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Mutapi F, Garba A, Woolhouse M, Kazyoba P. Paediatric schistosomiasis: last mile preparations for deploying paediatric praziquantel. Trends Parasitol 2024:S1471-4922(24)00169-7. [PMID: 39033047 DOI: 10.1016/j.pt.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/12/2024] [Accepted: 06/19/2024] [Indexed: 07/23/2024]
Abstract
Schistosomiasis is the second most important parasitic disease of public health importance in Africa, affecting over 50 million children aged <5 years old. Schistosomiasis control has focused on treating school-aged children (>6 years) and adults through mass drug administration (MDA). Following the recent development of a paediatric praziquantel (PZQ) formulation for children aged <5 years, there are now concerted efforts to determine optimal and effective ways to integrate treatment of these children into national schistosomiasis control programmes. In this opinion article we outline the pathway for successful drug access, delivery, and mainstreaming of the new formulation in endemic country health systems. Effective and sustained paediatric schistosomiasis treatment is an important target of the 2030 World Health Organization (WHO) neglected tropical diseases (NTDs) roadmap.
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Affiliation(s)
- Francisca Mutapi
- Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh EH9 3FL, UK; Tackling Infections to Benefit Africa (TIBA) Partnership, TIBA Global Health Research Unit, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK.
| | - Amadou Garba
- Department of the Control of Neglected Tropical Diseases, World Health Organization, Geneva, 1211, Switzerland
| | - Mark Woolhouse
- Tackling Infections to Benefit Africa (TIBA) Partnership, TIBA Global Health Research Unit, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK; Usher Institute of Population Health Sciences and Informatics, Ashworth Laboratories, University of Edinburgh, Edinburgh, UK
| | - Paul Kazyoba
- National Institute for Medical Research, 2448 Barack Obama Dr, Dar es Salaam, Tanzania; TIBA Partnership, NIMR, Tanzania, 2448 Barack Obama Dr, Dar es Salaam, Tanzania
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Sheehy C, Lawson H, Andriamasy EH, Russell HJ, Reid A, Raderalazasoa GU, Dodge G, Kornitschky R, Penney JMS, Ranaivoson TN, Andrianiaina A, Emmanoela JS, Bustinduy AL, Stothard JR, Andrianjaka L, Spencer SA. Prevalence of intestinal schistosomiasis in pre-school aged children: a pilot survey in Marolambo District, Madagascar. Infect Dis Poverty 2021; 10:87. [PMID: 34172089 PMCID: PMC8235251 DOI: 10.1186/s40249-021-00871-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/07/2021] [Indexed: 12/28/2022] Open
Abstract
School-aged children (SAC) have a considerable burden of intestinal schistosomiasis in Madagascar yet its burden in pre-school aged children (PSAC) is currently overlooked. To assess the at-risk status of PSAC, we undertook a pilot epidemiological survey in June 2019 examining children (n = 89), aged 2–4-years of balanced gender, in six remote villages in Marolambo District, Madagascar. Diagnosis included use of urine-circulating cathodic antigen (CCA) dipsticks and coproscopy of stool with duplicate Kato-Katz (K-K) thick smears. Prevalence of intestinal schistosomiasis by urine-CCA was 67.4% (95% confidence interval [CI]: 56.5–77.2%) and 35.0% (95% CI: 24.7–46.5%) by K-K. The relationship between faecal eggs per gram (epg) and urine-CCA G-scores (G1 to G10) was assessed by linear regression modelling, finding for every increment in G-score, epg increased by 20.4 (6.50–34.4, P = 0.006). Observed proportions of faecal epg intensities were light (78.6%), moderate (17.9%) and heavy (3.6%). Soil-transmitted helminthiasis was noted, prevalence of ascariasis was 18.8% and trichuriasis was 33.8% (hookworm was not reported). Co-infection of intestinal schistosomiasis and soil-transmitted helminthiasis occurred in 36.3% of PSAC. These results provide solid evidence highlighting the overlooked burden of intestinal schistosomiasis in PSAC, and they also offer technical  guidance for better surveillance data for the Madagascan national control programme. ![]()
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Affiliation(s)
- Caitlin Sheehy
- The University of Manchester Medical School, University of Manchester, Manchester, M13 9NT, UK.
| | | | | | - Hannah J Russell
- The University of Manchester Medical School, University of Manchester, Manchester, M13 9NT, UK
| | - Alice Reid
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | | | - Graham Dodge
- Department of Imaging, Brighton and Sussex University Hospital NHS Trust, Brighton, BN2 5BA, UK
| | - Robbie Kornitschky
- The University of Manchester Medical School, University of Manchester, Manchester, M13 9NT, UK
| | - James M StJ Penney
- The University of Manchester Medical School, University of Manchester, Manchester, M13 9NT, UK
| | | | - Antsa Andrianiaina
- Faculté de Médecine, Université D'Antananarivo, Antananarivo, Madagascar
| | - Jenny S Emmanoela
- Faculté de Médecine, Université D'Antananarivo, Antananarivo, Madagascar
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | | | - Stephen A Spencer
- The University of Manchester Medical School, University of Manchester, Manchester, M13 9NT, UK.,Postgraduate Medical Centre, Royal United Hospitals Bath NHS Foundation Trust, Bath, BA1 3NG, UK
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Fukushige M, Chase-Topping M, Woolhouse MEJ, Mutapi F. Efficacy of praziquantel has been maintained over four decades (from 1977 to 2018): A systematic review and meta-analysis of factors influence its efficacy. PLoS Negl Trop Dis 2021; 15:e0009189. [PMID: 33730095 PMCID: PMC7968639 DOI: 10.1371/journal.pntd.0009189] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/01/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The antihelminthic drug praziquantel has been used as the drug of choice for treating schistosome infection for more than 40 years. Although some epidemiological studies have reported low praziquantel efficacy in cure rate (CR) and/or egg reduction rate (ERR), there is no consistent robust evidence of the development of schistosome resistance to praziquantel (PZQ). There is need to determine factors that lead to variable treatment CR and/or ERR. Therefore, we conducted a systematic review and meta-analysis to review CR and ERR as well as identify their predictors. METHODOLOGY/PRINCIPAL FINDINGS In this systematic review and meta-analysis, a literature review was conducted using Biosis Citation Index, Data Citation Index, MEDLINE, and Web of Science Core Collection all of which were provided through Web of Science. Alongside these, EMBASE, and CAB abstracts were searched to identify relevant articles. Random effect meta-regression models were used to identify the factors that influence CR and/or ERR by considering differences in host characteristics and drug dose. In total, 12,127 potential articles were screened and 146 eligible articles (published from 1979 to 2020) were identified and included for the meta-analysis. We found that there has been no significant reduction in CR or ERR over the study period. The results showed more variability in CR, compared with ERR which was more consistent and remained high. The results showed a positive effect of "PZQ treatment dose" with the current recommended dose of 40 mg/kg body weight achieving 57% to 88% CR depending on schistosome species, age of participants, and number of parasitological samples used for diagnosis, and ERR of 95%. CONCLUSIONS/SIGNIFICANCE Based on a review of over 40 years of research there is no evidence to support concerns about schistosomes developing resistance to PZQ. These results indicate that PZQ remains effective in treating schistosomiasis.
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Affiliation(s)
- Mizuho Fukushige
- Institute of Immunology and Infection Research, Centre for Immunity, Infection & Evolution, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Margo Chase-Topping
- Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Francisca Mutapi
- Institute of Immunology and Infection Research, Centre for Immunity, Infection & Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, United Kingdom
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