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and analyzes levels and trends for causes and risk factors within the same computational framework, which maxim izes comparability across states, years, and different age groups by sex. GBD is now conducted on an annual cycle, with GBD 2016 providing updated estimates of mortality, morbidity, and risk factors in 195 locations, including the United States, from 1990 to 2016 The findings of GBD 2016 indicate that while the United States overall is experiencing improvements in health outcomes, the patterns of health burden at the state level vary across geography. Routinely monitoring the trend of burden of disease at the state level is essential given the vital role of states in many aspects of health and social policy-from the Medicaid program to regulation of private insurers and considering that individual states also experience different economic circumstances. The current study uses GBD 2016 to report the change in burden of disease, including injuries and risk factors at the state level, from 1990 to 2016 Introduction (3) The World Health Organization defines tropical diseases as encompassing all diseases that occur solely, or principally, in the tropics and that in practice, the term is often taken to refer to infectious diseases that thrive in hot, humid conditions While tropical infectious disease prevalence is, in general, dependent on a broad number of factors, including econom ic, demographic, and socio-cultural determinants, rainfall and temperature frequently underlie overall prevalence. This is especially true for arthropod vector-borne diseases for which vector presence, abundance, activity, and seasonality are highly dependent on climate. As a result vector-borne diseases, including targeted diseases such as malaria as well as neglected infectious diseases, have a highly skewed distribution with increased prevalence in tropical countries Specific to Africa, the tendency to incorrectly infer that tropical diseases are unifomly prevalent throughout the roughly 75% of the continent that lies within the tropics has been overcome, at least partially, with solid epidemiologic data, including the data presented here from Ghana. This finer resolution epidemiologic data has at least two important implications. First is that prevalence data can guide treatment, especially in areas where the diagnosis is primarily based on clinical signs. Illustrative of this are findings from northem Tanzania in which non- malarial febrile illness greatly exceeded the proportion attributed to malaria and for which different therapy is required. Second is the importance for population immunity. Boundaries where higher prevalence zones, with a correspondingly higher level of population immunity, intersect with zones of lower prevalence and low population immunity create risk for more rapid spread and more severe disease if the underlying transmission determinants change. We hypothesized that vector-bome pathogen prevalence would significantly differ according to zonal differences in environmental parameters such as rainfall, temperature, relative humidity and vegetation, even in the overall context of a national tropical climate. We addressed this question by determining the prevalence of tick-bome pathogens within three vegetation zones of Ghana. These areas are located entirely within the tropics (between 4° and 12°N 4°W and 2°E) and are considered to have a tropical climate at the national level as characterized by high mean temperature and rainfall. Despite this national level tropical classification, Ghana has three climatic zones (humid, sub-humid humid, and sub-humid dry) and encompasses a variety of vegetation zones (rain forest, semi-deciduous forest, Guinea savannah, Sudan savannah and coastal savannah). To control for movement between climatic regions, we determined the prevalence of tick-borne pathogens in cattle raised exclusively within the three distinct vegetation zones in which cattle are predominantly raised: the Guinea savannah, the semi-deciduous forest and the coastal savannah. Here, we report the testing of the hypothesis of significant differences in pathogen prevalence in cattle within a national level tropical climate, determine if weather data and the enhanced vegetation index (EVI) could be used to predict pathogen prevalence and discuss the results in the context of transm ission and mitigation of disease risk Introduction (4) According to the latest (November 28) figures from the World Health Organization (WHO) and US Centers for Disease Control and Prevention, almost 6,000 people have died so far in the 2014 Ebola outbreak in West Africa, with estimates that the deaths will easily exceed 7,000 deaths before years end.

There is no question that Ebola virus infection is one of the most lethal of all of the neglected tropical disease (NTD) pathogens, but on a global scale there are a number of other NTDs that also cause large numbers of deaths The WHO currently lists 17 major disease conditions as NTDs. Shown in Fig. 1 is an illustration from our previous publication in PLOS Neglected Tropical Diseases that compares the proportion of disability-adjusted life years (DALYs) that result either from disability (YLDs - years lived with a disability) colored in blue, or death (YLLs years of life lost) colored in orange. Its clear that there is a lot more blue than orange meaning that most of the worlds NTDs are disablers rather than killers. But there are also important exceptions such as the kinetoplastid infections, including leishmaniasis (kala-azar), African sleeping sickness, and Chagas disease, as well as the viral infections rabies and dengue fever which also represent major killers. Schistosomiasis, which is a major disabler. is another important cause of mortality in Africa 0% 20% 40% 60% 80% 100% Rabies Alrican trvpanoscmiasis Dengue Leishmaniasis Chagas disease Neglected tropical diseases and malaria Echinococcosis Other neglected tropical diseases Ascariasis Schistosomiass Cysticercoss Intestinal nematode infections Lymphatic filarissis Onchacerciasis Trachoma Yellow fever Trichuriass Hookworm disease Food borne trematcd ases 622010 YLD % ■ 2010 YUL % Indeed, if we compare the number of people who have died in this years Ebola epidemic with the number of deaths caused by NTDs from the Global Burden of Disease Study 2010, we find that there are some very serious and lethal NTDs that get very little attention. At least six NTDs kill more people each year than all those who perished from Ebola virus infection this year Our takeaway is that while we urgently need new drugs, diagnostics, and vaccines for Ebola virus infection, the same could be said for all of the NTDs listed in Table 1. As the global policy leaders in the United States, Europe and elsewhere meet in the coming weeks and months, we hope they will consider new Ebola virus technologies in the context of each of our planets killer NTDs

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