maternal Newborn-Children Working Group, MNCH) and the COVID-19 Ethics Working Group. 

Of particular importance is her collaboration with the Pan American Health Organization (PAHO) on issues related to research ethics and in the last year she was appointed as Director of the PAHO/WHO Collaborating Center for Bioethics in Santiago, Chile.

Minister of Health of Brazil; University of Brasilia/Faculty of Health Science

Yago Santana holds the following academic degrees: A nursing Degree; a Specialization in Public Health; Master in Collective Health.

He has experience in Public Management, Health Management, with an emphasis on Public Health. He currently works as a technical supporter in health at the Special Secretariat for Indigenous Health, monitoring and evaluating public health programs and projects.

Minister of Health and Social Protection of Colombia

Julian Trujillo holds the following academic degrees: a Bachelor’s in Bacteriology and Clinical Laboratory; a Specialization in Quality Systems Management; a Graduate of the Training Program in Epidemiology for Health Managers (JHBS); and a Master’s in Epidemiology.

Supported interventions to control tungiasis and other neglected infectious diseases (NIDs) in the Colombian Amazon between 2000 and 2005 in the departments of Guainía and Vaupés. Since 2015 he has been developing or supporting operational research projects in the control of tungiasis and other parasitic skin diseases in the departments of Cauca and the Colombian Amazon, including publications (series of cases of extremely severe tungiasis in Vaupés; Review of use of dimethicones in treatment of tungiasis).

He has participated in meetings to exchange experiences in the diagnosis, treatment, and control of tungiasis convened by PAHO / WHO and in the preparation of a document systematizing experiences in Brazil and Colombia. He worked on the inclusion of tungiasis and its treatment in different public policy instruments in Colombia such as the Ten-Year Public Health Plan, the National Plan for the Prevention, Control, Elimination, and Eradication of Neglected Infectious Diseases in Colombia (Resolution 518 of 2015, Resolution 3280 of 2018). He developed the national plan for the prevention and control of tungiasis in Colombia and the technical and operational guidelines for addressing this pathology. He is responsible for implementing technical assistance processes on tungiasis at the subnational level in Colombia.