An overview of human helminthioses in Vietnam: Their prevention, control and lessons learnt.

In Vietnam, helminthioses remain a major threat to public health and contribute to the maintenance of poverty in highly endemic regions. Through increased awareness of the damaging effects caused by helminthioses, the Vietnamese government has implemented many national programs over the past 30 years for the prevention and control of the most important helminthioses, such as, lymphatic filariasis, soil transmitted helminths, food borne zoonotic helminths, and others. Various control strategies have been applied to reduce or eliminate these worms, e.g. mass drug administration, economic development, control of vectors or intermediate hosts, public health interventions through education, proper composting procedures for excreta potentially containing helminth eggs, and the expansion of food supply chains and improved technologies for the production and inspection of food products. These control measures have resulted in a significant reduction in the distribution and transmission of helminth infections and have improved the overall living conditions and health outcomes of the Vietnamese citizens. However, the persistence of several helminth diseases continues in some endemic areas, especially where poverty is widespread and local traditions include the consumption of raw foods, especially fish and meats. This manuscript provides an overview of the helminth infection prevention and control programs conducted in Vietnam, their achieved results, learned lessons, and future works.

Total Dietary Intake and Health Risks Associated with Exposure to Aflatoxin B1, Ochratoxin A and Fuminisins of Children in Lao Cai Province, Vietnam.

The health burden of foodborne mycotoxins is considerable, but particularly for children due to their lower detoxification capacity, rapid growth and high intake of food in proportion to their weight. Through a Total Dietary Study approach, the objective was to estimate the dietary exposure and health risk caused by mycotoxins for children under 5 years living in the Lao Cai province in northern Vietnam. A total of 40 composite food samples representing 1008 individual food samples were processed and analyzed by ELISA for aflatoxin B1, ochratoxin A and fumonisins. Results showed that dietary exposure to aflatoxin B1, ochratoxin A and total fumonisins were 118.7 ng/kgbw/day, 52.6 ng/kg bw/day and 1250.0 ng/kg bw/day, respectively. Using a prevalence of hepatitis of 1%, the risk of liver cancer related to exposure of aflatoxin B1 was 12.1 cases/100,000 individual/year. Age-adjusted margin of exposure (MOE) of renal cancer associated with ochratoxin A was 127, while MOE of liver cancer associated with fumonisins was 542. Antropometric data show that 50.4% (60/119) of children were stunted, i.e. height/length for age z-scores (HAZ) below -2, and 3.4% (4/119) of children were classified as wasted, i.e. weight for height z-scores (WHZ) below -2. A significant negative relationship between dietary exposure to individual or mixture of mycotoxins and growth of children was observed indicating that the high mycotoxin intake contributed to stunning in the children studied.

Inflammation dynamics after praziquantel treatment of Schistosoma haematobium reflected by urinary eosinophil cationic protein.

Background: This cohort study assessed urinary eosinophil cationic protein (ECP) as an indicator for urinary tract morbidity and inflammation indication related to single-dose or dual-dose praziquantel (PZQ) treatment. Methods: Urinary ECP was measured at baseline, 24 h and 9 weeks after treatment (baseline 305, follow-up 204 participants, ages 2-40 years). Results: ECP was significantly associated with the intensity of infection at baseline (p<0.05). Levels at baseline were 8.31 times higher (p<0.01) in participants with bladder morbidity than in those without. There was no correlation with kidney morbidity and no significant effect of a repeated dose of PZQ 40 mg/kg. Baseline ECP and ECP after 9 weeks were associated with microhaematuria (geometric mean ratio at baseline 7.56 [95% confidence limit {CL} 2.34-24.45]; p<0.01) and macrohaematuria (geometric mean ratio at baseline 6.22 [95% CL 2.71-14.24]; p<0.001). Mean levels of ECP dropped significantly during the first follow-up period and far less so in the second follow-up period (mean ECP at baseline: 70.8 ng/mL; ECP at 24 h: 24.5 ng/mL; ECP at 9 weeks: 14.6 ng/mL). Conclusion: The urine ECP decrease happened immediately after treatment, reflecting the rapid action of PZQ on eggs in the bladder tissue. ECP in urine can be used as an indirect marker of the degree of local inflammatory reaction in the bladder and is not significantly affected by a repeated dose of PZQ.

Anemia and growth retardation associated with Schistosoma haematobium infection in Mali: a possible subtle impact of a neglected tropical disease.

Background: The aim of this cross-sectional study was to investigate a possible association of Schistosoma haematobium with child growth development and describe a plausible schistosomiasis-related anemia in children and adults in a highly schistosomiasis endemic area of Mali. Methods: Urine, feces and blood samples from 399 participants of both sexes (2-40 years of age) were analyzed and supplemented by anthropometric measurements. Results: S. haematobium prevalence was 79.8%, S. mansoni 13.2% and Plasmodium falciparum 80.2%. S. haematobium infection intensity as five categories was significantly associated with anemia; i.e., odds of having anemia in the highest and the next highest category was 3.25 (95% CL 1.61-6.55; p<0.01) and 2.45 (95% CL 1.28-4.70; p<0.01), respectively, of that in the three lower categories combined after adjusting for age group and gender and the interaction between the two factors. Anemia was most pronounced in the 2-5 year olds males (55.5%, n=98). P. falciparum infection was not significantly associated with anemia. Stunting (body mass index [BMI] for age z-score<-2.00) was observed in 2.6% (2/78) of the 2-5 years olds and in 7.7% (14/182) in the 6-19 years age group. Lower BMI-z-scores (as continuous variable) were associated with anemia (p<0.05) while high intensity of S. haematobium infection was not significant when adjusting for age group and anemia. Participants with malaria infection had lower z-scores (as continuous variables) of weight and height for age. Lower height for age z-scores were also associated with anemia. Conclusions: S. haematobium infection is likely to impact on child growth and possibly also anemia in all age groups and advocates for inclusion of whole populations into future control programes.

Schistosoma haematobium and soil-transmitted Helminths in Tana Delta District of Kenya: infection and morbidity patterns in primary schoolchildren from two isolated villages.

BACKGROUND: Schistosomes and soil-transmitted helminths (STH) (hookworm, Trichuris trichiura and Ascaris lumbricoides) are widely distributed in developing countries where they infect over 230 million and 1.5 billion people, respectively. The parasites are frequently co-endemic and many individuals are co-infected with two or more of the species, but information on how the parasites interact in co-infected individuals is scarce. The present study assessed Schistosoma haematobium and STH infection and morbidity patterns among school children in a hyper-endemic focus in the Tana River delta of coastal Kenya. METHODS: Two hundred and sixty-two children aged 5-12 years from two primary schools were enrolled in the study. For each child, urine was examined for S. haematobium eggs and haematuria, stool was examined for STH eggs, peripheral blood was examined for eosinophilia and haemoglobin level, the urinary tract was ultrasound-examined for S. haematobium-related pathology, and the height and weight was measured and used to calculate the body mass index (BMI). RESULTS: Prevalences of S. haematobium, hookworm, T. trichiura and A. lumbricoides infection were 94, 81, 88 and 46 %, respectively. There was no significant association between S. haematobium and STH infection but intensity of hookworm infection significantly increased with that of T. trichiura. Lower BMI scores were associated with high intensity of S. haematobium (difference =-0.48, p > 0.05) and A. lumbricoides (difference =-0.67, p < 0.05). Haematuria (both macro and micro) was common and associated with S. haematobium infection, while anaemia was associated with high intensity of S. haematobium (OR = 2.08, p < 0.05) and high hookworm infections OR = 4.75; p < 0.001). The majority of children had eosinophilia, which was significantly associated with high intensity of hookworm infection (OR = 5.34, p < 0.05). Overall 38 % of the children had ultrasound-detectable urinary tract morbidity, which was associated with high intensity of S. haematobium infection (OR = 3.13, p < 0.05). CONCLUSION: Prevalences of S. haematobium and STH infections among the primary school children were high and the parasites were responsible for significant morbidity. A clear synergistic interaction was observed between hookworm and T. trichiura infections. Increased coverage in administration of praziquantel and albendazole in the area is recommended to control morbidity due to these infections.

Field trial of praziquantel for control of fishborne zoonotic trematodes in reservoir hosts in Vietnam.

This field trial was conducted to determine whether 40 or 75 mg/kg of praziquantel is suitable for treatment of fishborne zoonotic trematodes (FZT) in naturally infected dogs (n=10) and cats (n=11). Three days after treatment all animals at either dose were negative for small trematode eggs. In two cats and one dog treated with 75 mg/kg, however, a few damaged eggs were found 3 days post-treatment; no small trematode eggs were seen in these animals at day 14 post-treatment. In addition, at the 75 mg dose, two cats and two dogs experienced vomiting or diminished appetite. Therefore a praziquantel dose of 40 mg/kg is suggested for treatment of FZT in dogs and cats.

Molecular phylogenetic investigations of the Viviparidae (Gastropoda: Caenogastropoda) in the lakes of the Rift Valley area of Africa.

The freshwater gastropod family Viviparidae is nearly cosmopolitan, but absent from South America. On the African continent, two genera are recognized; the widespread Bellamya and the monotypic Neothauma, which is confined to Lake Tanganyika. Most of the African Bellamya species are confined to the major lakes of the Rift Valley area in Africa, i.e. Lake Albert, Lake Malawi, Lake Mweru, and Lake Victoria. The phylogenetic analyses of mitochondrial (COI and 16S) and nuclear (H3, 18S and 28S) DNA inferred three major lake-clades; i.e. Lake Victoria/Kyoga/Albert, Lake Malawi and Lake Mweru/Bangweulu. The endemic B. rubicunda from Lake Albert and B. unicolor from Lake Kyoga were inferred to be part of the Lake Victoria clade. Bellamya capillata as identified by shell characters was polyphyletic in gene trees. The monophyletic Bellamya species radiation in Lake Malawi was most nearly related to the Lake Victoria/Kyoga/Albert-clade. Taxa from the Zambian lakes, Mweru and Bangweulu, were inferred together and placed ancestral to the other lakes. Neothauma tanganyicense was inferred as the sister-group to the Zambian Bellamya. Within the lake-clades the endemic radiations show very low genetic diversities (0-4.1% in COI), suggesting much faster morphological divergence than molecular divergence. Alternatively, Bellamya in Africa constitutes only a few species with several sub-species or eco-phenotypic morphs. The African viviparids were inferred to be the sister-group to a clade comprising Asian species, and the relatively low genetic diversity between the clades (12.6-15.5% in COI) makes a recent Miocene dispersal event from Asia to Africa much more likely than an ancient Gondwana vicarience distribution.

Comparison of gastropod mollusc (Apogastropoda: Hydrobiidae) habitats in two crater lakes in Nicaragua

The aquatic gastropod mollusc, Pyrgophorus coronatus, may perform an important role in the transmission of an emergent ocular pathology among fishes in Lake Apoyo, Nicaragua. This disease emerged after an introduction of tilapia (Oreochromis niloticus) and the subsequent loss of Chara sp. beds in the lake. We compared the mollusc population densities in three habitats (sandy/muddy substrates, rocks, and Chara vegetation) at varying depths (1.5, 10, 20, and 30 m) in two volcanic crater lakes in Nicaragua: Lake Apoyo and Lake Xiloa. where lower numbers of affected fishes were found and tilapia has not been introduced. Duplicate samples at 1.5 m depth were taken in each habitat monthly for a year, and triplicate samples for bathymetric analysis of snail populations were performed during August, 2005. Samples of fixed surface area were filtered in a 0.4 cm size screen and live snails were counted from each sample. The preferred snail habitat in both lakes, Chara beds, was vastly reduced in Lake Apoyo via consumption by introduced Nile tilapia (Oreochromis niloticus). Structureless sandy substrates (mean +/- standard error 3.1+/-1.3 ind/m2) had lower population densities than other habitats in Lake Xiloa (rocks 590.9+/-185.3 ind/m2; vegetation 3 686.5+/-698.2 ind/m2; ANOVA 1, p<0.01 in both cases) but this difference was attenuated in Lake Apoyo (sand 384.4+/-111.1 ind/m2; rocks 1 480.4+/-384.8 ind/m2: 0.0 1

El gasterópodo acuático, Pyrgophorus coronatus, podría jugar un papel importante en la transmisión de una patología ocular emergente entre los peces de la laguna de Apoyo, Nicaragua. Esta enfermedad surgió después de una introducción de tilapia (Oreochromis niloticus) y la subsecuente pérdida de lechos de Chara sp. en la laguna. Comparamos las densidades poblacionales del caracol en tres hábitats (substratos arenosos/lodosos, rocas y vegetación de Chara) en dos lagunas cratéricas volcánicas en Nicaragua: La laguna de Apoyo y la laguna de Xiloá, donde no se encuentraron grandes cantidades de peces afectados y donde no se han introducido tilapias. Mensualmente, por un año tomamos muestras duplicadas a 1.5 m profundidad mensualmente por un año, y durante agosto de 2005, muestreos triplicados de las poblaciones del molusco, para análisis batimétrico (1.5, 10, 20 y 30 m). Para determinar el número de individuos por unidad de área superficial, las muestras fueron filtradas en un colador de 0.4 cm de apertura de malla y contamos los moluscos vivos en cada muestra. El hábitat preferido de los caracoles en ambas lagunas fue la vegetación de Chara, que en la laguna de Apoyo fue vastamente reducida al ser consumida por las tilapias nilóticas introducidas (Oreochromis niloticus). Los substratos arenosos, menos estructurados que los otros sustratos estudiados, tuvieron densidades poblacionales más bajas (media ± error estándar 3.1±1.3 ind/m2) que en los otros hábitats en la laguna de Xiloá (vegetation 590.9±185.3 ind/m2; rocas 3 686.5±698.2 ind/m2; ANOVA I, p<0.01 en ambos casos) pero esta diferencia fue atenuada en la laguna de Apoyo (arena 384.4±111.1 ind/m2; rocas 1 480.4±384.8 ind/ m2; 0.01

Ecological studies on the intermediate host snails and the relevance to schistosomiasis control

A detailed knoledge of distribution patterns schistosome intermediate hsts and their populations dynamics and factors affecting these patterns will provide useful information about the possibilities and desirability of conducting snail control measures in various transmission situations. On the basis of various case studies the association between the occurence of human water contacts and the presence of schistosome intermediate hosts or infections in the intermediate hosts is illustrated. Other parameters affecting snail distribution patterns and density fluctuations are discussed. It is concluded that ecological studies on the intermediate host are extremely relevant, either to optimally apply existing control measures or to develop alternative measures of snail control, such as ecological or biological control