Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children (original) (raw)
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Paediatric and maternal schistosomiasis: shifting the paradigms
British Medical Bulletin, 2017
Background: In endemic areas, schistosomiasis causes both overt and subclinical disease in young children and their mothers, as well as in returned travellers. Sources of data: Key recently published literature. Areas of agreement: An action plan for paediatric schistosomiasis and female genital schistosomiasis (FGS) is needed with expanded access to praziquantel (PZQ) treatment required. Areas of controversy: Schistosomiasis-related morbidity is underappreciated. Present and future demand for PZQ treatment is bottlenecked, imbalanced and inequitable. Current dosing, treatment algorithms and access plans are suboptimal with treatment stalled during pregnancy. Growing points: Raised dosing of PZQ (>40 mg/kg) is being explored in young children. Surveillance of female genital schistosomiasis FGS is increasing. Use of PZQ in pregnancy is safe and preventive chemotherapy guidelines are being revised in morbidity-and transmission-control settings. Areas timely for developing research: Shifting focus of population-level control to individual-case management. Detection and prevention of FGS within general health services and integration of PZQ treatment for women and children in antenatal clinics. Feasibility studies assessing alternative and expanded access to PZQ treatment to at-risk children and mothers and pregnant women.
International Health, 2010
The Ugandan national control programme for schistosomiasis has no clear policy for inclusion of preschool-children (≤5 years old) children. To re-balance this health inequality, we sought to identify best diagnosis of intestinal schistosomiasis, observe treatment safety and efficacy of praziquantel (PZQ), and extend the current WHO dose pole for chemotherapy. We examined and treated 363 preschool children from shoreline villages of Lakes Albert and Victoria, and found that 62·3% (CI 95 57·1-67·3) of the children were confirmed to have intestinal schistosomiasis. One day after treatment, children were reported as having headaches (3·6%), vomiting (9·4%), diarrhoea (10·9%) and urticaria/rash (8·9%) with amelioration at 21-day follow-up, where the parasitological cure rate was found to be 100·0%. Height and weight data were collected from a further 3303 preschool children to establish and validate an extended PZQ dose pole that now includes two new heightintervals: 60-84 cm for one-half tablet and 84-99 cm for three-quarter tablet divisions; which would result in 97·6% of children receiving an acceptable dose (30-60 mg/kg). To conclude, preschool children in lakeshore communities of Uganda are at significant risk of intestinal schistosomiasis; we now strongly advocate for their immediate inclusion within the national control programme to eliminate this health inequity.
BMC Infectious Diseases, 2018
Background: Large scale administration of the anthelminthic drug praziquantel (PZQ) to at-risk populations is the cornerstone of schistosomiasis control, although persisting high prevalence of infections in some areas and growing concerns of PZQ resistance have revealed the limitations of this strategy. Most studies assessing PZQ efficacy have used relatively insensitive parasitological diagnostics, such as the Kato-Katz (KK) and urine-filtration methods, thereby overestimating cure rates (CRs). This study aims to determine the efficacy of repeated PZQ treatments against Schistosoma mansoni infection in school-aged children in Côte d'Ivoire using the traditional KK technique, as well as more sensitive antigen-and DNA-detection methods. Methods: An open-label, randomised controlled trial will be conducted in school-aged children (5 to 18 years) from the region of Taabo, Côte d'Ivoire, an area endemic for S. mansoni. This 8-week trial includes four two-weekly standard doses of PZQ in the "intense treatment" intervention group and one standard dose of PZQ in the "standard treatment" control group. The efficacy of PZQ will be evaluated in stool samples using the KK technique and real-time PCR as well as in urine using the point-of-care circulating cathodic antigen test and the up-converting phosphor, lateral flow, circulating anodic antigen assay. The primary outcome of the study will be the difference in CR of intense versus standard treatment with PZQ on individuals with a confirmed S. mansoni infection measured by KK. Secondary outcomes include the difference in CR and intensity reduction rate between the intense and standard treatment groups as measured by the other diagnostic tests, as well as the accuracy of the different diagnostic tests, and the safety of PZQ. Discussion: This study will provide data on the efficacy of repeated PZQ treatment on the clearance of S. mansoni as measured by several diagnostic techniques. These findings will inform future mass drug administration policy and shed light on position of novel diagnostic tools to evaluate schistosomiasis control strategies.
BMC Research Notes
Objective: Preschool age children (PSAC) are excluded from community based praziquantel treatment programs mainly due to paucity of evidence on the magnitude of schistosomiasis, efficacy and safety of this treatment in PSAC. The aim of this study is to assess Schistosoma mansoni infection rate and evaluate response to praziquantel in PSAC. A facility based longitudinal study was employed from April to June 2016 at Erer Health Center, Eastern Ethiopia. Stool sample was examined for schistosomiasis in 236 PSAC and repeated after 4 weeks post-treatment in positive individuals. Treatment outcomes were recorded and interpreted. Results: Out of the 236 study participants, 59 (25%) were infected with S. mansoni. Praziquantel treatment (40 mg/ kg) resulted in 96.4% cure rate and 99.4% egg reduction rate. Children of 3-5 year old were significantly affected with S. mansoni infection. Nausea and fatigue were common mild adverse events within 4 h of treatment however moderate and severe adverse events and allergic reactions were not observed. In conclusion, praziquantel at 40 mg/kg, the dose utilized in standard care for school age children, is tolerable and efficacious in the treatment of S. mansoni infection in PSAC, which calls for the healthcare system to provide appropriate service for this population.
International Journal of Biological and Chemical Sciences, 2019
Schistosomiasis, a major public health challenge is caused by trematodes of the genus Schistosoma whose intermediate host is snails. Sub-Saharan African (SSA) carried 85% of the global burden of this infection principally amongst school age children. Similarly, Nigeria bears the highest weight of this highly preventable infection in SSA. Preventive chemotherapy (PC) with 40-60 mg\kg praziquantel (PZQ) annually is the focal control strategy in endemic areas. Despite more than two decades of PZQ usage in Nigeria, the disease is still prevalent in affected communities. Thus, the study sought to assess the current post-treatment efficacy of PZQ use for urinary schistosomiasis among primary school age children of Ipogun village. Urine reagent strip (Haemastix) ® was initially used to screen pupils for haematuria, while Kato-Katz and urine filtration were employed to confirm the presence of schistosome ova in the faeces and urine of the study population pre-and post-treatment. A total of 202 children were screened, out of which 117 (57.9%) were positive for microhaematuria and 91 (45.0%) had ova of Schistosoma haematobium in their urine. The 14 and 21 day post-treatment assessment revealed 73.6% and 23.1% of the initially infected children to still be with infection respectively. Additionally, there was a statistical significant (P=0.02) in the reduction of egg count twenty-one days post-treatment. Though the efficacy of the drug as observed in the egg reduction rate in the study area can be classified as satisfactory, continuous monitoring of schistosome response should not cease if the global target of eliminating morbidity due to schistosomiasis by year 2020 is to be achieved.