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Faust CL, Crotti M, Moses A, Oguttu D, Wamboko A, Adriko M, Adekanle EK, Kabatereine N, Tukahebwa EM, Norton AJ, Gower CM, Webster JP, Lamberton PHL. Two-year longitudinal survey reveals high genetic diversity of Schistosoma mansoni with adult worms surviving praziquantel treatment at the start of mass drug administration in Uganda. Parasit Vectors 2019; 12:607. [PMID: 31881923 PMCID: PMC6935072 DOI: 10.1186/s13071-019-3860-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/17/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A key component of schistosomiasis control is mass drug administration with praziquantel. While control interventions have been successful in several endemic regions, mass drug administration has been less effective in others. Here we focus on the impact of repeated praziquantel treatment on the population structure and genetic diversity of Schistosoma mansoni. METHODS We examined S. mansoni epidemiology, population genetics, and variation in praziquantel susceptibility in parasites isolated from children across three primary schools in a high endemicity region at the onset of the Ugandan National Control Programme. Children were sampled at 11 timepoints over two years, including one week and four weeks post-praziquantel treatment to evaluate short-term impacts on clearance and evidence of natural variation in susceptibility to praziquantel. RESULTS Prevalence of S. mansoni was 85% at baseline. A total of 3576 miracidia larval parasites, isolated from 203 individual children, were genotyped at seven loci. Overall, genetic diversity was high and there was low genetic differentiation, indicating high rates of parasite gene flow. Schistosome siblings were found both pre-treatment and four weeks post-treatment, demonstrating adult worms surviving treatment and natural praziquantel susceptibility variation in these populations at the beginning of mass drug administration. However, we did not find evidence for selection on these parasites. While genetic diversity decreased in the short-term (four weeks post-treatment), diversity did not decrease over the entire period despite four rounds of mass treatment. Furthermore, within-host genetic diversity was affected by host age, host sex, infection intensity and recent praziquantel treatment. CONCLUSIONS Our findings suggest that praziquantel treatments have short-term impacts on these parasite populations but impacts were transient and no long-term reduction in genetic diversity was observed. High gene flow reduces the likelihood of local adaptation, so even though parasites surviving treatment were observed, these were likely to be diluted at the beginning of the Ugandan National Control Programme. Together, these results suggest that MDA in isolation may be insufficient to reduce schistosome populations in regions with high genetic diversity and gene flow.
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Affiliation(s)
- Christina L. Faust
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, UK
| | - Marco Crotti
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Arinaitwe Moses
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - David Oguttu
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Aidah Wamboko
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Moses Adriko
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Elizabeth K. Adekanle
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | | | - Alice J. Norton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Charlotte M. Gower
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Joanne P. Webster
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hawkshead, UK
| | - Poppy H. L. Lamberton
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, UK
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Debaveye S, Gonzalez Torres CV, De Smedt D, Heirman B, Kavanagh S, Dewulf J. The public health benefit and burden of mass drug administration programs in Vietnamese schoolchildren: Impact of mebendazole. PLoS Negl Trop Dis 2018; 12:e0006954. [PMID: 30419030 PMCID: PMC6258429 DOI: 10.1371/journal.pntd.0006954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/26/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mass anthelmintic drug administration is recommended in developing countries to address infection by soil-transmitted helminthiases (STH). We quantified the public health benefit of treatment with mebendazole in eight million Vietnamese children aged 5-14 years from 2006 to 2011. This was compared to the environmental impact of the pharmaceutical supply chain of mebendazole, as the resource use and emissions associated with pharmaceutical production can be associated with a public health burden, e.g. through emissions of fine particulate matter. METHODOLOGY Through Markov modelling the disability due to STH was quantified for hookworm, Ascaris lumbricoides and Trichuris trichiura. For each worm type, four levels of intensity of infection were included: none, light, medium and heavy. The treatment effect on patients was quantified in Disability-Adjusted Life Years (DALYs). The public health burden induced by the pharmaceutical supply chain of mebendazole was quantified in DALYs through Life Cycle Assessment. PRINCIPAL FINDINGS Compared to 'no treatment', the modelled results of five-year treatment averted 116,587 DALYs (68% reduction) for the three worms combined and largely driven by A. lumbricoides. The main change in DALYs occurred in the first year of treatment, after which the results stabilized. The public health burden associated with the pharmaceutical supply chain was 6 DALYs. CONCLUSIONS The public health benefit of the Mass Drug Administration (MDA) averted substantially more DALYs than those induced by the pharmaceutical supply chain. These results were verified in a sensitivity analysis. The starting prevalence for each worm was the most sensitive model parameter. This methodology is useful for policymakers interested in a holistic approach towards the public health performance of MDA programs, enveloping both the treatment benefit received by the patient and the public health burden associated with the resource consumption and environmental emissions of the pharmaceutical production and supply chain.
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Affiliation(s)
- Sam Debaveye
- Department of Green Chemistry and Technology, Ghent University, Campus Coupure, Ghent, Belgium
| | | | - Delphine De Smedt
- Department of Public Health, Ghent University, Campus UZ, Ghent, Belgium
| | - Bert Heirman
- Johnson & Johnson EHS&S, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Shane Kavanagh
- Health Economics, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jo Dewulf
- Department of Green Chemistry and Technology, Ghent University, Campus Coupure, Ghent, Belgium
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Li G, Zhou X, Liu J, Chen Y, Zhang H, Chen Y, Liu J, Jiang H, Yang J, Nie S. Comparison of three data mining models for prediction of advanced schistosomiasis prognosis in the Hubei province. PLoS Negl Trop Dis 2018; 12:e0006262. [PMID: 29447165 PMCID: PMC5831639 DOI: 10.1371/journal.pntd.0006262] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/28/2018] [Accepted: 01/23/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In order to better assist medical professionals, this study aimed to develop and compare the performance of three models-a multivariate logistic regression (LR) model, an artificial neural network (ANN) model, and a decision tree (DT) model-to predict the prognosis of patients with advanced schistosomiasis residing in the Hubei province. METHODOLOGY/PRINCIPAL FINDINGS Schistosomiasis surveillance data were collected from a previous study based on a Hubei population sample including 4136 advanced schistosomiasis cases. The predictive models use LR, ANN, and DT methods. From each of the three groups, 70% of the cases (2896 cases) were used as training data for the predictive models. The remaining 30% of the cases (1240 cases) were used as validation groups for performance comparisons between the three models. Prediction performance was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. Univariate analysis indicated that 16 risk factors were significantly associated with a patient's outcome of prognosis. In the training group, the mean AUC was 0.8276 for LR, 0.9267 for ANN, and 0.8229 for DT. In the validation group, the mean AUC was 0.8349 for LR, 0.8318 for ANN, and 0.8148 for DT. The three models yielded similar results in terms of accuracy, sensitivity, and specificity. CONCLUSIONS/SIGNIFICANCE Predictive models for advanced schistosomiasis prognosis, respectively using LR, ANN and DT models were proved to be effective approaches based on our dataset. The ANN model outperformed the LR and DT models in terms of AUC.
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Affiliation(s)
- Guo Li
- Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China
| | - Xiaorong Zhou
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China
| | - Jianbing Liu
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China
| | - Yuanqi Chen
- Department of Mathematics, Wuhan University, Wuhan, Hubei, China
| | - Hengtao Zhang
- Department of Mathematics, Wuhan University, Wuhan, Hubei, China
| | - Yanyan Chen
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China
| | - Jianhua Liu
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Junjing Yang
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China
| | - Shaofa Nie
- Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Lo NC, Addiss DG, Hotez PJ, King CH, Stothard JR, Evans DS, Colley DG, Lin W, Coulibaly JT, Bustinduy AL, Raso G, Bendavid E, Bogoch II, Fenwick A, Savioli L, Molyneux D, Utzinger J, Andrews JR. A call to strengthen the global strategy against schistosomiasis and soil-transmitted helminthiasis: the time is now. THE LANCET. INFECTIOUS DISEASES 2016; 17:e64-e69. [PMID: 27914852 DOI: 10.1016/s1473-3099(16)30535-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 01/01/2023]
Abstract
In 2001, the World Health Assembly (WHA) passed the landmark WHA 54.19 resolution for global scale-up of mass administration of anthelmintic drugs for morbidity control of schistosomiasis and soil-transmitted helminthiasis, which affect more than 1·5 billion of the world's poorest people. Since then, more than a decade of research and experience has yielded crucial knowledge on the control and elimination of these helminthiases. However, the global strategy has remained largely unchanged since the original 2001 WHA resolution and associated WHO guidelines on preventive chemotherapy. In this Personal View, we highlight recent advances that, taken together, support a call to revise the global strategy and guidelines for preventive chemotherapy and complementary interventions against schistosomiasis and soil-transmitted helminthiasis. These advances include the development of guidance that is specific to goals of morbidity control and elimination of transmission. We quantify the result of forgoing this opportunity by computing the yearly disease burden, mortality, and lost economic productivity associated with maintaining the status quo. Without change, we estimate that the population of sub-Saharan Africa will probably lose 2·3 million disability-adjusted life-years and US$3·5 billion of economic productivity every year, which is comparable to recent acute epidemics, including the 2014 Ebola and 2015 Zika epidemics. We propose that the time is now to strengthen the global strategy to address the substantial disease burden of schistosomiasis and soil-transmitted helminthiasis.
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Affiliation(s)
- Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA; Division of Epidemiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - David G Addiss
- Children Without Worms, Task Force for Global Health, Decatur, GA, USA
| | - Peter J Hotez
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine at Baylor College of Medicine, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Darin S Evans
- United States Agency for International Development, Global Health, Washington, DC, USA
| | - Daniel G Colley
- Center for Tropical and Emerging Global Diseases and the Department of Microbiology, University of Georgia, Athens, GA, USA
| | - William Lin
- Global Public Health, Johnson & Johnson, New Brunswick, NJ, USA
| | - Jean T Coulibaly
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Amaya L Bustinduy
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Giovanna Raso
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Eran Bendavid
- Division of General Medical Disciplines, Stanford University, Stanford, CA, USA; Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Imperial College London, London, UK
| | - Lorenzo Savioli
- Global Schistosomiasis Alliance, Chavannes de Bogis, Switzerland
| | - David Molyneux
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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