Schistosomiasis and soil-transmitted helminthiasis morbidity control in selected communities in Eastern Visayas, Philippines: Post-Haiyan

Objective@#As part of the evaluation of control programs recommended by WHO, this study describes the local implementation of schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) morbidity control as well as water, sanitation, and hygiene (WASH) interventions post calamity. It likewise determines the challenges, areas for improvement, and good practices in SCH and STH morbidity control strategies in Haiyan-stricken areas in Eastern and Western Samar, the Philippines. @*Methods@#Twenty key informant interviews and eight focus group discussions documented the implementation of SCH and STH control strategies in Eastern Visayas. Data analysis was done manually by a multi-disciplinary team. @*Results@#Mass drug administration (MDA) in schools and communities was conducted for morbidity control. MDA for STH for pre-school-age children was integrated into the Garantisadong Pambata program, while a schoolbased teacher-assisted approach was used for school-age children. WASH facilities, such as sanitary toilets, were constructed through the initiatives of the local government units (LGUs) and other private sectors. Partnerships with Plan International Philippines helped in the implementation of WASH through the conduct of Community-led Total Sanitation. Health advocacies helped instill behavioral change in the community. SCH surveillance was conducted annually while STH surveillance was irregularly implemented. Data on MDA coverage were validated through Rapid Coverage Assessment before final reporting. Discrepancies were observed due to typographical errors and the inclusion of teachers and transient migrants in the reports submitted. Challenges in the implementation of MDA include delays in drug delivery, lack of human resources, non-compliance of participants, and drug unpalatability. Challenges in WASH included the lack of hand washing facilities, inaccessibility to safe water, as well as non-utility of sanitary toilets. Strengthening health advocacy and education may help address these challenges.@*Conclusion@#The involvement and partnership of various stakeholders such as LGUs, WASH, and veterinary sectors, together with the academe are needed to strengthen and enhance the implementation of SCH and STH control activities. An integrated approach may contribute to improvements in SCH and STH prevention and control of the communities in selected Haiyanstricken areas.

Socio-environmental factors and schistosomiasis hospitalizations in Minas Gerais, Brazil (2007-2017) / Factores socioambientales y hospitalizaciones por esquistosomiasis en Minas Gerais, Brasil (2007-2017) / Fatores socioambientais e internações por esquistossomose em Minas Gerais, Brasil (2007-2017)

Objective:to present a spatial analysis of hospitalizations for schistosomiasis in Minas Gerais (2007-2017). Method:ecological study, with spatio-temporal distribution. Data collection was carried out in 2019, at DataSUS, for the period between 01/01/2007 and 12/31/2017. The average rates, Moran Local Bivariate rates and thematic maps were performed using the QGis program. Results:higher hospitalization rates were observed in the North, East and Northeast parts of the state. Lower rates were observed in the Southeastern portion. The variables MHDI and percentage of households without garbage collection had higher values of Local Moran Index. Municipalities in the eastern and southeastern portions of the state were classified under the "high-high" stratum. Conclusion:hospitalizations were associated with lack of basic sanitation, conditions of poverty and inequality and strong presence of water collections. There are still regions where schistosomiasis remains endemic, having a focused character.

Objetivo: presentar un análisis espacial de las hospitalizaciones por esquistosomiasis en Minas Gerais (2007-2017). Método: estudio ecológico, con distribución espacio-temporal. La recolección de datos se realizó en 2019, en DataSUS, para el período comprendido entre el 01/01/2007 y el 31/12/2017. Las tasas promedio, las tasas Bivariadas Locales de Moran y los mapas temáticos se realizaron mediante el programa QGis. Resultados: se observaron mayores tasas de hospitalización en las zonas Norte, Este y Noreste del Estado. Se observaron tasas más bajas en la parte Sureste. Las variables IDHM y porcentaje de viviendas sin recolección de basura presentaron valores más altos de Índice Moran Local. Los municipios de las partes este y sureste del estado se clasificaron en el estrato "alto-alto". Conclusión: las hospitalizaciones se asociaron a la falta de saneamiento básico, condiciones de pobreza y desigualdad y fuerte presencia de captaciones de agua. Todavía hay regiones donde la esquistosomiasis sigue siendo endémica, teniendo un carácter focalizado.

Objetivo:apresentar análise espacial das internações por esquistossomose em Minas Gerais (2007-2017). Método:estudo ecológico, com distribuição espaço-temporal. A coleta de dados foi realizada em 2019, no DataSUS, referente ao período entre 01/01/2007 e 31/12/2017. As taxas médias, as taxas de Moran Local Bivariado e os mapas temáticos foram realizados com uso do programa QGis. Resultados:foram observadas maiores taxas deinternação nas partes Norte, Leste e Nordeste do Estado. Menores taxas foram observadas na porção Sudeste. As variáveis IDHM e porcentagem de residências sem coleta de lixo tiveram maiores valores de índice de Moran Local. Municípios das porções Leste e Sudeste do Estado foram classificados sob estrato "alto-alto". Conclusão:as internações estiveram associadas à falta de saneamento básico, condições de pobreza e desigualdade,e forte presença de coletas de água. Ainda há regiões onde a esquistossomose permanece endêmica, tendo caráter focalizado.

Burden of foodborne trematodiases and taeniasis in selected areas in southern Philippines

Background@#There are limited reports on foodborne trematodiases (FBT) and taeniasis prevalence and distribution in the Philippines. @*Objective@#This study aimed to describe their prevalence and distribution and determine the species causing these infections in selected areas in southern Philippines. @*Methodology@#The study was implemented in selected barangays in Caraga and Davao regions in southern Philippines. School-age children and adults with gastrointestinal manifestations within the last two weeks were examined using the modified Kato thick technique, while adults with cough for more than two weeks underwent sputum examination using NaOH concentration technique. The adult helminths from patients positive for FBT and/or taeniasis were processed, mounted, and stained for species identification.@*Results@#Variable FBT and taeniasis prevalence across geographic areas and population groups was seen with a highly focal distribution. Heterophyidiasis was the most common FBT with a 7.5% (168 out of 2,238) prevalence. Species not known to be endemic in the area were identified including Haplorchis taichui, Opisthorchis felineus, and Echinostoma ilocanum. Variable prevalence of soil-transmitted helminthiasis and schistosomiasis was also seen. @*Conclusion@#The study revealed the hidden burden of FBT and taeniasis and identified species not known to be endemic in selected areas in southern Philippines. Addressing this hidden burden will require enhancing service delivery. This may be done by utilizing more accurate diagnosis, updating treatment guidelines, implementing evidence-based control interventions, and improving surveillance. Integrating control programs, for instance, integrating FBT and taeniasis control with STH and schistosomiasis control, and integrating paragonimiasis control with the national TB program, may also help in optimizing resources.

The 2013-2015 Nationwide Prevalence Survey of Soil-Transmitted Helminths (STH) and Schistosomiasis among school-gge children in public schools in the Philippines

Objectives@#The Department of Health (DOH) aims to reduce the prevalence of intestinal parasitism and proportion of heavy intensity of infection in the country by 2022. Among the interventions is school-based mass drug administration (MDA). Regular assessment of MDA gives guidance to the DOH. The aim of this survey was to determine the prevalence of soil transmitted helminthiasis and histosomiasis among public school children ages 5 to 16 years old. @*Methodology@#A cross-sectional, school-based study using multi-stage stratified cluster sampling was conducted from 2013 to 2015, covering the National Capital Region (NCR), and all provinces, except Maguindanao and Sulu. Stool samples were examined using the duplicate Kato Katz (KK). @*Results@#Of the 26,171 school children with stool samples examined, 7,440 (28.4%) were infected with at least one soil-transmitted helminth (STH). Infections among male students were significantly higher than female students (31.0% versus 26.0%). Heavy, moderate, and light intensity of infections were 3.2%, 29.0% and 67.7%, respectively. STH cumulative prevalence per province ranged between 0.5% and 89.5%. Schistosomiasis infections were detected in known non-endemic provinces: Ilocos Norte, Biliran, Tawi-Tawi, Basilan, and Dinagat Islands. Majority (68%) of the infections were with single parasites but as many as five parasites were detected in one child. Infections with heterophyids were also observed. @*Conclusion@#While the national prevalence of schistosomiasis was less than 1.0%, the cumulative prevalence of soil-transmitted helminthiasis among school-aged children was higher than the global figure of 24.0%.

In vitro and in silico evaluation of the schistosomicidal activity of eugenol derivatives using biochemical, molecular, and morphological tools

Background Eugenol shows both antibacterial and antiparasitic activities, suggesting that it might be evaluated as an option for the treatment of praziquantel-resistant schistosome. Methods The in vitro activities of three eugenol derivatives (FB1, FB4 and FB9) on adult worms from Schistosoma mansoni were examined by fluorescence and scanning electron microscopy to analyze effects on the excretory system and integument damage, respectively. Biochemical tests with verapamil (a calcium channel antagonist) and ouabain (a Na+/K+-ATPase pump inhibitor) were used to characterize eugenol derivative interactions with calcium channels and the Na+/K+-ATPase, while in silico analysis identified potential Na+/K+-ATPase binding sites. Results The compounds showed effective doses (ED50) of 0.324 mM (FB1), 0.167 mM (FB4), and 0.340 mM (FB9). In addition, FB4 (0.322 mM), which showed the lowest ED50, ED90 and ED100 (p < 0.05), caused the most damage to the excretory system and integument, according to both fluorescence and scanning electron microscopy analysis. The death of adult worms was delayed by ouabain treatment plus FB1 (192 versus 72 hours) and FB9 (192 versus 168 hours), but the response to FB4 was the same in the presence or absence of ouabain. Besides, no changes were noted when all of the eugenol derivatives were combined with verapamil. Moreover, FB1 and FB9 inhibited Na+/K+-ATPase activity according to in silico analysis but FB4 did not show a time-dependent relationship and may act on targets other than the parasite Na+/K+-ATPase. Conclusion Eugenol derivatives, mainly FB4 when compared to FB1 and FB9, seem to act more effectively on the integument of adult S. mansoni worms.(AU)

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.

Esquistossomose mansônica como doença profissional: a importância de estabelecer o nexo / Schistosomiasis mansoni as an occupational disease: the importance of establishing the link

Resumo Este ensaio destaca o perfil do trabalhador de área rural, portador da Esquistossomose mansônica, doença endêmica adquirida durante suas atividades laborais em áreas alagadas da baixada maranhense. Faz-se uma análise da legislação previdenciária e trabalhista utilizada para fins de concessão de benefícios e do nexo causal que estabelece a relação entre a situação de trabalho e o surgimento da doença. Para tal, utilizamos pesquisa bibliográfica sobre a temática e pesquisa documental do plano jurídico formal da previdência. O estudo aponta para a necessidade de reconhecer esta relação nas regiões endêmicas, no sentido de aprimorar o proposto na "Lista de Doenças Relacionadas ao Trabalho".

Abstract This study highlights the profile of rural workers with schistosomiasis mansoni, an endemic disease acquired during their work activities in flooded areas in the Baixada Maranhense. In order to analyze the social security and labor legislation used to grant benefits and the causal link that establishes the relationship between the work situation and the onset of the disease, we performed a bibliographical research on the topic and a documentary research on the formal legal plan of social security. This study addresses the need to recognize this relationship in endemic regions in order to improve what is proposed by the List of Work-Related Diseases.

Exploring the effects of artesunate and fuzheng huayu decoction on mitochondria in the treatment of schistosomiasis liver fibrosis / 中华肝脏病杂志

Objective: To compare the effects of artesunate (Art) and fuzheng huayu decoction on mitochondrial autophagy in the treatment of schistosomiasis liver fibrosis. Methods: Eighty C57BL/6 female mice were randomly divided into healthy control group, infection group, Art treatment group and Fuzheng Huayu Decoction treatment group, with 20 mice in each group. Mice in the infection group and treatment group were infected with 16 Schistosoma japonicum cercariae. After 6 weeks, praziquantel (300 mg/kg) was used for 2 days to kill the worms. The Art treatment group was treated with intraperitoneal injection of 100 mg/kg/day, while the Fuzheng Huayu Decoction treatment group was fed 16g of fuzheng huayu decoction per 1kg per day. After 6 weeks, fresh liver tissues of the four groups were collected. Masson staining and Western blot were used to observe the succinate dehydrogenase subunit A (SDHA) and malate dehydrogenase (MDH2), citrate synthase (CS), ketoglutarate dehydrogenase (OGDH), and target of rapamycin 1 (mTORC1) pathway involved in mitochondrial tricarboxylic acid cycle in liver tissues. The relative expression levels of adenylate activated protein kinase (AMPK) and mitochondrial autophagy pathway kinase (PINK1) were detected. Liver tissue samples were extracted from each group to detect the mitochondrial oxygen consumption rate. Two-way ANOVA was used to compare the significance and difference between two sets of samples. Results: Masson staining showed that the infection group mice had significantly higher liver fibrosis area than the healthy control group, while the Art treatment group and Fuzheng Huayu Decoction treatment group mice had lower liver fibrosis area than the infection group. Western blot analysis showed that the infection group (0.82 ± 0.05) had significantly lower relative expression of SDHA protein than the healthy control group (1.00 ± 0.05) (t = 11.23, P = 0.0035), while the Art treatment group (0.73 ± 0.05) had significantly higher relative expression of SDHA protein than the infection group (t = 10.79, P = 0.0073). However, there was no significant change in Fuzheng Huayu Decoction treatment group (0.98±0.05) (t = 1.925, P = 0.1266). The relative expression of p-AMPK protein was significantly higher in the infection group (1.15 ±0.05) than in the healthy control group (0.98 ± 0.07, t = 12.18, P = 0.0029), and the expression of p-AMPK in the Art treatment group (0.50 ± 0.05) was significantly lower than the infection group (t = 11.78, P = 0.0032). The relative protein expression of AMPK was significantly lower in the infection group (0.80 ± 0.05) than in the healthy control group (1.00 ± 0.05, t = 10.53, P = 0.0046). The expression of AMPK was significantly lower in the Art treatment group (0.54 ± 0.05) than in the infection group (T = 13.98, P = 0.0036). The relative expression of p-mTORC1 protein (0.93 ± 0.08) was not significantly different in the infection group than in the healthy control group (t = 2.28, P = 0.065), while the Art treatment group (0.63 ± 0.05) had significantly lower relative expression of p-mTORC1 protein than the infection group (t = 10.58, P = 0.029). The expression of p-mTORC1/ m-TORC1 was not significantly different in the infection group (0.98 ± 0.03) than in the healthy control group (0.97 ± 0.03, t = 0.98, P = 0.085), while the Art treatment group (0.63 ± 0.05) had significantly lower relative expression of p-mTORC1/ m-TORC1 than the infection group (t = 14.58, P = 0. 009). The relative protein expression of PINK1 was significantly lower in the infection group (0.55 ± 0.05) than in the healthy control group (1.00 ± 0.03, t = 13.49, P = 0.0011), while the Art treatment group (1.21 ± 0.05, t = 9.98, P = 0.0046) and Fuzheng Huayu Decoction treatment group (1.31 ±0.35, t = 6.98, P = 0.027) had significantly higher relative protein expression of PINK1 than the infection group. Mitochondrial function tests showed that after adding substrate complex II, the oxygen consumption of the infection group was lower than the healthy control group, while the Art treatment group and the Fuzheng Huayu Decoction treatment group had higher oxygen consumption than the infection group. The oxygen consumption was significantly lower after adding the substrate complex III in the infection group than the healthy control group, while the Art treatment group and Fuzheng Huayu Decoction treatment group had higher oxygen consumption than the infection group. Conclusion: Art can alleviate schistosomiasis liver fibrosis by inhibiting AMPK/mTORC1 signaling pathway activity and enhancing mitochondrial oxygen consumption, autophagy and SDHA expression.

Diagnostic efficacy of indirect haemagglutination assay for detection of Schistosoma japonicum infections among boatmen and fishermen in the Dongting Lake region / 中国血吸虫病防治杂志

OBJECTIVE@#To evaluate the diagnostic efficacy of indirect haemagglutination assay (IHA) for detection of Schistosoma japonicum infections among boatmen and fishermen in Dongting Lake region, so as to provide insights into improving the schistosomiasis surveillance program among boatmen and fishermen.@*METHODS@#The boatmen and fishermen were detected for S. japonicum infections using IHA and Kato-Katz technique or miracidium hatching test nylon gauze simultaneously at schistosomiasis testing sites in the anchor sites for boatmen and fishermen in the Dongting Lake region during the period from 2014 to 2016, and using IHA for serological screening followed by parasitological testing of seropositives during the period from 2017 to 2019. The sensitivity and specificity of IHA were evaluated for detection of S. japonicum infections among boatmen and fishermen, with the 2014-2016 parasitological testing results as a gold standard. In addition, the seroprevalence of S. japonicum infections was compared among boatmen and fishermen with different characteristics and among years.@*RESULTS@#A total of 306 schistosomiasis testing sites were assigned for boatmen and fishermen, and a total of 143 360 person-time boatmen and fishermen were tested for S. japonicum infections in the Dongting Lake region from 2014 to 2019. The sensitivity and specificity of IHA were 69.9%, 97.3% and 96.1% (χ2 = 74.6, P < 0.05), and 70.9%, 74.5% and 71.9% for detection of S. japonicum infections from 2014 to 2016 (χ2 = 29.4, P < 0.05), respectively. The seroprevalence of S. japonicum infections reduced from 30.3% in 2014 to 1.8% in 2019 among boatmen and fishermen, appearing an overall tendency towards a decline (Z = 1 552.4, P < 0.05). In addition, male, individuals at ages of 45 to 60 years, full-time boatmen and fishermen were more likely to be seropositive for S. japonicum infections (all P values < 0.05).@*CONCLUSIONS@#The seroprevalence of S. japonicum infections appeared a tendency towards a decline among boatmen and fishermen in the Dongting Lake region year by year from 2014 to 2019. IHA presented a high efficacy for screening of S. japonicum infections among boatmen and fishermen in the Dongting Lake region.

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.

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.

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.

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.

Aceitação entre estudantes do ensino básico do desenho animado O X na Xistose para construção de conhecimentos sobre esquistossomose / Acceptance of the cartoon O X na Xistose for the knowledge construction about schistosomiasis among middle school students / Aceptación entre estudiantes del ciclo básico de lo dibujo animado O X na Xistose para el desarrollo del conocimiento sobre la esquistosomiasis

O trabalho dos educadores pode ser enriquecido com o uso de recursos pedagógicos importantes no processo de ensino e aprendizagem. Considerando este aspecto, uma animação baseada no livro O feitiço da lagoa, de Virginia Schall, que trata do tema esquistossomose foi construída para estimular o conhecimento sobre a doença entre escolares e exibida para alunos do ensino básico em quatro municípios endêmicos: Jaboticatubas, Malacacheta e Santa Luzia, em Minas Gerais; e João Pessoa, na Paraíba. Após sua exibição, um questionário foi aplicado com a finalidade de verificar a aceitação e o entendimento do material. De acordo com as respostas, o desenho animado apresentou boa aceitação. Todos identificaram a esquistossomose como a doença retratada e o caramujo como o transmissor do esquistossomo. Os resultados apontaram que o desenho pode ser um importante recurso pedagógico no processo educativo, auxiliando os programas de controle da endemia, especialmente quando desenvolvidos no espaço escolar.

The educators' work can be enriched with the use of pedagogical resources which are important in the teaching and learning process. With this aspect in mind, a cartoon with the theme schistosomiasis was created, so as to promote knowledge about the disease among middle school students, and exhibited in four endemic municipalities - Jaboticatubas, Malacacheta and Santa Luzia in the state of Minas Gerais; and João Pessoa in the state of Paraíba. The animation was based on the book O feitiço da lagoa by Virginia Schall and it was shown to students in those four towns. A questionnaire was answered by them after the respective exhibitions in order to verify the acceptance and understanding of the material that was shown. According to the responses, the cartoon presented good acceptance. Everyone identified schistosomiasis as the disease displayed, and the snail that transmits the schistosome. The results showed that the cartoon can be an important pedagogical resource in the educational process, helping endemic control programs, especially when these programs are developed in the school environment.

El trabajo de los educadores puede ser enriquecido con el uso de recursos pedagógicos importantes en el proceso de enseñanza y aprendizaje. Considerando este aspecto, un dibujo animado sobre el tema esquistosomiasis fue realizado para estimular el conocimiento, entre estudiantes del ciclo básico, acerca de la enfermedad y exhibido en cuatro municipios endémicos: Jaboticatubas, Malacacheta y Santa Luzia en Minas Gerais; y João Pessoa en Paraíba. La animación fue basada en el libro O feitiço da lagoa de Virginia Schall y fue mostrada a alumnos en las cuatro localidades. Un cuestionario fue aplicado, después de cada proyección, con la finalidad de verificar la aceptación y el entendimiento del material exhibido. De acuerdo con las respuestas, el dibujo tuvo buena aceptación. Todos identificaron la esquistosomiasis como la enfermedad retratada y el caracol como el transmisor del esquistosoma. Los resultados indicaran que el dibujo animado puede ser un importante recurso pedagógico en el proceso educativo, auxiliando a los programas de control de la endemia, especialmente cuando desarrollados en el espacio escolar.

Association of the polymorphism Exon 1 (A/O) region of the mannose-binding lectin gene and periportal fibrosis regression in schistosomiasis after specific treatment

Abstract INTRODUCTION: We evaluated the association between genetic polymorphisms in exon 1 (A/O alleles) and promoter regions at positions -550 (H/L variant, rs11003125) and -221 (X/Y variant, rs7096206) MBL2 and periportal fibrosis regression. METHODS: This was a retrospective cohort study involving 114 Brazilians infected with Schistosoma mansoni, who were subjected to follow-up for three years after specific treatment for schistosomiasis to estimate the probability of periportal fibrosis regression. RESULTS: A risk association was observed between polymorphism at the exon 1 MBL2 and periportal fibrosis regression. CONCLUSIONS: This study suggests that the polymorphism of exon 1 MBL2 may potentially be used to predict periportal fibrosis regression in this population.

O índice esplênico como preditor de sangramento e recidiva varicosa no seguimento tardio de paciente esquistossomóticos após tratamento endoscópico exclusivo / The splenic index as predictor of bleeding and variceal recurrence in the late follow-up of schistosomotic patients after exclusive endoscopic treatment

RESUMO - RACIONAL: O tratamento endoscópico das varizes esofágicas tem sido utilizado como principal intervenção em pacientes com hipertensão portal secundária à esquistossomose, mas com taxas significativas de recorrência de varizes esofágicas e ressangramento. Os resultados em longo prazo do tratamento endoscópico exclusivo são pouco estudados quanto à relação das dimensões esplênicas neste contexto. OBJETIVO: Avaliar, por meio da ultrassonografia, o índice esplênico e a dimensão longitudinal (craniocaudal) do baço como preditores de ressangramento e recorrência de varizes no seguimento tardio de pacientes esquistossomóticos não operados, após erradicação endoscópica das varizes esofágicas. MÉTODOS: Estudo observacional retrospectivo por meio da análise de prontuários de pacientes com diagnóstico de esquistossomose hepatoesplênica. A curva ROC foi usada para determinar o melhor ponto de corte para o índice esplênico médio como preditor de recorrência e sangramento. RESULTADOS: Foram analisados 54 pacientes, durante o período de 2002 a 2018. O tempo médio de seguimento foi de 8 anos. O índice esplênico provou ser um teste sensível em valores acima de 144 como preditor de ressangramento. Na análise da dimensão longitudinal, o valor acima de 20 cm apresentou teste estatisticamente significativo para recorrência de varizes e valor acima de 19 cm apresentou-se como teste muito sensível e estatisticamente significativo para ressangramento. CONCLUSÃO: A análise do índice esplênico e da dimensão craniocaudal, obtidos por ultrassonografia, podem predizer recorrência de varizes e ressangramento após erradicação endoscópica exclusiva.

ABSTRACT - BACKGROUND: Endoscopic treatment for esophageal variceal has been used as the main intervention in patients with portal hypertension secondary to schistosomiasis, but with significant rates of recurrence of esophageal variceal and rebleeding. The long-term results of exclusive endoscopic treatment are poorly studied as the relationship of the splenic dimensions in this context. AIM: The aim of this study was to identify, through ultrasonography, whether the splenic index and the longitudinal (craniocaudal) dimension of the spleen are the predictors of rebleeding and variceal recurrence in late follow-up of patients with nonoperated schistosomiasis, after endoscopic eradication of esophageal variceal. METHODS: This is a retrospective and observational study analyzing the medical records of patients diagnosed with hepatosplenic schistosomiasis. The receiver operating characteristic curve was used to determine the best cutoff point for the mean splenic index as a predictor of recurrence and bleeding. Results: A follow-up of 54 patients were analyzed during the period from 2002 to 2018. The mean follow-up time was 8 years. The splenic index with value >144 was proved to be a sensitive test for rebleeding. In the analysis of the longitudinal dimension, the spleen length of >20 cm showed a statistically significant test for recurrence of variceal and a length >19 cm presented as a very sensitive and statistically significant test for rebleeding. CONCLUSION: Splenic index and craniocaudal dimension analysis, obtained by ultrasonography, can predict recurrence of varicose veins and rebleeding after exclusive endoscopic treatment.

Does the drop in portal pressure after esophagogastric devascularization and splenectomy influence the variation of variceal calibers and the rebleeding rates in schistosomiasis in late follow-up? / A queda da pressão portal após desvascularização esofagogástrica e esplenectomia influencia a variação do calibre das varizes e as taxas de ressangramento na esquistossomose no seguimento em longo prazo?

ABSTRACT Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up. Aim: To assess the impact on behavior of esophageal varices and bleeding recurrence after post-operative endoscopic treatment of patients submitted to EGDS. Methods: Thirty-six patients submitted to EGDS were followed for more than five years. They were divided into two groups, according to the portal pressure drop, more or less than 30%, and compared with the behavior of esophageal varices and the rate of bleeding recurrence. Results: A significant reduction on the early and late post-operative varices caliber when compared the pre-operative data was observed despite an increase in diameter during follow-up that was controlled by endoscopic therapy. Conclusion: The drop in portal pressure did not significantly influence the variation of variceal calibers when comparing pre-operative and early or late post-operative diameters. The comparison between the portal pressure drop and the rebleeding rates was also not significant.

RESUMO Racional: O tratamento de escolha para pacientes com hipertensão portal esquistossomótica com sangramento de varizes é a desconexão ázigo-portal mais esplenectomia (DAPE) associada à terapia endoscópica. Porém, estudos mostram aumento do calibre das varizes em alguns pacientes durante o seguimento em longo prazo. Objetivo: Avaliar o impacto da DAPE e tratamento endoscópico pós-operatório no comportamento das varizes esofágicas e recidiva hemorrágica, de pacientes esquistossomóticos. Métodos: Foram estudados 36 pacientes com seguimento superior a cinco anos, distribuídos em dois grupos: queda da pressão portal abaixo de 30% e acima de 30% comparados com o calibre das varizes esofágicas no pós-operatório precoce e tardio além do índice de recidiva hemorrágica. Resultados: Após a DAPE houve diminuição significativa no calibre das varizes esofágicas que, durante o seguimento aumentaram de calibre e foram controladas com tratamento endoscópico. A queda da pressão portal não influenciou significativamente o comportamento do calibre das varizes no pós-operatório precoce nem tardio nem os índices de recidiva hemorrágica. Conclusão: A queda na pressão portal não influenciou significativamente a variação dos calibres das varizes ao comparar os diâmetros pré e pós-operatórios precoces ou tardios. A comparação entre a queda de pressão do portal e as taxas de ressangramento também não foi significativa.

Primary school educational intervention r egarding schistosomiasis in a riverside community, northeastern Brazil

Schistosomiasis is still a serious public health concern in Brazil and Sergipe State presents the highest prevalence rate of the disease. Brazil implemented the Schistosomiasis Control Program (PCE) with several strategies to control the disease, including health education actions in endemic areas. Herein, we assessed the impact of an educational intervention on knowledge concerning schistosomiasis in students from a riverside village of Sergipe, Northeastern Brazil. The study was carried out in 3 phases. 1) A questionnaire was applied to assess the students' knowledge about the biological, clinical, and epidemiological aspects of schistosomiasis mansoni (pre-test). 2) Next, an educational intervention was conducted. Pamphlets about schistosomiasis were distributed to the entire school community, who were then invited to a lecture. 3) A post-test was performed using the questionnaire to assess acquired knowledge. 151 elementary school students were interviewed. 2.6% of the pre-test students and 4.3% of the post-test group had already been diagnosed with schistosomiasis. In the pre-test, only 24.5% knew the cause of the disease and 48.3% the transmission sites. In the post-test, 74.3% (OR= 8.9; p-value<0.0001) knew the etiology and 77.1% the possible transmission sites (OR= 3.6; p-value<0.0001). There was also significant improvement in knowledge regarding signs, symptoms and prophylactic measures. Most students were unaware of the risk of reinfection by Schistosoma mansoni after treatment. The educational intervention proved quite effective in increasing information on schistosomiasis. These results reinforce the importance of health education as an auxiliary tool in the control of schistosomiasis.

Geographic Information System-based association between the sewage network, geographical location of intermediate hosts, and autochthonous cases for the estimation of risk areas of schistosomiasis infection in Ourinhos, São Paulo, Brazil

Abstract INTRODUCTION: Ourinhos is a municipality located between the Pardo and Paranapanema rivers, and it has been characterized by the endemic transmission of schistosomiasis since 1952. We used geospatial analysis to identify areas prone to human schistosomiasis infections in Ourinhos. We studied the association between the sewage network, co-occurrence of Biomphalaria snails (identified as intermediate hosts [IHs] of Schistosoma mansoni), and autochthonous cases. METHODS: Gi spatial statistics, Ripley's K12-function, and kernel density estimation were used to evaluate the association between schistosomiasis data reported during 2007-2016 and the occurrence of IHs during 2015-2017. These data were superimposed on the municipality sewage network data. RESULTS: We used 20 points with reported IH; they were colonized predominantly by Biomphalaria glabrata, followed by B. tenagophila and B. straminea. Based on Gi statistics, a significant cluster of autochthonous cases was superimposed on the Christoni and Água da Veada water bodies, with distances of approximately 300 m and 2200 m from the points where B. glabrata and B. straminea were present, respectively. CONCLUSIONS: The residence geographical location of autochthonous cases allied with the spatial analysis of IHs and the coverage of the sewage network provide important information for the detection of human-infection areas. Our results demonstrated that the tools used for direct surveillance, control, and elimination of schistosomiasis are appropriate.