Early lessons from schistosomiasis mass drug administration programs

Abstract

Mass drug administration using praziquantel is the backbone of the current strategy for the control of schistosomiasis. As the theoretical plans have moved into practical application, certain challenges with this approach have surfaced, and it is likely that annual mass drug administration alone may not be sufficient to achieve program goals. However, mass drug administration is still the only available intervention that can be readily used in the wide variety of settings where schistosomiasis is endemic. The task then becomes how to improve this approach and identify what adjuncts to mass drug administration are effective, as programs move from morbidity control to elimination goals. Other aspects worthy of consideration include how best to employ new diagnostic tools to more easily identify where treatment is needed, and new formulations of praziquantel to extend the availability of treatment to all age groups. The aim of this review is to highlight both areas of challenge and of opportunity to improve the public health impact of schistosomiasis control programs.

Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda

“…Provision of mass treatment with praziquantel has faced obstacles such as inadequate supplies of praziquantel, the costs associated with delivery to the target communities and lack of compliance with treatment [30]. Factors such as population migration, change in food supply, conspiracy theories about the intentions of MDA, fear of drug side effects and relations between drug distributors and the target community have been identified to determine MDA success in communities in Uganda [31].…”

Methyl-CpG-binding (SmMBD2/3) and chromobox (SmCBX) proteins are required for neoblast proliferation and oviposition in the parasitic blood fluke Schistosoma mansoni

“…Predominantly found in sub-tropical and tropical regions of resource-poor communities, schistosomiasis kills thousands of individuals per year and causes chronic disability in millions more [ 1 ]. Until a immunoprophylactic vaccine can be developed, existing treatment relies on chemotherapeutic administration of praziquantel (PZQ) to individuals living in endemic communities [ 2 ]. Use of a single anti-parasitic drug with a currently unknown mechanism of action (perhaps acting as a G-protein coupled receptor agonist [ 3 ]) and limited efficacy against juvenile schistosomes [ 4 ], however, raises serious concerns in meeting the ambitious targets set by the World Health Organisation for achieving schistosomiasis elimination in selected regions and countries by 2020 [ 5 ].…”

Molluscicidal effectiveness of Luo-Wei, a novel plant-derived molluscicide, against Oncomelania hupensis, Biomphalaria alexandrina and Bulinus truncatus

“…However, this approach has an important limitation: people at risk of infections who miss or decline treatment remain infected and continue to contribute to local transmission of Schistosoma parasites [19]. Multiyear experiences in mass treatment campaigns indicate that population participation declines over time, and further suggest that drug efficacy may be lower for those residents who continue to be infected after multiple rounds of treatment [20]. There is a need for additional practical interventions that can interrupt the process of parasite transmission [21].…”