Tackling Neglected Tropical Diseases in Ethiopia: Adugna Abera’s Contribution to Genomic Surveillance
The International Day of Neglected Tropical Diseases (World NTD Day) is observed annually on January 30th. It aims to raise awareness about neglected tropical diseases and inspire global action to combat these illnesses, which affect over a billion people, primarily in underserved communities.
We had the privilege of speaking with Adugna Abera, a dedicated EpiGen Ethiopia researcher specializing in vector-borne neglected tropical diseases like Dengue and Leishmaniasis. With years of experience in the field, Adugna has made significant contributions to understanding these diseases and their impact on marginalized communities, combining genomic surveillance with public health strategies to drive meaningful change. He shares his insights today.
Could you start by introducing yourself and sharing a bit about your background? What inspired you to focus your research on neglected tropical diseases like Dengue and Leishmaniasis?
My name is Adugna Abera. I hold a BSc in Medical Laboratory Sciences and an MSc in Medical Microbiology from Addis Ababa University, where I am currently pursuing a PhD in Applied Genetics. My PhD research focuses on emerging vector-borne infectious diseases in Ethiopia.
I began my career as an assistant researcher at the Armauer Hansen Research Institute, working on Leishmania antigens for diagnostic and vaccine development. Later, I joined the Ethiopian Public Health Institute in 2016, coordinating projects on malaria, leishmaniasis, human African trypanosomiasis, and arboviral diseases. Over the years, my team has published more than 50 peer-reviewed articles.
My interest in neglected tropical diseases (NTDs) stems from my work on leishmaniasis risk mapping in Ethiopia. Witnessing the lack of standardized treatments and vaccines, particularly for cutaneous leishmaniasis (CL), deeply motivated me. Additionally, the emergence of arboviral diseases like dengue and chikungunya in Ethiopia, causing severe outbreaks over the past decade, further inspired me to focus on these pressing health challenges.
As someone researching neglected tropical diseases, what do you see as the biggest challenges in raising awareness and securing funding for diseases like Dengue and Leishmaniasis, especially given their "neglected" status?
Both dengue and leishmaniasis are vector-borne diseases with high transmission potential, often involving animal reservoirs. Unfortunately, most funding for NTDs prioritizes those that can be addressed with chemoprophylaxis, leaving diseases like dengue and leishmaniasis underfunded. Raising awareness requires affected countries to actively report the prevalence and types of circulating pathogens, as we did for Dengue and Leishmania tropica variants in Ethiopia.
Collaboration at both local and continental levels is vital, given that these diseases can cross borders due to their vector-borne nature. For example, dengue, historically confined to tropical and subtropical regions, is now emerging in temperate areas due to increased human mobility and climate change. It has become endemic in over 134 countries and was listed among the top public health emergencies in 2024.
Similarly, the global rise in cutaneous leishmaniasis cases, driven by war, displacement, and climate change, underscores the need for global and local attention. These diseases cause significant morbidity, social stigma, and economic strain, highlighting the urgent need for research on treatments, control strategies, and surveillance mechanisms.
Your recent preprints on Dengue and Leishmaniasis contribute valuable insights. Could you summarize the key findings?
In our recent project on genomic characterization of dengue virus in Ethiopia , conducted with Stellenbosch University in South Africa and the EpiGen Ethiopia team, we analyzed the genetic makeup of dengue viruses found in Ethiopia. In this study:
Two types of dengue virus, DENV-1 and DENV-3, were identified. DENV-1 and DENV-3 came from Dire Dawa, while DENV-3 also appeared in the Afar region.
DENV-1 viruses in Ethiopia are part of a cluster originating in Africa, suggesting hidden spread of the virus since 2019. For DENV-3, two clusters were identified: one linked to Italy and the other to India.
Similarly, we did genomic characterization for the recent outbreak of CL in the Somali region, Ethiopia.
For the first time, we found that Leishmania tropica, not the expected L. aethiopica, is causing CL in Ethiopia’s lowland regions.
More than 77% of patients had over 10 lesions, which is unusual for L. tropica infections.
A new variant of L. tropica was discovered with unique genetic traits related to drug resistance.
The genetic uniformity in the samples confirmed that the outbreak was due to a single strain of L. tropica.
How do diseases like Dengue and Leishmaniasis impact communities where they are endemic, both in terms of health and socio-economic factors? What role can genomic surveillance, as implemented in projects like EpiGen Ethiopia, play in mitigating these impacts?
In communities where dengue is prevalent, the infection can significantly impact individual health and the broader socio-economic structure. It directly causes illness and fatalities while also disrupting livelihoods. This disruption often leads to workforce absences, increased strain on healthcare systems, and economic losses, particularly in regions that depend on tourism. Vulnerable populations are disproportionately affected due to limited access to healthcare and sanitation facilities. Dengue symptoms can range from mild fever and headache to severe complications like dengue hemorrhagic fever (DHF) and dengue shock syndrome, which can be life-threatening, especially for young children and pregnant women. Illness frequently renders individuals unable to work, resulting in significant productivity losses for households and businesses alike. During outbreaks, healthcare systems can become overwhelmed, with shortages of hospital beds, medical supplies, and trained healthcare professionals. In areas with inadequate access to medical care, dengue outbreaks can lead to higher mortality rates, particularly among vulnerable groups.
Cutaneous leishmaniasis is the most common form of leishmaniasis, significantly impacting communities where it is endemic. The disease causes severe health issues, including disfiguring skin lesions, and contributes to socio-economic challenges such as stigma, reduced productivity, and financial strain. These challenges are particularly acute in impoverished regions with limited access to healthcare. The situation is often worsened by poor housing conditions, inadequate sanitation, and a lack of awareness about the disease. The visible lesions or scars, often on exposed areas of the body, can cause considerable psychological distress and social stigma for those affected. If left untreated, these lesions may lead to secondary infections and permanent scarring. Accessing treatment also imposes a significant financial burden on households in resource-limited settings, particularly due to the costs associated with traveling to healthcare facilities.
Genomic surveillance plays a crucial role in tracking the sources of infections and identifying the variants or strains involved in outbreak situations. It is also important for disease elimination programs, as it helps determine whether the pathogens involved are endemic or imported from other countries. The recent outbreaks of dengue and leishmaniasis are part of this effort within the EpiGen project in Ethiopia. In both outbreaks, we have successfully traced the sources of infection using genomic surveillance methods, and we plan to extend our work on both diseases as part of the EpiGen project. The EpiGen project will have a significant impact as it targets a wide range of diseases, thereby enhancing the current disease surveillance system in Ethiopia and beyond.
In Ethiopia, where climate change, urbanization, and ecological shifts are influencing the spread of diseases, how do you foresee the distribution and severity of Dengue and Leishmaniasis evolving?
Dengue is an emerging viral disease in Ethiopia, first reported in 2013 in Dire Dawa. Since then, it has spread to regions like Afar and Somali, with the 2023 outbreak affecting multiple areas, including Amhara and Oromia. Increasing urbanization creates environments conducive to Aedes mosquito breeding, facilitating the disease’s alarming spread. The involvement of multiple serotypes in outbreaks has heightened infection severity, as seen in Dire Dawa’s hospital bed shortages.
Cutaneous leishmaniasis is often associated with conflicts, displacement, and war. The recent outbreak is notable because this is the first time the disease has been identified in an area typically isolated from lowland settings. The outbreak occurred in a region that is not normally inhabited by people; instead, it is primarily used by nomadic communities for cattle grazing. Although the ongoing conflict at the outbreak site has hindered thorough investigation, we strongly suspect that zoonotic transmission is involved due to the severity and atypical clinical presentations of most lesions. New ecological encroachments may increase the likelihood of such unprecedented outbreaks, like the one observed in the Somali region.
On this International Day of NTDs, what message would you like to convey to policymakers, researchers, and the global community about the importance of investing in genomic surveillance, capacity building, and holistic approaches to tackle diseases like Dengue and Leishmaniasis?
The International Day of NTDs is an opportunity to raise awareness and highlight the urgent need for increased funding, research, and treatment programs to address neglected tropical diseases (NTDs). Genomic surveillance is an emerging and powerful tool for identifying new pathogen variants and guiding outbreak responses. These new variants may be more infectious or more deadly. Changes, or the absence of changes, in a genome provide insight into how the pathogen is spreading, helping us track the source of infections. Therefore, I urge policymakers to incorporate genomic surveillance into existing routine surveillance systems. I also call on funders, the global community, and researchers to increase funding and enhance research on the use of genomic surveillance in particular for dengue and leishmaniasis for future outbreaks of disease control and elimination.