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Chapter 8 : The Urban Neglected Tropical Diseases: Leptospirosis, Dengue, and Rabies
The neglected tropical diseases (NTDs) leptospirosis, dengue, and rabies have particular importance as urban health problems in developing countries. For both leptospirosis and dengue, urban flooding is a key component of transmission. Dengue virus replicates in the salivary glands of Aedes mosquitoes. Once contracted and once clinical signs become evident, rabies is almost invariably fatal. The first rabies vaccine was developed by Louis Pasteur in the 19th century. This development led to the establishment of Pasteur Institutes all over the Francophone world, which made available first-generation rabies vaccine to many developing countries. Unless significant steps are taken to reduce squalor in the urban areas of the developing world, one can anticipate increases in dengue, leptospirosis, rabies, and other urban NTDs. Dengue fever is one of the most common NTDs of urban areas, with an estimated 50 million cases worldwide. Like leptospirosis, most dengue cases present as a nonspecific febrile illness. However, classical dengue is sometimes known as break bone fever because of the severe myalgias and headache that can accompany the illness. Many developing-country manufacturers still produce rabies vaccines derived from neural tissues.