Control of neglected tropical diseases needs a long-term commitment

Lima

Rev. Soc. Bras. Med. Trop.

et al. 2016

Introduction: Schistosomiasis is a parasitic infectious disease with a worldwide prevalence. The objective of this work is to identify risk areas for schistosomiasis mansoni transmission in the State of Sergipe, Brazil, during the period from 2005 to 2014. Methods: We conducted an epidemiological study with secondary data from the Information System Control Program of Schistosomiasis [Sistema de Informação do Programa de Controle da Esquistossomose (SISPCE)]. Temporal trends were analyzed to obtain the annual percentage change (APC) in the rates of annual prevalence. In addition to the description of general indicators of the disease, the spatial analysis was descriptive, by means of the estimator of intensity kernel, and showed spatial dependence by indicators of global Moran (I) and Local Index of Spatial Association (LISA). Thematic maps of spatial distribution were made, identifying priority intervention areas in need of healthcare. Results: There were 78,663 cases of schistosomiasis, with an average of 8.7% positivity recorded; 79.8% of the cases were treated, and Sergipe showed a decreasing positive trend (APC: -2.78). There was the presence of spatial autocorrelation and a significant global Moran index (I = 0.19; p-value = 0.03). We identified clusters of highrisk areas, mainly located in the northeast and southcentral of the state, which each had equally high infection rates. Conclusions: There was a decreasing positive trend of schistosomiasis in Sergipe. Spatial analysis identified the geographic distribution of risk and allowed the definition of priority areas for the maintenance and intensification of control interventions.

Section: Introductionmentioning

confidence: 99%

Spatial analysis for the identification of risk areas for schistosomiasis mansoni in the State of Sergipe, Brazil, 2005-2014

Lima

Rev. Soc. Bras. Med. Trop.

et al. 2016

Antimicrob Agents Chemother

“…However, helminths may have beneficial effects as well, such as dampening of excessive inflammatory responses against other pathogens or environmental antigens (14, 20,21). Nevertheless, it is commonly accepted that the risks of helminth infection outweigh the benefits, and several public health interventions are in place to control soil-transmitted helminths.Albendazole is frequently used in mass drug administration (MDA) campaigns as a principal control tool for intestinal helminth infections (2,(22)(23)(24). However, there is a need to reevaluate its efficacy and safety in a rigorous clinical trial to provide scientific evidence for the continued use of such interventions.…”

mentioning

confidence: 99%

“…Albendazole is frequently used in mass drug administration (MDA) campaigns as a principal control tool for intestinal helminth infections (2,(22)(23)(24). However, there is a need to reevaluate its efficacy and safety in a rigorous clinical trial to provide scientific evidence for the continued use of such interventions.…”

mentioning

confidence: 99%

Randomized, Controlled, Assessor-Blind Clinical Trial To Assess the Efficacy of Single- versus Repeated-Dose Albendazole To Treat Ascaris lumbricoides, Trichuris trichiura, and Hookworm Infection

Adegnika

Zinsou

Issifou

et al. 2014

In many regions where soil-transmitted helminth infections are endemic, single-dose albendazole is used in mass drug administration programs to control infections. There are little data on the efficacy of the standard single-dose administration compared to that of alternative regimens. We conducted a randomized, controlled, assessor-blinded clinical trial to determine the efficacies of standard and extended albendazole treatment against soil-transmitted helminth infection in Gabon. A total of 175 children were included. Adequate cure rates and egg reduction rates above 85% were found with a single dose of albendazole for Ascaris infection, 85% (95% confidence interval [CI], 73, 96) and 93.8% (CI, 87.6, 100), respectively, while two doses were necessary for hookworm infestation (92% [CI, 78, 100] and 92% [CI, 78, 100], respectively). However, while a 3-day regimen was not sufficient to cure Trichuris (cure rate, 83% [CI, 73, 93]), this regimen reduced the number of eggs up to 90.6% (CI, 83.1, 100). The rate ratios of two-and three-dose regimens compared to a single-dose treatment were 1.7 (CI, 1.1, 2.5) and 2.1 (CI, 1.5, 2.9) for Trichuris and 1.7 (CI, 1.0, 2.9) and 1.7 (CI, 1.0, 2.9) for hookworm. Albendazole was safe and well tolerated in all regimens. A singledose albendazole treatment considerably reduces Ascaris infection but has only a moderate effect on hookworm and Trichuris infections. The single-dose option may still be the preferred regimen because it balances efficacy, safety, and compliance during mass drug administration, keeping in mind that asymptomatic low-level helminth carriage may also have beneficial effects. (This study has been registered at ClinicalTrials.gov under registration number NCT01192802.) S oil-transmitted helminths affect more than two billion people worldwide (1, 2). They are widely endemic in the tropics and are prevalent mostly in preschool and school-age children (3, 4) as well as in pregnant women (5). Infections are related to poor sanitation and hygiene and classified as neglected tropical diseases (6). These infections are responsible for significant morbidity, which includes anemia (7,8), stunting (9), and iron and vitamin A deficiencies (10-13). Additionally, helminth infections have the capacity to reduce the host immune response to vaccines as well as to environmental and parasitic antigens (14-16). The consequences of such hyporesponsiveness may explain changes in host susceptibility to commonly encountered pathogens, as reported recently (17)(18)(19). However, helminths may have beneficial effects as well, such as dampening of excessive inflammatory responses against other pathogens or environmental antigens (14, 20,21). Nevertheless, it is commonly accepted that the risks of helminth infection outweigh the benefits, and several public health interventions are in place to control soil-transmitted helminths.Albendazole is frequently used in mass drug administration (MDA) campaigns as a principal control tool for intestinal helminth infections (2,(22)(23)(24). Howeve...

“…17 Depending mostly on external support may be followed by a disastrous situation after completion of the funding period if the available local resources are not adequate as in the case after termination of the BNHP. 7,8 As praziquantel will be available free of charge for several years from the Merck company, the Ministry of Health felt the need for an appropriate channel of distribution particularly for school and preschool children and hence this approach was initiated.…”

Section: Lessons Learntmentioning

confidence: 99%

Teachers-Centred Distribution of Praziquantel to Control Schistosomiasis in Gezira State, Sudan

Malik¹,

Abdalla²,

Babiker³

et al. 2016

Public Health Open J

Schistosomiasis is a major public health problem in Gezira State, Sudan. The statewide prevalence survey among school children showed that the prevalence reached up to 82% in some districts and the reported mean intensity reached up to 223 eggs/gm of stool for S. mansoni and 28 eggs/10 ml of urine for S. haematobium. Based on this, a plan was established to control schistosomiasis. A teacher-centered distribution of praziquantel was organized in 22 districts targeting school pupils only. This short communication describes the intervention, the coverage and lessons learnt. With negligible cost and minimal efforts the target coverage of school pupils with praziquantel was reached by teachers in a demonstrable short time. In the successive two rounds the coverage exceeded 90% of the target school enrolled children. This approach can be extended to target all school and preschool children plus children not attending school in the state, as they represent a very important reservoir for schistosomiasis and soil transmitted helminthes.