Spatial distribution of Oncomelania hupensis spread in Hubei Province from 2020 to 2022 / 中国血吸虫病防治杂志

OBJECTIVE@#To identify the spatial distribution pattern of Oncomelania hupensis spread in Hubei Province, so as to provide insights into precision O. hupensis snail control in the province.@*METHODS@#Data pertaining to emerging and reemerging snails were collected from Hubei Province from 2020 to 2022 to build a spatial database of O. hupensis snail spread. The spatial clustering of O. hupensis snail spread was identified using global and local spatial autocorrelation analyses, and the hot spots of snail spread were identified using kernel density estimation. In addition, the correlation between environments with snail spread and the distance from the Yangtze River was evaluated using nearest-neighbor analysis and Spearman correlation analysis.@*RESULTS@#O. hupensis snail spread mainly occurred along the Yangtze River and Jianghan Plain in Hubei Province from 2020 to 2022, with a total spread area of 4 320.63 hm2, including 1 230.77 hm2 emerging snail habitats and 3 089.87 hm2 reemerging snail habitats. Global spatial autocorrelation analysis showed spatial autocorrelation in the O. hupensis snail spread in Hubei Province in 2020 and 2021, appearing a spatial clustering pattern (Moran's I = 0.003 593 and 0.060 973, both P values < 0.05), and the mean density of spread snails showed spatial aggregation in Hubei Province in 2020 (Moran's I = 0.512 856, P < 0.05). Local spatial autocorrelation analysis showed that the high-high clustering areas of spread snails were mainly distributed in 50 settings of 10 counties (districts) in Hubei Province from 2020 to 2022, and the high-high clustering areas of the mean density of spread snails were predominantly found in 219 snail habitats in four counties of Jiangling, Honghu, Yangxin and Gong'an. Kernel density estimation showed that there were high-, secondary high- and medium-density hot spots in snail spread areas in Hubei Province from 2020 to 2022, which were distributed in Jingzhou District, Wuxue District, Honghu County and Huangzhou District, respectively. There were high- and medium-density hot spots in the mean density of spread snails, which were located in Jiangling County, Honghu County and Yangxin County, respectively. In addition, the snail spread areas negatively correlated with the distance from the Yangtze River (r = -0.108 9, P < 0.05).@*CONCLUSIONS@#There was spatial clustering of O. hupensis snail spread in Hubei Province from 2020 to 2022. The monitoring and control of O. hupensis snails require to be reinforced in the clustering areas, notably in inner embankments to prevent reemerging schistosomiasis.

Construction of a schistosomiasis transmission risk assessment system in Wuhan City based on analytic hierarchy process / 中国血吸虫病防治杂志

OBJECTIVE@#To construct a schistosomiasis transmission risk assessment system in Wuhan City and preliminary evaluate its application effect, so as to promote the rational allocation of schistosomiasis control resources and accelerate the progress towards schistosomiasis elimination.@*METHODS@#The schistosomiasis risk assessment indicators were collected through referring schistosomiasis surveillance data of Wuhan City from 2014 to 2020, literature review and expert interviews. Indicators within each criterion and sub-criterion were screened using the Delphi method, and a hierarchical structure model was created based on analytic hierarchy process. Quantitative assignment of each indicator was conducted according to relative importance, and the weight and combination weight of each criterion were calculated in each analytic hierarchy framework to create a schistosomiasis transmission risk assessment system, which was used for the schistosomiasis transmission risk assessment in 12 national schistosomiasis surveillance sites in Wuhan City.@*RESULTS@#A three-level schistosomiasis transmission risk assessment system was preliminarily constructed, which included a target layer, 5 criterion layers and 21 sub-criterion layers. Of all indicators in the criterion layer, transmission route had the highest weight (0.433), followed by source of Schistosoma japonicum infection (0.294); and among all indicators in the sub-criterion layer, S. japonicum infection in Oncomelania hupensis and sentinel mice had the highest combination weight (0.125), followed by prevalence of S. japonicum infection in humans (0.091) and bovines (0.053), snail control by chemical treatment (0.049), positive rate of inquiry examinations (0.048), allocation of schistosomiasis control professionals (0.045), and areas of submerged snail-infested settings (0.041). Of the 12 national schistosomiasis surveillance sites in Wuhan City, there were 5 sites with weights of > 0.8, 4 sites with weights of 0.6 to 0.8, and 3 sites with weights of < 0.6 in 2020.@*CONCLUSIONS@#A schistosomiasis transmission risk assessment system has been constructed based on analytic hierarchy process in Wuhan City, which may provide a evidence-based basis for health resource allocation and decision-making for schistosomiasis control.

Distribution characteristics of emerging and reemerging Oncomelania hupensis in China from 2015 to 2021 / 中国血吸虫病防治杂志

OBJECTIVE@#To analyze the distribution characteristics of emerging and reemerging Oncomelania hupensis snails after the criteria for transmission control of schistosomiasis were achieved in China, so as to provide insights into assessment of schistosomiasis transmission risk and formulation of snail control strategies during the elimination phase.@*METHODS@#O. hupensis survey data in China from 2015 to 2021 were collected from the National Schistosomiasis Pevention and Control Information Management System, and the distribution characteristics of emerging and reemerging O. hupensis snails were descriptively analyzed.@*RESULTS@#Emerging and reemerging O. hupensis snails were identified in China each year from 2015 to 2021, with relatively larger areas with emerging and reemerging O. hupensis snail habitats in 2016 and 2021, and relatively higher numbers of counties (districts) where emerging and reemerging O. hupensis snails were detected in 2016 and 2021. A total of 4 586.30 hm2 of emerging O. hupensis snail habitats were found in 10 schistosomiasis-endemic provinces of China (except Fujian and Yunnan Provinces) from 2015 to 2021, with 96.80% in Anhui, Hunan and Hubei provinces, where marshland and lake endemic foci were predominant. A total of 21 023.90 hm2 of reemerging O. hupensis snail habitats were found in 12 schistosomiasis-endemic provinces of China from 2015 to 2021, with 97.67% in six provinces of Hubei, Sichuan, Jiangxi, Jiangsu, Yunnan and Anhui, where marshland and lake and hilly endemic regions were predominant. Emerging snail habitats were found in 15.08% of all schistosomiasisendemic counties (districts) in China from 2015 to 2021, and 78.75% of all emerging snail habitats were identified in 11 schistosomiasis-endemic counties (districts), with the largest area of emerging snail habitats found in Lixian County, Hunan Province (645.00 hm2). Reemerging snail habitats were found in 47.67% of all schistosomiasis-endemic counties (districts) in China from 2015 to 2021, and 43.29% of all reemerging snail habitats were identified in 11 schistosomiasis-endemic counties (districts), with the largest area of reemerging snail habitats found in Weishan Li and Hui Autonomous County of Hunan Province (1 579.70 hm2).@*CONCLUSIONS@#Emerging and reemerging O. hupensis snails were identified in China each year from 2015 to 2021, with much larger areas of reemerging snail habitats than emerging snail habitats, and larger numbers of schistosomiasis-endemic provinces and counties (districts) with reemerging snails were found that those of provinces and counties (districts) with emerging snails. Specific snail control interventions are required tailored to the causes of emerging and reemerging snail habitats. Both emergence and reemergence of O. hupensis snails should be paid attention to in marshland and lake endemic areas, and Guangxi Zhuang Autonomous Region, Shanghai Municipality and Zhejiang Province where schistosomiasis had been eliminated, and reemergence of O. hupensis snails should be given a high priority in hilly areas. In addition, monitoring of O. hupensis snails should be reinforced in snail-free areas after flooding.

Construction of a surveillance and early warning index system for schistosomiasis transmission risk along the middle and lower reaches of the Yangtze River basin / 中国血吸虫病防治杂志

OBJECTIVE@#To establish a surveillance and early warning index system for schistosomiasis transmission risk along the middle and lower reaches of the Yangtze River basin, so as to provide insights into creation of a sensitive and highly efficient surveillance and early warning system for schistosomiasis.@*METHODS@#National and international publications, documents, laws and regulations pertaining to schistosomiasis control were retrieved with keywords including schistosomiasis, surveillance, early warning and control interventions from 2008 to 2022, and a thematic panel discussion was held to preliminarily construct surveillance and early warning index system for schistosomiasis transmission risk along the middle and lower reaches of the Yangtze River basin. The index system was then comprehensively scored and screened using the Delphi method, and the weight of each index was determined using analytic hierarchy process and the modified proportional allocation method. In addition, the credibility of the Delphi method was evaluated using positive coefficient, authority coefficient, degree of concentration and degree of coordination of experts.@*RESULTS@#Following two rounds of expert consultation, a surveillance and early warning index system for schistosomiasis transmission risk in endemic areas along the middle and lower reaches of the Yangtze River basin was preliminarily constructed, including 3 primary indicators, 9 secondary indicators and 41 tertiary indicators. The normalized weights of primary indicators epidemics, natural and social factors and comprehensive control were 0.639 8, 0.145 6 and 0.214 6, respectively, and among all secondary indicators, snail status (0.321 3) and schistosomiasis prevalence (0.318 5) had the highest combined weights, while social factors had the lowest combined weight (0.030 4). Of all tertiary indicators, human egg-positive rate (0.041 9), number of acute schistosomiasis cases (0.041 5), number of stool-positive bovine and sheep (0.041 1), and prevalence of Schistosoma japonicum in free-ranging livestock (0.041 1) had the highest combined weights. During two rounds of consultation, the positive coefficient of experts was both 100%, and the authority coefficient was both 0.9 and greater, while the coordination coefficients were 0.338 to 0.441 and 0.426 to 0.565 (χ2 = 22.875 to 216.524, both P values < 0.05).@*CONCLUSIONS@#The established surveillance and early warning index system for schistosomiasis transmission risk along the middle and lower reaches of the Yangtze River basin is of great scientific values and authority, which may provide insights into construction of the sensitive and highly efficient surveillance and early warning system for schistosomiasis in the context of low prevalence and low intensity of infection in China.

Analysis of the new WHO guideline to accelerate the progress towards elimination of schistosomiasis in China / 中国血吸虫病防治杂志

On February 2022, WHO released the evidence-based guideline on control and elimination of human schistosomiasis, with aims to guide the elimination of schistosomiasis as a public health problem in disease-endemic countries by 2030 and promote the interruption of schistosomiasis transmission across the world. Based on the One Health concept, six evidence-based recommendations were proposed in this guideline. This article aims to analyze the feasibility of key aspects of this guideline in Chinese national schistosomiasis control program and illustrate the significance to guide the future actions for Chinese national schistosomiasis control program. Currently, the One Health concept has been embodied in the Chinese national schistosomiasis control program. Based on this new WHO guideline, the following recommendations are proposed for the national schistosomiasis control program of China: (1) improving the systematic framework building, facilitating the agreement of the cross-sectoral consensus, and building a high-level leadership group; (2) optimizing the current human and livestock treatments in the national schistosomiasis control program of China; (3) developing highly sensitive and specific diagnostics and the framework for verifying elimination of schistosomiasis; (4) accelerating the progress towards elimination of schistosomiasis and other parasitic diseases through integrating the national control programs for other parasitic diseases.

Decoding the evolution of preventive chemotherapy schemes for schistosomiasis in China to improve the precise implementation of the WHO guideline on control and elimination of human schistosomiasis / 中国血吸虫病防治杂志

Preventive chemotherapy is one of the pivotal interventions for the control and elimination of schistosomiasis, which is effective to reduce the morbidity and prevalence of schistosomiasis. In order to promote the United Nations' sustainable development goals and the targets set for schistosomiasis control in the Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021-2030, WHO released the guideline on control and elimination of human schistosomiasis in 2022, with major evidence-based updates of the current preventive chemotherapy strategy for schistosomiasis. In China where great success has been achieved in schistosomiasis control, the preventive chemotherapy strategy for schistosomiasis has been updated several times during the past seven decades. This article reviews the evolution of the WHO guidelines on preventive chemotherapy and Chinese national preventive chemotherapy schemes, compares the current Chinese national preventive chemotherapy scheme and the recommendations for preventive chemotherapy proposed in the 2022 WHO guideline on control and elimination of human schistosomiasis, and proposes recommendations for preventive chemotherapy during the future implementation of the 2022 WHO guideline, so as to provide insights into schistosomiasis control among public health professionals engaging in healthcare foreign aid.

Contribution to global implementation of WHO guideline on control and elimination of human schistosomiasis by learning successful experiences from the national schistosomiasis control program in China / 中国血吸虫病防治杂志

Schistosomiasis is a parasitic disease that seriously hinders socioeconomic developments and threatens public health security. To achieve the global elimination of schistosomiasis as a public health problem by 2030, WHO released the guideline on control and elimination of human schistosomiasis on February, 2022, with aims to provide evidence-based recommendations for schistosomiasis morbidity control, elimination of schistosomiasis as a public health problem, and ultimate interruption of schistosomiasis transmission in disease-endemic countries. Following concerted efforts for decades, great achievements have been obtained for schistosomiasis control in China where the disease was historically highly prevalent, and the country is moving towards schistosomiasis elimination. This article reviews the successful experiences from the national schistosmiasis control program in China, and summarizes their contributions to the formulation and implementation of the WHO guideline on control and elimination of human schistosomiasis. With the progress of the "Belt and Road" initiative, the world is looking forward to more China's solutions on schistosomiasis control.

Sharing the WHO guideline on control and elimination of human schistosomiasis to achieve the goal of schistosomiasis elimination in China / 中国血吸虫病防治杂志

Currently, the national schistosomiasis control program of China is moving from transmission interruption to elimination, and there are multiple challenges during the stage moving towards the progression of schistosomiasis elimination, including a high difficulty in shrinking snail-infested areas, unstable achievements for infectious source control, imperfect surveillance system and a reduction in schistosomiasis control and administration. Based on the core suggestions proposed in the 2022 WHO guideline on control and elimination of human schistosomiasis, recommendations on schistosomiasis surveillance system building, development of novel diagnostics, adjustment of the schistosomiasis control strategy and maintaining and improvements of the schistosomiasis control capability are proposed for the national schistosomiasis control program of China in the new era according to the actual status of schistosomiasis control in China. Formulation of the national schistosomiasis control strategy and goal from One Health perspective, verification of transmission interruption and elimination of schistosomiasis, precision implementation of schistosomiasis control interventions with adaptations to local circumstances, development and application of highly sensitive and specific diagnostics are recommended for elimination of schistosomiasis in China. In addition, the implementation of the 2022 WHO guideline on control and elimination of human schistosomiasis may guide the elimination of schistosomiasis in China.

Evaluation of the schistosomiasis control program (PCE) in an endemic area, northeastern Brazil: a population-based and 10-year time series study

Schistosomiasis is an endemic disease in Brazil and the State with the highest positive rate in the country is Sergipe. Herein, we assessed data from the Brazilian Schistosomiasis Control Program (PCE) in the State of Sergipe between the period 2008 and 2017. We evaluated data about schistosomiasis and snails of the genus Biomphalaria. We used the log-linear regression model (joinpoint) to assess temporal trends and the Kernel estimator for spatial statistics analysis. According to the PCE, Sergipe has 51 endemic municipalities for schistosomiasis. Nevertheless, information about the disease and that collected by the PCE has not been recorded regularly in all endemic municipalities. Additionally, only nine municipalities (17.6%) carried out the malacological survey. The average of positive rate from schistosomiasis in Sergipe was 8.4%. However, our data suggest that it may be underestimated. The spatial analysis maps (Kernel maps) showed areas of high transmission of the disease in municipalities close to the São Francisco River and in the metropolitan region of the State. Altogether, our findings suggest that schistosomiasis has been underreported and it is still a serious public health concern in Sergipe. In addition, there are significant failures in the conduction of PCE's activities by the municipalities.

Ocotea pulchellaas an alternative against schistosomiasis: chemical analysis, development of nanoemulsion and biological control activity / Ocotea pulchellacomo una alternativa ante esquistosomiasis: análisis químico, desarrollo de una nanoemulsión y actividad en control biológico

The aim of this work was to evaluate the potential of the essential oil (EO) from Ocotea pulchella leaves as an alternative in the control of schistosomiasis. It was tested O. pulchella EO nanoformulation to assess its activity against adult Biomphalaria glabrata, their spawning and Schistossoma mansoni cercariae. Additionally, the EO chemical composition was investigated by gas-chromatography. Nanoemulsion were elaborated by the low energy method. The adult mollusks, their spawning and cercariae were placed in contact with nanoemulsion to calculate lethal concentrations. Myristicin, bicyclogermacrene and α-Pinene were the main substances in the EO. Nanoemulsion caused mortality of adult B. glabrata, its egg embryos and S. mansoni. These results suggest the use of this nanoemulsion as an alternative in the control of the schistosomiasis cycle.

El objetivo de este trabajo fue evaluar el potencial de los aceites esenciales (AE) de las hojas de Ocotea pulchellacomo una alternativa en el control de esquistosomiasis. Se probó una nanoformulación de AE de O. pulchellapara evaluar su actividad ante adultos de Biomphalaria glabrata, sus huevos y cercarías de Schistossoma mansoni. La nanoemulsión fue elaborada por el método de baja energía. Los moluscos adultos, sus huevos y cercarías se colocaron en contacto con la nanoemulsión para calcular concentraciones letales. Los compuestos mayoritarios en el AE fueron miristicina, biciclogermacreno y α-pineno. La nanoemulsión causó mortalidad en adultos de B. glabrata, sus huevos y a S. mansoni. Los resultados sugieren el uso de esta nanoemulsión como una alternativa en el control del ciclo de esquistosomiasis.

O desenvolvimento de vacinas contra as doenças tropicais negligenciadas / Desarrollo de vacunas contra enfermedades tropicales desatendidas / Vaccine development against neglected tropical diseases

As doenças tropicais negligenciadas constituem um grupo heterogêneo de enfermidades que apresentam como característica comum afetarem populações pobres e desassistidas, com pouca capacidade de vocalização e de poder político. Em consequência, recebem pouca atenção da indústria farmacêutica e da academia. O presente estudo teve como propósito resumir o estado da arte quanto ao desenvolvimento de vacinas para três doenças tropicais negligenciadas de relevância no Brasil, a doença de Chagas, a esquistossomose mansoni e as leishmanioses. Para tanto, realizou-se uma revisão narrativa da literatura científica, na qual foram incluídas publicações que permitiram traçar um panorama atual do desenvolvimento de vacinas para as três doenças. Essas vacinas estão em estágios distintos de desenvolvimento. Os projetos de desenvolvimento de vacinas contra a tripanossomíase americana ainda não chegaram à fase clínica de avaliação. Já para a esquistossomose há candidatos à vacina em fase avançada de avaliação clínica. Para as leishmanioses já existem vacinas veterinárias licenciadas e produtos candidatos à vacina humana em etapa intermediária de avaliação clínica. O reduzido financiamento para esses projetos tem contribuído para retardar o desenvolvimento dos produtos.

Las enfermedades tropicales desatendidas constituyen un grupo heterogéneo de enfermedades, que presentan como característica común el hecho de que afectan a poblaciones pobres y desasistidas, con poca capacidad de interlocución y poder político. En consecuencia, reciben poca atención de la industria farmacéutica, así como de la academia. Este estudio tuvo como propósito resumir el estado de la cuestión, respecto al desarrollo de vacunas para tres enfermedades tropicales desatendidas relevantes en Brasil como son: la enfermedad de Chagas, la esquistosomiasis y leishmaniosis. Para ello, se realizó una revisión narrativa de la literatura científica, en la que se incluyeron publicaciones que permitieron trazar un panorama actual del desarrollo de vacunas para las tres enfermedades. Estas vacunas están en estadios distintos de desarrollo. Los proyectos de desarrollo de vacunas contra la tripanosomiasis americana todavía no llegaron a la fase clínica de evaluación. Ya en el caso de la esquistosomiasis hay candidatos a la vacuna en fase avanzada de evaluación clínica. Para las leishmaniosis ya existen vacunas veterinarias licenciadas y productos candidatos a la vacuna humana en etapa intermedia de evaluación clínica. La reducida financiación para esos proyectos ha contribuido al retraso en el desarrollo de los productos.

Neglected tropical diseases constitute a heterogeneous group of diseases that have as a common characteristic to affect poor and unassisted populations with little vocalization capacity and political power. As a result, they receive little attention from the pharmaceutical industry and academia. The present study aimed to summarize the state of the art regarding vaccine development for three relevant neglected tropical diseases in Brazil: Chagas disease, schistosomiasis (Schistosoma mansoni), and leishmaniasis. To this end, we conducted a narrative review of the scientific literature, including publications that allowed us to outline a current overview on the vaccine development for the three diseases. Vaccines against the three diseases are in different stages of development. Vaccine development projects against American trypanosomiasis have yet to reach the clinical evaluation phase. For schistosomiasis, we have candidates for the vaccine in the advanced phase of clinical evaluation. For leishmaniasis, there are already licensed veterinary vaccines, and product candidates for human vaccine in the intermediate stage of clinical evaluation. The reduced funding for these projects has contributed to slow product development.

Nanoemulsion containing essential oil from Xylopia ochrantha Mart. produces molluscicidal effects against different species of Biomphalaria (Schistosoma hosts)

BACKGROUND This work describes a chemical study of the essential oil from leaves of Xylopia ochrantha, an endemic Annonaceae species from Brazil, and its activity against Biomphalaria species. Considering its poor solubility in aqueous medium, the essential oil was nanoemulsified to evaluate its action on controlling some mollusc species of genus Biomphalaria, snail hosts of Schistosoma mansoni that causes schistosomiasis, which mainly affects tropical and subtropical countries. OBJECTIVES The main aims of this work were to analyse the chemical composition of essential oil from X. ochrantha, and to evaluate the effect of its nanoemulsion on molluscs of genus Biomphalaria and their oviposition. METHODS Chemical analysis was performed by gas chromatography coupled to mass spectrometry. Nanoemulsions were prepared by a low energy method and characterised by particle size and polydispersity index. Biological assays evaluating the mortality of adult species of B. glabrata, B. straminea and B. tenagophila and their ovipositions upon contact with the most stable nanoemulsion during 24 and 48 h were performed. FINDINGS Chemical analysis by mass spectrometry revealed the majority presence of bicyclogermacrene and germacrene D in the essential oil. The formulation with a hydrophilic-lipophilic balance (HLB) of 9.26 was the most suitable for the oil delivery system. This nanoemulsion caused the mortality in B. tenagophila, B. straminea and B. glabarata of different sizes at levels ranging from 50 to 100% in 48 h. Additionally, the formulation could inhibit the development of deposited eggs. CONCLUSION Thus, these results suggest the use of nanoemulsified essential oil from X. ochrantha as a possible alternative in controlling some Biomphalaria species involved in the schistosomiasis cycle.

Irrigation canals in Melo creek basin (Rio Espera and Capela Nova municipalities, Minas Gerais, Brazil): habitats to Biomphalaria (Gastropoda: Planorbidae) and potential spread of schistosomiasis / Canais de irrigação na bacia do ribeirão do Melo (Municípios de Rio Espera e Capela Nova, Minas Gerais, Brasil): habitats para a proliferação de Biomphalaria (Gastropoda: Planorbidae) e potencial disseminação da esquistossomose

Abstract This study analyzed the presence of Biomphalaria in Melo creek basin, Minas Gerais state, and its relationship to irrigation canals. Seventeen of these canals were used to determine a limnological, morphological and hydrological characterization during an annual seasonal cycle. Biomphalaria samples were sent to René Rachou Research Center/FIOCRUZ for identification and parasitological examination. Six canals were identified as breeding areas for mollusks and in one of them it was registered the coexistence of B. tenagophila (first report to this basin) and B. glabrata species. Results indicated that the low flow rate and speed of water flow were the main characteristics that contributed to this specific growth of the mollusks in the area. These hydraulic characteristics were created due to anthropogenic action through the canalization of lotic areas in Melo creek, which allowed ideal ecological conditions to Biomphalaria outbreak. The results emphasize the need of adequate handling and constant monitoring of the hydrographic basin, subject to inadequate phytosanitary conditions, aiming to prevent the occurrence and propagation of schistosomiasis.

Resumo Neste estudo avaliou-se a presença de espécies de Biomphalaria na bacia do Ribeirão do Melo, municípios de Rio Espera e Capela Nova, sudeste do estado de Minas Gerais, e sua relação com os canais de irrigação presentes na região. Em 17 desses canais foi realizada uma caracterização limnológica, morfológica e hidrológica durante um ciclo sazonal anual. Espécimes de Biomphalaria foram coletados e encaminhados ao Centro de Pesquisas René Rachou/FIOCRUZ (Belo Horizonte, MG) para identificação e exame parasitológico. Dos 17 canais estudados, foram identificados seis como criadouros do caramujo, sendo que em um dos canais coexistiam as espécies B. tenagophila (primeiro registro para a bacia) e B. glabrata. Os resultados indicaram que a baixa vazão e a velocidade do fluxo foram os fatores que contribuíram para a ocorrência pontual dos caramujos na bacia. Estas características hidrológicas foram modificadas por ação antropogênica, através da canalização de trechos lóticos do ribeirão do Melo. Os resultados destacam a necessidade do manejo adequado e monitoramento constante da bacia hidrográfica, sujeita a condições sanitárias inadequadas, como forma de prevenção da ocorrência e propagação da esquistossomose.

Caracterização de materiais educativos impressos sobre esquistossomose, utilizados para educação em saúde em áreas endêmicas no Brasil / Characterization of printed educational materials about schistosomiasis used in health education in endemic areas in Brazil / Evaluación de materiales educativos impresos sobre la esquistosomiasis, utilizados en educación para la salud en zonas endémicas de Brasil

OBJETIVO: caracterizar os materiais educativos impressos sobre esquistossomose produzidos no Brasil, nos níveis federal, estadual e municipal. MÉTODOS: os materiais foram caracterizados considerando-se as categorias 'formato', 'parasito e hospedeiro intermediário', 'hospedeiro definitivo' (doente) e 'doença'. RESULTADOS: dos 60 materiais avaliados, três não traziam informação sobre as atividades de risco e 41 indicavam mais de um nome popular para a doença, possibilitando maior alcance do público-alvo nas diversas áreas endêmicas; em 53 materiais, o ciclo biológico estava ausente ou incorreto; o molusco, hospedeiro intermediário, estava retratado incorretamente, com imagens estereotipadas em 39 materiais, e ausente em um; o diagnóstico foi mencionado em 36 materiais. CONCLUSÃO: os materiais educativos impressos avaliados mostraram incorreções que podem comprometer o trabalho de educação em saúde; ademais, o diagnóstico da esquistossomose foi pouco abordado.

OBJECTIVE: to characterize printed educational materials about schistosomiasis produced at federal, state and municipal levels in Brazil. METHODS: the educational materials were characterized considering the following categories: 'format', 'parasite and intermediate host', 'definitive host (ill)' and 'disease'. RESULTS: 60 materials were assessed, three had no information about risk activities and 41 indicated more than one popular name for the disease, thus allowing greater reach among the target audience in diverse endemic areas; the biological cycle was missing or incorrect in 53 materials; the intermediate host (snail) was incorrectly illustrated, with use of stereotyped images in 39 and no image in one material; diagnosis was mentioned in 36 materials. CONCLUSION: the printed educational materials assessed had incorrect content which may compromise health education efforts; little attention was paid to schistosomiasis diagnosis.

OBJETIVO: evaluar materiales educativos impresos (MEIs) sobre esquistosomiasis producidos en Brasil a nivel Federal, Estatal y Municipal. MÉTODOS: los MEIs fueron sometidos a una evaluación de contenidos teniendo en cuenta las categorías: formato, parásito y hospedero intermediario, hospedero definitivo y enfermedad. RESULTADOS: de los 60 MEIs evaluados, tres no tenían información sobre actividades de riesgo y 41 daban más de un nombre popular a la enfermedad, permitiendo un mayor alcance de público objetivo en diferentes zonas endémicas; en 53 MEIs el ciclo de vida no era mencionado o era incorrectoo; el molusco, hospedero intermediario, era retratado incorrectamente, con imágenes estereotipadas em 39 MEIs y ausente en uno; se daba poca importancia al diagnóstico, siendo mencionado en apenas 36 de ellos. CONCLUSIÓN: los MEIs mostraron inexactitudes que podrían comprometer el trabajo de educación de la salud.

Avaliação das ações de controle da esquistossomose na Estratégia de Saúde da Família em municípios do Vale do Jequitinhonha em Minas Gerais / Evaluation of schistosomiasis control activities in the Family Health Strategy in municipalities in the Jequitinhonha Valley, Minas Gerais, Brazil

RESUMO: Estudo observacional que analisa a qualidade das ações de diagnóstico, tratamento e controle da esquistossomose na Estratégia Saúde da Família (ESF) em área endêmica. Foram utilizados questionários estruturados em 97 profissionais de saúde da ESF e em secretários municipais de saúde de 25 municípios pertencentes à Gerência Regional de Saúde de Pedra Azul, Minas Gerais. Foram utilizados os Modelos de Variáveis Latentes para definir um escore a fim de avaliar a qualidade da proposta. Os resultados mostraram que 57,8% das equipes da ESF realizam suas ações de maneira insatisfatória ou crítica. Os profissionais não realizam ações efetivas para controle da infecção e 8,1% não utilizam o método diagnóstico preconizado pelo governo. As estratégias de vigilância e controle ainda são incipientes. Da mesma forma, os profissionais não receberam treinamento adequado para o desenvolvimento das ações de prevenção e controle da esquistossomose. Falta material educativo para o desempenho das atividades de educação em saúde, sendo que as equipes da ESF realizam atividades educativas nas escolas em 48% dos municípios. Menos da metade dos profissionais entrevistados conhecia o Programa de Controle da Esquistossomose (PCE). É necessário integrar as práticas do PCE à ESF, além de buscar um adequado suporte da gestão municipal por meio de pactuações e do controle social.

ABSTRACT: Observational study that examined the quality of the preventive actions for schistosomiasis control in the Brazilian Family Health Strategy (FHS) in an endemic area. Structured questionnaires were used to interview 97 health professionals of the FHS and the Secretary of Health of 25 municipalities belonging to the State Health Department of Pedra Azul, Minas Gerais, Brazil. Models of latent variables were used to define a score to evaluate the quality of the process. The results showed that 57.8% of the FHS teams' actions were unsatisfactory or critical. The professionals did not perform effective activities for the control of the infection and 8.1% did not use the diagnostic methods required by the government. Similarly, the professionals did not receive adequate training for the development of schistosomiasis prevention and control. There was a lack of educational materials to carry out health education activities, and the FHS teams conducted educational activities in only 48% of the schools of municipalities. Less than half of the professionals interviewed knew about the Schistosomiasis Control Program. We concluded that it is necessary to integrate this Program's practices to the FHS, and seek a suitable support of municipal management through pacts and social control.

Participação da via do Hedgehog na fibrose hepática da esquistossomose mansoni humana e murina experimental / Participation via the Hedgehog in liver fibrosis of human schistosomiasis and experimental murine

INTRODUÇÃO/OBJETIVO: A esquistossomose mansonica é causa importante de fibrose hepática e hipertensão porta em regiões tropicais, e a patogênese da fibrose não está bem esclarecida. Como a via do hedgehog e um dos seus genes alvos, a osteopontina, estão envolvidos em fibroses hepáticas de outras etiologias o objetivo foi investigar a ativação destas vias na esquIsitossomose humana e murina experimental, no intuito de verificar o seu envolvimento no desenvolvimento da forma hepatoesplênica da esquistossomose mansonica (FHE). MATERIAL E MÉTODOS: 87 biópsias em cunha de fígados de pacientes com FHE submetidos a cirurgia e fragmentos de fígado de camundongos suiços infectados com Schistosoma mansoni foram submetidos a métodos imunohistoquímicos e de biologia molecular para avaliar a expressão de ligantes hedgehog (Ihh, Shh), receptor Patched, fatores de transcrição Gli 1 e 2...

inglês: BACKGROUND AND AIMS: Schistosomiasis is a major cause of liver fibrosis and portal hypertension in tropical regions, and the pathogenesis of fibrosis is not well established. As hedgehog pathway and one of its target genes, osteopontin, are involved in liver fibrosis of other etiologies our aims were to investigate the activation of these pathways in human and experimental murine schistosomiasis, in an attempt to verify their involvement in the development of hepatosplenic schistosomiasis mansoni (HS). METHODS: 87 wedge liver biopsies of patients with HS submitted to surgery and liver fragments Swiss mice infected with Schistosoma mansoni were submitted to immunohistochemistry and molecular biology methods to evaluate the expression of hedgehog ligands (Ihh, Shh), patched receptor , Gli transcription factors and osteopontin...

Participação da via do Hedgehog na fibrose hepática da esquistossomose mansoni humana e murina experimental / Participation via the Hedgehog in liver fibrosis of human schistosomiasis and experimental murine

INTRODUÇÃO/OBJETIVO: A esquistossomose mansonica é causa importante de fibrose hepática e hipertensão porta em regiões tropicais, e a patogênese da fibrose não está bem esclarecida. Como a via do hedgehog e um dos seus genes alvos,a osteopontina, estão envolvidos em fibroses hepáticas de outras etiologias o objetivo foi investigar a ativação destas vias na esquIsitossomose humana e murina experimental, no intuito de verificar o seu envolvimento no desenvolvimento da forma hepatoesplênica da esquistossomose mansonica (FHE). MATERIAL E MÉTODOS: 87 biópsias em cunha de fígados de pacientes com FHE submetidos a cirurgia e fragmentos de fígado de camundongos suiços infectados com Schistosoma mansoni foram submetidos a métodos imunohistoquímicos e de biologia molecular para avaliar a expressão de ligantes hedgehog (Ihh, Shh), receptor Patched, fatores de transcrição Gli 1 e 2 e osteopontina. Osteopontina sérica e ligante Shh do hedgehog foram avaliados em camundongos suíços infectados e os de osteopontina em camundongos CBA/J infectados e em pacientes com FHE e forma hepatointestinal da esquistossomose. In vitro foi avaliado o efeito de antígeno solúvel do ovo (SEA) em células de Kuppfer, células estreladas, macrófagos, colangiócitos e células endoteliais sinusoidais hepáticas. A relação com a via da IL-13 foi avaliada em camundongos geneticamente deficientes ou hiperexpressando a citocina. Foi avaliado in vitro se a IL-13 induz ligantes hedghog ou ativação da via em células de Kuppfer. RESULTADOS: Os resultados mostraram: (a) aumento expressão de ligantes Ihh, de fatores de transcrição Gli2 e de osteopontina no fígado de camundongos suíços infectados com Schistosoma mansoni, aumento de shh e osteopontina no plasma de camundongos suíços e de osteopontina no plasma de camundongos CBA/J infectados com S. mansoni; (b) aumento na expressão de Ihh, Shh, Gli1 e 2, receptor Patched e de osteopontina no fígado de pacientes com esquistossomose e aumento da osteopontina sérica em pacientes com a FHE; (c) A expressão de ligantes hedgehog e de Gli2 foi observada em macrófagos, células estreladas, ductos biliares e células endoteliais, e a de osteoponina em ductos biliares,macrófagos e células estreladas/miofibroblastos; (d) correlação positiva entre ativação do hedgehog (Gli2 e osteopontina) e fibrose, no modelo murino experimental e nos pacientes; nestes a correlação também foi observada com o grau de fibrose classificada pelo ultrassom e com a hipertensão porta; (e) Inibição in vitro do hedgehog com ciclopamina e vismodegib ou por nocauteamento condicional de receptor Smoothened bloqueou a ativação alternativa de macrófagos e inibiu a angiogênese a partir de células endoteliais sinusoidais hepáticas; (f) que o bloqueio da via da IL-13 reduziu e a hiperexpressão aumentou a ativação da via do hedgehog e IL-13 diretamente induziu, in vitro,produção de ihh em células de Kupffer de camundongos e de humanos, demonstrando a inter-relação das duas vias...

BACKGROUND AND AIMS: Schistosomiasis is a major cause of liver fibrosis and portal hypertension in tropical regions, and the pathogenesis of fibrosis is not well established. As hedgehog pathway and one of its target genes, osteopontin, are involved in liver fibrosis of other etiologies our aims were to investigate the activation of these pathways in human and experimental murine schistosomiasis, in an attempt to verify their involvement in the development of hepatosplenic schistosomiasis mansoni (HS). METHODS: 87 wedge liver biopsies of patients with HS submitted to surgery and liver fragments Swiss mice infected with Schistosoma mansoni were submitted to immunohistochemistry and molecular biology methods to evaluate the expression of hedgehog ligands (Ihh, Shh), patched receptor , Gli transcription factors and osteopontin. Serum osteopontin and Shh were evaluated in infected Swiss mice and osteopontin was evaluated in serum of infected CBA/J mice and plasma from patients with hepatointestinal and HS forms of schistosomiasis. The effect of soluble egg antigen (SEA) on Kuppfer cells, stellate cells, macrophages, cholangiocytes and liver sinusoidal endothelial cells was evaluated in vitro. Relationship with IL-13 pathway was evaluated in mice genetically deficient or with hyperexpression of this cytokine. Whether IL-13 induces production of ligands and/or activation of the hedgehog pathway in Kuppfer cells was evaluated in vitro. RESULTS: Results demonstrated: (a) increased expression of Ihh, transcription factor Gli2 and osteopontin in the livers of Swiss mice infected with S. mansoni, increased plasma levels of shh and osteopontin in infected Swiss mice and increased osteopontin in plasma of S. mansoni infected CBA/J mice; (b) increased expression of ihh, shh, Gli1 and 2, patched and osteopontin receptor in the liver of patients with schistosomiasis and increased serum osteopontin in patients with HS; (c) expression of hedgehog ligands and Gli2 was observed in macrophages, stellate cells, endothelial cells and bile duct and expression of osteopontin was detected in macrophages and stellate/myofibroblast cells; (d) positive correlation between activation of the hedgehog (Gli2 and osteopontin) and fibrosis in experimental murine model and in patients; these correlation was also observed with the degree of fibrosis classified by ultrasound and with portal hypertension; (e) in vitro inhibition of hedgehog pathway with cyclopamine or vismogedib or by conditional knockout of Smoothened co-receptor blocked the alternative activation of macrophage and inhibited angiogenesis in liver sinusoidal endothelial cells; (f) reduction of IL-13 pathway or IL-13 over-expression respectively reduced or increased the activation of the hedgehog pathway and IL-13 directly induced in vitro ihh production in Kupffer cells from mice and human, demonstrating a cross-talk between the two pathways...

Entre desafios e potencialidades: avaliação da participação comunitária em um programa de controle da esquistossomose e de promoção da saúde / Among challenges and potentialities: community participation assessment in a schistosomiasis control and health promotion program

Este estudo teve por objetivo avaliar a participação comunitária (PC) a partir da implementação da segunda etapa de um programa de controle da esquistossomose e de promoção da saúde (PPC-SPJII). Trata-se de uma pesquisa participativa de base comunitária (PPBC) de caráter avaliativo, realizada com moradores do distrito rural de São Pedro do Jequitinhonha, no município de Jequitinhonha – Minas Gerais. Os dados foram coletados por meio de um questionário estruturado, aplicado aos membros comunitários e às pesquisadoras ao final do programa e por meio de oficinas e entrevistas informais. Para a avaliação da extensão da PC ocorrida no programa os dados do questionário foram empregados no modelo spidergram. Para a análise dos fatores contextuais intervenientes sobre a PC, apreendidos por meio das oficinas e entrevistas, utilizou-se a técnica de análise de conteúdo. O estudo indicou que o enfoque de PPBC utilizado possibilitou o desenvolvimento de uma consciência crítica, o aumento da capacidade dos membros comunitários participantes quanto ao uso de métodos investigativos, o estabelecimento de respeito mútuo e o desenvolvimento de confiança entre pesquisadoras e membros comunitários. Ademais, levou ao alcance de alguns resultados tais como a aquisição parcial de verba para a compra de uma ambulância para o distrito; a conclusão do regimento interno e da estruturação do Conselho Local de Saúde; e, o envio de um documento ao poder público, solicitando a implementação de um sistema de esgotamento canalizado no local. Foi possível apreender que a extensão de PC foi satisfatória em relação ao planejamento, às tomadas de decisão, à implementação das atividades do programa e à comunicação estabelecida entre os parceiros. Contudo, esta extensão foi reduzida quanto ao controle dos recursos financeiros, indicando alta dependência de financiamento externo e reduzida quanto ao monitoramento e à avaliação das ações, sugerindo insuficiente apropriação dos dados...

This study aimed to assess the process of community participation (CP) in a second stage of a schistosomiasis control and health promotion program (PPC-SPJII). It was a Community Based Participatory Research (CBPR), with evaluation feature, conduced with residents of São Pedro do Jequitinhonha, a rural district of Jequitinhonha – MG. Data collection was performed through a structured questionnaire, applied both to community members and researchers, and by means of group sessions and informal interviews. In order to evaluate the extent of CP reached, the data from the questionnaire were applied to the spidergram framework. To analyze the data obtained through group sessions and informal interviews, the content analysis technique was utilized. The study indicated that the CBPR approach enabled a critical consciousness development, the capacity building of community members in regard to the use of inquiry methodologies, the mutual respect building and the development of mutual trust among community members and researchers. Furthermore, it leaded to the achievement of specific results such as the partial acquisition of fund to buy an ambulance vehicle for the district, the conclusion of the statute and the organization of the Local Health Council and the dispatch of a document to the political managers soliciting the implementation of a channelized sewage system at the place. It was possible to apprehend that the extent of CP was satisfactory in relation to the planning, decision-making, activities implementation and communication established among partners. And was perceived as narrow in regard to financial resources and monitoring and evaluation, indicating large dependence of external funds and community members insufficient ownership of data obtained. It was encountered variations in scoring in relation to both groups of respondents, so that a definitive conclusion about the extent of PC was elusive. When compared to the program first stage, it was verified...

Clic saúde: prevenção da esquistossomose por meio das tecnologias da informação / Click health: prevention of schistomiasis by information and communication technologies

O presente estudo teve como objetivo analisar uma intervenção educativa, desenvolvida por meio da convergência de tecnologias da informação e comunicação, enquanto estratégia pedagógica para favorecer a construção de saberes sobre esquistossomose, a promoção da autonomia e da reflexão crítica, junto a escolares residentes em zona rural de Minas Gerais. Trata-se de um estudo exploratório, realizado com escolares do distrito de São Pedro do Jequitinhonha, no município de Jequitinhonha – MG. A intervenção educativa foi desenvolvida a partir da técnica da Fotovoz, na modalidade semipresencial. Os participantes foram convidados a problematizar os entendimentos sobre saúde e esquistossomose no cotidiano, através de um fórum virtual. Em oficinas presenciais, foram construídas fotografias da comunidade em que os participantes residem, as quais expressavam temas debatidos online. Os dados foram obtidos por meio de um questionário semiestruturado, respondido pelos escolares antes da intervenção e após seu encerramento, e do registro das interações empreendidas pelos participantes nos encontros virtuais e presenciais, desenvolvidos ao longo da intervenção. As respostas fornecidas ao questionário e os registros das interações foram transcritos e analisados por meio da técnica da análise de conteúdo. A análise dos dados evidenciou que a intervenção educativa viabilizou um processo dialógico de produção do conhecimento, por meio da confrontação de saberes. Percebe-se um esforço pela horizontalidade na relação entre a mediadora e os escolares, que contrasta com situações de transmissão do conhecimento. A intervenção educativa pode ter contribuído para uma ampliação do entendimento da comunidade, por meio da percepção de contradições no modo como a vida se organiza. Um conceito ampliado de saúde torna-se mais frequente no discurso dos escolares ao longo e após a intervenção. A identificação do modo como a doença acontece...

The present study aimed to analyze an educational intervention developed by means of the convergence of information and communication technologies, while pedagogical strategy to favor the construction of knowledge regarding schistosomiasis, autonomy’s promotion and critical reflection, alongside students who reside in a rural area of Minas Gerais state. This was an exploratory study, developed with students in São Pedro do Jequitinhonha, a Jequitinhonha municipality district. The educational intervention was constructed with basis on the PhotoVoice technique, in semi-presence modality. The participants were invited to problematize their understandings over health and schistosomiasis on everyday life through an online forum. In onsite workshops, the students constructed photographs of their community of residence, which expressed themes discussed on the virtual space. Data were obtained by means of a semi-structured questionnaire, which was answered by the students before and right after the end of the intervention and also by and record the conversations and interactions undertaken by the participants in virtual and onsite encounters throughout the intervention. The answers given to the open questions as well as the data collected by audio/video and written record were transcribed and submitted to content analysis technique. By the data analysis it was made evident that the educational intervention has promoted a dialogical process of knowledge production by means of knowledge confrontation. It was perceived that has occurred an effort by the mediator to relate horizontally with students, something that contrasts with knowledge transmission situations. The educational intervention may have contributed to an enlargement of the understanding over community, through the perception of contradictions in the way in which life it is organized. An enlarged health...

Avaliação da fosfoglicerato mutase de Schistosoma mansoni como potencial antígeno imunoprotetor e identificação de novos alvos para teste de diagnóstico e vacina contra esquistossomose

A esquistossomose é uma doença parasitária causada por parasitos do gênero Schistosoma. Apesar das tentativas de controle e introdução do tratamento com praziquantel,a doença persiste. Desse modo, o desenvolvimento de uma vacina poderá contribuir para o controle da doença. Dentre outras evidências, o alto nível de proteção alcançado pela vacinação com cercárias irradiadas em camundongos e a presença de indivíduos naturalmente resistentes à infecção por Schistosoma mansoni em áreas endêmicas sugerem a existência de mecanismos que induzem proteção contra esquistossomose. Por meio de experimentos de Western-blotting bidimensional utilizando soro de indivíduos de área endêmica para esquistossomose e extrato proteico de vermes adultos, selecionamos a proteína fosfoglicerato mutase de S. mansoni (SmPGM) para ser testada em ensaios de imunização em camundongos,uma vez que spots correspondentes a esta proteína foram reconhecidos pelo soro de indivíduos naturalmente resistentes à infecção e também porque análises in silico do seu potencial antigênico indicaram que SmPGM é uma das proteínas de S. mansoni que mais possuem peptídeos antigênicos. A região codificadora do gene foi inserida em vetor de expressão em células de mamíferos e após certificar a expressão da proteína por Western-blotting usando anticorpo anti-His (C-term) e extrato proteico de células HEK 293T transfectadas, outra construção de DNA similar, que não expressa a proteína em fusão com 6xHis, foi usada nos ensaios de imunização gênica em camundongos.

Entretanto, não houve redução no número de vermes adultos recuperados de camundongos vacinados e desafiados,bem como no número de ovos liberados nas fezes e retidos no fígado e intestino. Além disso,não houve alteração na ovoposição das fêmeas, nem no número e tamanho dos granulomas. A imunização gênica não foi capaz de induzir resposta humoral, resposta imune celular e produção de citocinas. Sendo assim, foram realizados experimentos de imunização de camundongos com dois peptídeos sintéticos de SmPGM, que também não resultou em proteção pelos parâmetros analisados. Este projeto também teve como objetivo identificar proteínas de membrana, principalmente do tegumento do parasito. Para isso, um extrato proteico de vermes adultos de S. mansoni enriquecido com proteínas de membrana foi obtido e também utilizado em experimentos de Western-blotting bidimensional. Foram detectados spots proteicos que reagiram diferencialmente aos pools de soro de indivíduos de área endêmica para esquistossomose. Entretanto, todos os spots imunorreativos foram submetidos à identificação por espectrometria de massas.