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Menezes CA, Montresor LC, Jangola STG, de Mattos AC, Domingues ALC, Júnior AM, Silva CCM, Barbosa CS, de Mendonça CLF, Massara CL, Fonseca CT, de Oliveira EJ, Gomes ECDS, da Silva EF, Bezerra FSDM, Silva-Jr FP, de Siqueira IC, Silva JRME, Heller L, Farias LP, Beck LCNH, Santos MCS, Lima MG, Mourão MDM, Enk MJ, Fernandez MA, Katz N, Carvalho ODS, Parreiras PM, Neves RH, Gava SG, de Oliveira SA, Thiengo SC, Favre TC, Graeff-Teixeira C, Pieri OS, Caldeira RL, da Silva-Pereira RA, Rocha RS, Oliveira RR. FioSchisto's expert perspective on implementing WHO guidelines for schistosomiasis control and transmission elimination in Brazil. Front Immunol 2023; 14:1268998. [PMID: 38143743 PMCID: PMC10739458 DOI: 10.3389/fimmu.2023.1268998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
The World Health Organization (WHO) recognizes schistosomiasis as one of the Neglected Tropical Diseases targeted for global elimination in the 2030 Agenda of the Sustainable Development Goals. In Brazil, schistosomiasis mansoni is considered a public health problem, particularly prevalent among vulnerable populations living in areas with poor environmental and sanitary conditions. In 2022, the WHO published a Guideline encompassing recommendations to assist national programs in endemic countries in achieving morbidity control, eliminating schistosomiasis as a public health problem, and advancing towards interrupting transmission. The perspectives presented here, collectively prepared by members of the Oswaldo Cruz Foundation's (Fiocruz) Schistosomiasis Translational Program (FioSchisto), along with invited experts, examine the feasibility of the WHO recommendations for the Brazilian settings, providing appropriate recommendations for public health policies applicable to the epidemiological reality of Brazil, and suggests future research to address relevant issues. In Brazil, the provision of safe water and sanitation should be the key action to achieve schistosomiasis elimination goals. The agencies involved in measures implementation should act together with the Primary Care teams for planning, executing, monitoring, and evaluating actions in priority municipalities based on their epidemiological indicators. Host snails control should prioritize judicious ecological interventions at breeding sites. The Information, Education, and Communication (IEC) strategy should be associated with water and sanitation and other control actions, actively involving school community. To identify infected carriers, FioSchisto recommends a two-stage approach of immunological and molecular tests to verify transmission interruption during the intervention and beyond. Praziquantel administration should be done under medical supervision at the Primary Care level. MDA should be considered in exceptional settings, as a measure of initial attack strategy in locations presenting high endemicity, always integrated with water and sanitation, IEC, and snail control. To assist decision-making, as well as the monitoring and evaluation of strategic actions, there is a need for an Information System. FioSchisto considers this systematization essential to make investments in strategic research to support the improvement of schistosomiasis control actions. Efforts toward schistosomiasis elimination in Brazil will succeed with a paradigm shift from the vertical prescriptive framework to a community-centered approach involving intersectoral and interdisciplinary collaboration.
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Affiliation(s)
| | | | | | | | - Ana Lúcia Coutinho Domingues
- Centro de Ciências da Saúde, Departamento de Medicina Clínica, Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Leo Heller
- Instituto René Rachou, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, Brazil
| | | | | | | | - Mariana Gomes Lima
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | | | - Naftale Katz
- Instituto René Rachou, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, Brazil
| | | | | | - Renata Heisler Neves
- Faculdade de Ciências Médicas, Universidade Estatual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandra Grossi Gava
- Instituto René Rachou, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, Brazil
| | | | | | | | - Carlos Graeff-Teixeira
- Centro de Ciências da Saúde, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | | | | | | | - Roberto Sena Rocha
- Instituto René Rachou, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, Brazil
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