Barriers to Child Development and Human Potential The Case for Including the Neglected Enteric Protozoa NEP) and Other Enteropathy Associated Pathogens in the NTDs.docVIP

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Barriers to Child Development and Human Potential The Case for Including the Neglected Enteric Protozoa NEP) and Other Enteropathy Associated Pathogens in the NTDs.doc

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Barriers to Child Development and Human Potential The Case for Including the Neglected Enteric Protozoa NEP) and Other Enteropathy Associated Pathogens in the NTDs

Viewpoints ‘‘Barriers’’toChildDevelopmentandHumanPotential: TheCaseforIncludingthe‘‘NeglectedEntericProtozoa’’ (NEP)andOtherEnteropathy-AssociatedPathogensin theNTDs LutherA.Bartelt1*,AldoA.M.Lima2,MargaretKosek3,PabloPen?ataroYori3,GwenythLee3, RichardL.Guerrant1 1CenterforGlobalHealthandDivisionofInfectiousDisease,UniversityofVirginia,Charlottesville,Virginia,UnitedStatesofAmerica,2DepartmentofPhysiologyand Pharmacology,InstituteoftheBrazilianSemi-Arid,SchoolofMedicine,FederalUniversityofCeara,Fortaleza,Brazil,3JohnsHopkinsSchoolofPublicHealthandHygiene, Baltimore,Maryland,UnitedStatesofAmerica The World Health Organization volunteers showed mild to moderate and its subsequent refinements, and the introductionofrotavirusvaccinesinsome populations [17], have led to significant reductions in diarrhea-related mortality from 4.5 million/year over a decade ago to 1.5 million/year in 2010 [18,19]. (WHO) has set forth ambitious efforts to control,andwherepossible,eliminatethe neglected tropical diseases (NTDs) that contribute to poverty and ‘‘impair the abilityofthoseinfectedtoachievetheirfull potential,bothdevelopmentallyandsocio- economically’’ [1,2]. This neglected dis- easeinitiative’s(NDI)purposehasbeento close the existing poverty gap between individuals living in low/middle-income jejunitis with decreased villus:crypt ratios [6]. Villus blunting along with chronic inflammation associates with impaired intestinal barrier function with resultant increasedintestinalpermeability [7].This combination of altered villus architecture and barrier function, so uniquely depen- dent upon one’s environment, has been termed‘‘environmentalenteropathy’’(EE) [8].ThesecharacteristicEEchangeshave beenepidemiologicallylinkedwithgrowth faltering and are one hypothesis for why intensive nutritional supplementation in- terventionsdoneunderevenidealclinical trialconditionshavesignificantbutlimited Currently, however, there are still .700,000deathsperyeargloballyrelated todiarrheal