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1.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(6): 551-558, 2020 Nov 19.
Artigo em Chinês | MEDLINE | ID: mdl-33325187

RESUMO

This report presented the endemic status of schistosomiasis in the People's Republic of China at a national level in 2019, and analyzed the data collected from the national schistosomiasis prevention and control system and 455 national schistosomiasis surveillance sites. Among the 12 provinces (municipality and autonomous region) endemic for schistosomiasis in China, Shanghai, Zhejiang, Fujian, Guangdong and Guangxi continued to consolidate the achievements of schistosomiasis elimination, Sichuan Province achieved transmission interruption, Jiangsu newly achieved the standard of transmission interruption and 5 provinces of Yunnan, Hubei, Anhui, Jiangxi and Hunan maintained transmission control by the end of 2019. There were 450 endemic counties (cities, districts) endemic for schistosomiasis, including 28 500 endemic villages covering 70 667 800 people at risk of infections. Among the 450 endemic counties (citis, districts), 66.89% (301/450), 28.44% (128/450) and 4.67% (21/450) kept the criteria of elimination, transmission interruption and transmission control of schistosomiasis, respectively. By the end of 2019, a total of 30 170 advanced schistosomiasis cases were documented in China. In 2019, a total of 12 090 712 individuals received inquiry examinations and 1 740 764 were positive; 5 158 369 individuals received serological tests and 89 753 were seropositive. A total of 327 475 individuals received stool examinations and 5 were positive, including one case of acute schistosomiasis. In 2019, snail survey was performed in 19 726 endemic villages in China and Oncomelania snails were found in 7 322 villages, accounting for 37.12% of all surveyed villages, with 6 villages with emerging snail habitats. Snail survey covered an area of 585 286.24 hm2 and 174 270.42 hm2 snail habitats were found, including emerging snail habitats of 64.20 hm2; however, no infected snails were identified. In 2019, a total of 605 965 bovines were raised in the schistosomiasis endemic areas of China, and 183 313 received serological examinations, with 1 176 positives detected, while 134 978 bovines received stool examinations, with 7 positives identified. In 2019, there were 28 557 patients with schistosomiasis receiving praziquantel chemotherapy, and expanded chemotherapy was given to 1 008 083 person-times; there were 7 bovines with schistosomiasis receiving praziquantel chemotherapy, and 296 053 herd-times expanded chemotherapy was given to bovines. In 2019, snail habitats at an area of 128 754.26 hm2 were given chemical treatment, and the actual area of chemical treatment was 69 605.55 hm2, while environmental improvements were performed in snail habitats covering an area of 2 847.00 hm2. Data from the 455 national schistosomiasis surveillance sites of China showed that the mean Schistosoma japonicum infection rates were both zero in humans and bovines in 2019, and no infected snails were found. The results demonstrate that the overall endemic situation of schistosomiasis remains at a lower infection level in China; however, there is still a risk of schistosomiasis transmission. To achieve the target set in the National Thirteenth Five-Year Plan for Schistosomiasis Control and consolidate the achievements of schistosomiasis control, precision control on schistosomiasis still needs to be reinforced in China.


Assuntos
Doenças Endêmicas , Esquistossomose Japônica , Esquistossomose , Animais , Bovinos/parasitologia , China/epidemiologia , Cidades , Humanos , Praziquantel/uso terapêutico , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Esquistossomose/veterinária , Caramujos/parasitologia
2.
PLoS Negl Trop Dis ; 14(9): e0008649, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32976496

RESUMO

Schistosomiasis control is heavily reliant on the drug praziquantel (PZQ), which is used as preventive chemotherapy as part of national helminth control strategies. Given the heavy reliance on PZQ for mass drug administration, there has been considerable research on the potential of parasites developing resistance to the drug, resulting in decreased drug efficacy. However, there have been comparatively fewer studies of other factors that can potentially alter PZQ efficacy. Here, we investigate whether host PZQ metabolism contributes towards variable cure rates. We evaluate factors that can influence the metabolism of PZQ and the resultant effect on the efficacy of PZQ treatment to determine factors that potentially influence an individual's response to the drug. The literature search was directed at published studies from three online databases: Web of Science, PubMed, and EMBASE. The search terms for the review comprised of ([praziquantel OR PZQ] AND [schistosom* OR bilharzia] AND [pharmaco*]) and included studies evaluating PZQ metabolism. Publications were categorised into pharmacokinetics, drug-drug interactions, pharmacogenetics, and metabolite analysis. Forty publications describing human and experimental studies fitted the inclusion criteria and were subjected to data extraction and analysis. The analyses showed that variable exposure to PZQ was associated with alterations in the liver's capacity to metabolise PZQ and observed drug-drug interactions. Other factors influencing the efficacy of PZQ were brand, formulation, and co-administered food. Although some work has been performed on metabolite identification, there was minimal information on PZQ's metabolic pathway, and no pharmacogenetics studies were identified. The study indicated that in both human and experimental studies alterations in the liver's capacity to metabolise PZQ as well as drug-drug interactions affected systemic levels of PZQ that could result in variable cure rates. The study confirmed previous findings of higher antischistosomal activity of (R)-PZQ enantiomer when administered alone compared to the racemate at the same dose as well as improved efficacy when the drug is administered with food. The study also highlighted the need for more comprehensive studies of the PZQ metabolic pathway and PZQ pharmacogenetic studies in humans.


Assuntos
Anti-Helmínticos/uso terapêutico , Praziquantel/uso terapêutico , Esquistossomose/tratamento farmacológico , Animais , Anti-Helmínticos/farmacocinética , Modelos Animais de Doenças , Humanos , Praziquantel/farmacocinética , Schistosoma mansoni/efeitos dos fármacos , Schistosoma mansoni/fisiologia , Esquistossomose/parasitologia
3.
PLoS Negl Trop Dis ; 14(8): e0008494, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32833994

RESUMO

Helminth control at the national level is currently based on mass drug administration (MDA) programs. Perception of the MDA programs for helminth control by the affected populations influences compliance and future designs of the programs. We determined the perception of Zimbabwe's National Helminth Control Program (2012-2017) with a specific focus on schistosomiasis in the school children treated with praziquantel, schoolteachers and village health workers (VHW). The study enrolled 409 children from Grades 6 and 7 who had the full benefit of the 6 years of MDA from 2012 to 2017. Thirty-six schoolteachers and 22 VHW serving the schools were also recruited. A structured questionnaire developed in English, translated into the local language Shona, and validated prior to the study was administered to the children and the adults. The questions focused on the perceived impact on health, school attendance and performance and Knowledge Attitudes and Practice (KAP) among the school children. Data were captured electronically on android platforms using the Open Data Kit. Overall, 84% of the children responded that their awareness of schistosomiasis (transmission, disease, treatment and infection avoidance) had improved because of participating in the MDAs. Of the 151 children self-diagnosed with schistosomiasis, 74% reported that their health had improved following treatment with praziquantel. This included resolution of haematuria, painful urination, sore stomach, tiredness and falling asleep during class lessons. The children and teachers reported improvements in both pupil school attendance and performance at school while the VHW and teachers reported an increase in health-seeking behaviour amongst the school children for schistosomiasis treatment in-between MDAs. The majority of VHW (96%) reported improvement in handwashing behaviour, schistosomiasis awareness (96%) and treatment uptake (91%) within the communities where the school children belonged. However, only 59% of the VHW reported improvement in toilet use while only 50% of the VHW reported improvement in clean water use within their communities. This study indicated that the surveyed children perceived the MDA program had improved their health, school attendance, school performance and awareness of schistosomiasis. The VHW also perceived that the MDA program had improved the community KAP.


Assuntos
Albendazol/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Administração Massiva de Medicamentos , Praziquantel/uso terapêutico , Esquistossomose/prevenção & controle , Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Criança , Serviços de Saúde Comunitária , Feminino , Humanos , Masculino , Praziquantel/administração & dosagem , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Instituições Acadêmicas , Zimbábue/epidemiologia
4.
PLoS Negl Trop Dis ; 14(8): e0008635, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32853206

RESUMO

BACKGROUND: In view of the potential immunosuppressive and regenerative properties of mesenchymal stem cells (MSC), we investigated whether transplantation of adipose tissue-derived stem cells (ASC) could be used to control the granulomatous reaction in the liver of mice infected with Schistosoma mansoni after Praziquantel (PZQ) treatment. METHODOLOGY/PRINICPAL FINDINGS: C57BL/6 mice infected with S. mansoni were treated with PZQ and transplanted intravenously with ASC from uninfected mice. Liver morpho-physiological and immunological analyses were performed. The combined PZQ/ASC therapy significantly reduced the volume of hepatic granulomas, as well as liver damage as measured by ALT levels. We also observed that ASC accelerated the progression of the granulomatous inflammation to the advanced/curative phase. The faster healing interfered with the expression of CD28 and CTLA-4 molecules in CD4+ T lymphocytes, and the levels of IL-10 and IL-17 cytokines, mainly in the livers of PZQ/ASC-treated mice. CONCLUSIONS: Our results show that ASC therapy after PZQ treatment results in smaller granulomas with little tissue damage, suggesting the potential of ASC for the development of novel therapeutic approaches to minimize hepatic lesions as well as a granulomatous reaction following S. mansoni infection. Further studies using the chronic model of schistosomiasis are required to corroborate the therapeutic use of ASC for schistosomiasis.


Assuntos
Tecido Adiposo/fisiologia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Hepatopatias/terapia , Fígado/parasitologia , Praziquantel/uso terapêutico , Esquistossomose/tratamento farmacológico , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Granuloma , Fígado/metabolismo , Fígado/patologia , Hepatopatias/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Schistosoma mansoni , Esquistossomose/patologia , Esquistossomose mansoni
5.
Am J Trop Med Hyg ; 103(4): 1572-1577, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32662392

RESUMO

We assessed the feasibility of using a test, treat, track, test, and treat (5T) active surveillance strategy to identify and treat individuals with schistosomiasis in three very low-prevalence villages in Kafr El Sheikh Governorate, Egypt. Primary index cases (PICs) were identified using the point-of-care circulating cathodic antigen (POC-CCA) assay in schools, in rural health units (retesting individuals with positive Kato-Katz examinations over the previous 6 months), and at potential water transmission sites identified by PICs and field observations. Primary cases identified potential second-generation cases-people with whom they shared water activities-who were then tracked, tested, and treated if infected. Those sharing water activities with second-generation cases were also tested. The yield of PICs from the three venues were 128 of 3,576 schoolchildren (3.6%), 42 of 696 in rural health units (6.0%), and 83 of 1,156 at water contact sites (7.2%). There were 118 second- and 19 third-generation cases identified. Persons testing positive were treated with praziquantel. Of 388 persons treated, 368 (94.8%) had posttreatment POC-CCA tests 3-4 weeks after treatment, and 81.8% (301) became negative. The 67 persons remaining positive had negative results after a second treatment. Therefore, all those found positive, treated, and followed up were negative following one or two treatments. Analysis of efforts as expressed in person-hours indicates that 4,459 person-hours were required for these 5T activities, with nearly 65% of that time spent carrying out interviews, treatments, and evaluations following treatment. The 5T strategy appears feasible and acceptable as programs move toward elimination.


Assuntos
Antígenos de Helmintos/análise , Praziquantel/uso terapêutico , Esquistossomose/epidemiologia , Adolescente , Criança , Erradicação de Doenças , Egito/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Prevalência , Esquistossomose/diagnóstico , Esquistossomose/tratamento farmacológico , Esquistossomose/prevenção & controle , Instituições Acadêmicas , Conduta Expectante
6.
PLoS One ; 15(6): e0232867, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497049

RESUMO

INTRODUCTION: The Neglected Tropical Diseases Roadmap of the WHO set targets for potential elimination as a "public health problem" for the period 2012-2020 in multiple countries in Africa, with the aim of global elimination of schistosomiasis as a "public health problem" by 2025. AIM: The purpose of the study was to estimate the cost from a provider's perspective of the Department of Health's Schistosomiasis Mass Drug Administration (MDA) in Ugu District, KwaZulu-Natal in 2012, with a view to project the costs for the entire KwaZulu Natal Province. METHODS: A total of 491 public schools and 16 independent schools in Ugu District, a predominantly rural district in KwaZulu-Natal with a total of 218 242 learners, were included in the schistosomiasis control programme. They were randomly selected from schools situated below an altitude of 300 meters, where schistosomiasis is endemic. A retrospective costing study was conducted using the provider's perspective to cost. Cost data were collected by reviewing existing records including financial statements, invoices, receipts, transport log books, equipment inventories, and information from personnel payroll, existing budget, and the staff diaries. RESULTS: A total of 15571 children were treated in 2012, resulting in a total cost of the MDA programme of ZAR 2 137 143 and a unit cost of ZAR 137. The three main cost components were Medication Costs (37%), Human Resources Cost (36%) and Capital items (16%). The total cost for treating all eligible pupils in KwaZulu-Natal will be ZAR 149 031 888. However, should the capital cost be excluded, then the unit cost will be ZAR 112 per patient and this will translate to a total cost of ZAR 121 836 288. CONCLUSIONS: Low coverage exacerbates the cost of the programme and makes a decision to support such a programme difficult. However, a normative costing study based on the integration of the programme within the Department of Health should be conducted.


Assuntos
Anti-Helmínticos/economia , Custos Diretos de Serviços/estatística & dados numéricos , Administração Massiva de Medicamentos/economia , Praziquantel/economia , Esquistossomose/tratamento farmacológico , Serviços de Saúde Escolar/economia , Adolescente , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Gastos de Capital/estatística & dados numéricos , Criança , Custos de Medicamentos/estatística & dados numéricos , Doenças Endêmicas/economia , Doenças Endêmicas/prevenção & controle , Feminino , Humanos , Masculino , Folhetos , Praziquantel/administração & dosagem , Praziquantel/uso terapêutico , Estudos Retrospectivos , População Rural , Amostragem , Esquistossomose/economia , Esquistossomose/epidemiologia , África do Sul/epidemiologia
7.
Lancet Infect Dis ; 20(7): e165-e172, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32595046

RESUMO

Although preventive chemotherapy has been instrumental in reducing schistosomiasis incidence worldwide, serious challenges remain. These problems include the omission of certain groups from campaigns of mass drug administration, the existence of persistent disease hotspots, and the risk of recrudescent infections. Central to these challenges is the fact that the diagnostic tools currently used to establish the burden of infection are not sensitive enough, especially in low-endemic settings, which results in underestimation of the true prevalence of active Schistosoma spp infections. This central issue necessitates that the current schistosomiasis control strategies recommended by WHO are re-evaluated and, possibly, adapted. More targeted interventions and novel approaches have been used to estimate the prevalence of schistosomiasis, such as establishing infection burden by use of precision mapping, which provides high resolution spatial information that delineates variations in prevalence within a defined geographical area. Such information is instrumental in guiding targeted intervention campaigns. However, the need for highly accurate diagnostic tools in such strategies is a crucial factor that is often neglected. The availability of highly sensitive diagnostic tests also opens up the possibility of applying strategies of sample pooling to reduce the cost of control programmes. To interrupt the transmission of, and eventually eliminate, schistosomiasis, better local targeting of preventive chemotherapy, in combination with highly sensitive diagnostic tools, is crucial.


Assuntos
Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Testes Diagnósticos de Rotina/métodos , Erradicação de Doenças , Esquistossomose/diagnóstico , Esquistossomose/tratamento farmacológico , Humanos , Administração Massiva de Medicamentos
8.
Trends Parasitol ; 36(7): 582-591, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32430274

RESUMO

Despite accelerating progress towards schistosomiasis control in sub-Saharan Africa, several age groups have been eclipsed by current treatment and monitoring strategies that mainly focus on school-aged children. As schistosomiasis poses a threat to people of all ages, unfortunate gaps exist in current treatment coverage and associated monitoring efforts, preventing subsequent health benefits to preschool-aged children as well as certain adolescents and adults. Expanding access to younger ages through the forthcoming pediatric praziquantel formulation and improving treatment coverage in older ages is essential. This should occur alongside formal inclusion of these groups in large-scale monitoring and evaluation activities. Current omission of these age groups from treatment and monitoring exacerbates health inequities and has long-term consequences for sustainable schistosomiasis control.


Assuntos
Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , África ao Sul do Saara/epidemiologia , Distribuição por Idade , Anti-Helmínticos/uso terapêutico , Humanos , Esquistossomose/tratamento farmacológico
9.
Am J Trop Med Hyg ; 103(1_Suppl): 36-41, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32400342

RESUMO

In 2010, the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) began the design of randomized controlled trials to compare different strategies for praziquantel mass drug administration, whether for gaining or sustaining control of schistosomiasis or for approaching local elimination of Schistosoma transmission. The goal of this operational research was to expand the evidence base for policy-making for regional and national control of schistosomiasis in sub-Saharan Africa. Over the 10-year period of its research programs, as SCORE operational research projects were implemented, their scope and scale posed important challenges in terms of research performance and the final interpretation of their results. The SCORE projects yielded valuable data on program-level effectiveness and strengths and weaknesses in performance, but in most of the trials, a greater-than-expected variation in community-level responses to assigned schedules of mass drug administration meant that identification of a dominant control strategy was not possible. This article critically reviews the impact of SCORE's cluster randomized study design on performance and interpretation of large-scale operational research such as ours.


Assuntos
Esquema de Medicação , Administração Massiva de Medicamentos , Esquistossomose/tratamento farmacológico , África ao Sul do Saara/epidemiologia , Animais , Anti-Helmínticos/uso terapêutico , Humanos , Praziquantel/uso terapêutico , Prevalência , Projetos de Pesquisa , Schistosoma haematobium/efeitos dos fármacos , Schistosoma mansoni/efeitos dos fármacos , Esquistossomose/epidemiologia , Esquistossomose/transmissão
10.
Am J Trop Med Hyg ; 103(1_Suppl): 5-13, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32400343

RESUMO

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was established in late 2008 to conduct operational research that would inform practices related to the control and elimination of schistosomiasis. This article traces SCORE's beginnings and underpinnings. These include an emphasis on openness and contributing to the development of a cohesive schistosomiasis control community, building linkages between researchers and national programs, and focusing on answering questions that will help Neglected Tropical Disease program managers to better control and eliminate schistosomiasis. It describes the development and implementation of SCORE's multiple projects. SCORE began by drawing on advice from a broad range of experts by holding wide-ranging meetings that informed the priorities and protocols for SCORE research. SCORE's major efforts included large, multicountry field studies comparing multiple strategies for mass drug administration with praziquantel, assessment of approaches to elimination, evaluation of a point-of-care assay for field mapping Schistosoma mansoni, and increasing the sensitivity of a laboratory-based diagnostic. SCORE also supported studies on morbidity due to schistosomiasis, quantification of vector snails and the detection of schistosome infections in snails, and changes in schistosome population genetics under praziquantel drug pressure. SCORE data and specimens are archived and will remain available for future research. Although much remains to be carried out, our hope is that through the already published articles and SCORE results described in this supplement, we will have provided a body of evidence to assist policy makers in the development of judicious guidelines for the control and elimination of schistosomiasis.


Assuntos
Esquistossomose mansoni , Esquistossomose , Animais , Reservatórios de Doenças , Vetores de Doenças , História do Século XXI , Humanos , Administração Massiva de Medicamentos , Morbidade , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Parasitologia/história , Praziquantel/uso terapêutico , Prevalência , Schistosoma haematobium , Schistosoma mansoni , Esquistossomose/diagnóstico , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/prevenção & controle , Caramujos/parasitologia
11.
Am J Trop Med Hyg ; 103(1_Suppl): 125-134, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32400345

RESUMO

Herein, we summarize what we consider are major contributions resulting from the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) program, including its key findings and key messages from those findings. Briefly, SCORE's key findings are as follows: i) biennial mass drug administration (MDA) with praziquantel can control schistosomiasis to moderate levels of prevalence; ii) MDA alone will not achieve elimination; iii) to attain and sustain control throughout endemic areas, persistent hotspots need to be identified following a minimal number of years of annual MDA and controlled through adaptive strategies; iv) annual MDA is more effective than biennial MDA in high-prevalence areas; v) the current World Health Organization thresholds for decision-making based on the prevalence of heavy infections should be redefined; and vi) point-of-care circulating cathodic antigen urine assays are useful for Schistosoma mansoni mapping in low-to-moderate prevalence areas. The data and specimens collected and curated through SCORE efforts will continue to be critical resource for future research. Besides providing useful information for program managers and revision of guidelines for schistosomiasis control and elimination, SCORE research and outcomes have identified additional questions that need to be answered as the schistosomiasis community continues to implement effective, evidence-based programs. An overarching contribution of SCORE has been increased cohesiveness within the schistosomiasis field-oriented community, thereby fostering new and productive collaborations. Based on SCORE's findings and experiences, we propose new approaches, thresholds, targets, and goals for control and elimination of schistosomiasis, and recommend research and evaluation activities to achieve these targets and goals.


Assuntos
Diretrizes para o Planejamento em Saúde , Schistosoma mansoni/efeitos dos fármacos , Esquistossomose/prevenção & controle , África/epidemiologia , Animais , Anti-Helmínticos/uso terapêutico , Antígenos de Helmintos/imunologia , Biomarcadores/sangue , Criança , Fezes/parasitologia , Glicoproteínas/imunologia , Proteínas de Helminto/imunologia , Humanos , Masculino , Administração Massiva de Medicamentos , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Contagem de Ovos de Parasitas , Praziquantel/uso terapêutico , Prevalência , Saúde Pública , Esquistossomose/diagnóstico , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/prevenção & controle
12.
Am J Trop Med Hyg ; 103(1_Suppl): 114-124, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32400350

RESUMO

For the past 10 years, the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), funded by the Bill & Melinda Gates Foundation, has been supporting operational research to provide a stronger evidence base for controlling and moving toward elimination of schistosomiasis. The SCORE portfolio was developed and implemented with engagement from many stakeholders and sectors. Particular efforts were made to include endemic country neglected tropical disease program managers. Examples of the challenges we encountered include the need to balance rigor (e.g., conducting large cluster-randomized trials) with ensuring relevance to real-world settings, allowing for local contexts while standardizing key study aspects, adjusting to evolving technologies, and incorporating changing technologies into multiyear studies. The Schistosomiasis Consortium for Operational Research and Evaluation's findings and data and the collected specimens will continue to be useful in the years to come. Our experiences and lessons learned can benefit both program managers and researchers conducting similar work in the future.


Assuntos
Diretrizes para o Planejamento em Saúde , Esquistossomose/prevenção & controle , África/epidemiologia , Anti-Helmínticos/uso terapêutico , Análise de Dados , Humanos , Administração Massiva de Medicamentos , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Prevalência , Saúde Pública , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Resultado do Tratamento , Medicina Tropical/estatística & dados numéricos
13.
Am J Trop Med Hyg ; 103(1_Suppl): 105-113, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32400352

RESUMO

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was created to conduct research that could inform programmatic decision-making related to schistosomiasis. SCORE included several large cluster randomized field studies involving mass drug administration (MDA) with praziquantel. The largest of these were studies of gaining or sustaining control of schistosomiasis, which were conducted in five African countries. To enhance relevance for routine practice, the MDA in these studies was coordinated by or closely aligned with national neglected tropical disease (NTD) control programs. The study protocol set minimum targets of at least 90% for coverage among children enrolled in schools and 75% for all school-age children. Over the 4 years of intervention, an estimated 3.5 million treatments were administered to study communities. By year 4, the median village coverage was at or above targets in all studies except that in Mozambique. However, there was often a wide variation behind these summary statistics, and all studies had several villages with very low or high coverage. In studies where coverage was estimated by comparing the number of people treated with the number eligible for treatment, denominator estimation was often problematic. The SCORE experiences in conducting these studies provide lessons for future efforts that attempt to implement strong research designs in real-world contexts. They also have potential applicability to country MDA campaigns against schistosomiasis and other NTDs, most of which are conducted with less logistical and financial support than was available for the SCORE study efforts.


Assuntos
Anti-Helmínticos/uso terapêutico , Administração Massiva de Medicamentos , Esquistossomose/tratamento farmacológico , África , Animais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Moçambique , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/prevenção & controle , Praziquantel/uso terapêutico , Prevalência , Saúde Pública , População Rural , Schistosoma , Esquistossomose/prevenção & controle , Instituições Acadêmicas
14.
Am J Trop Med Hyg ; 103(1_Suppl): 80-91, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32400355

RESUMO

Analyses of the population genetic structure of schistosomes under the "Schistosomiasis Consortium for Operational Research and Evaluation" (SCORE) contrasting treatment pressure scenarios in Tanzania, Niger, and Zanzibar were performed to provide supplementary critical information with which to evaluate the impact of these large-scale control activities and guide how activities could be adjusted. We predicted that population genetic analyses would reveal information on a range of important parameters including, but not exclusive to, recruitment and transmission of genotypes, occurrence of hybridization events, differences in reproductive mode, and degrees of inbreeding, and hence, the evolutionary potential, and responses of parasite populations under contrasting treatment pressures. Key findings revealed that naturally high levels of gene flow and mixing of the parasite populations between neighboring sites were likely to dilute any effects imposed by the SCORE treatment arms. Furthermore, significant inherent differences in parasite fecundity were observed, independent of current treatment arm, but potentially of major impact in terms of maintaining high levels of ongoing transmission in persistent "biological hotspot" sites. Within Niger, naturally occurring Schistosoma haematobium/Schistosoma bovis viable hybrids were found to be abundant, often occurring in significantly higher proportions than that of single-species S. haematobium infections. By examining parasite population genetic structures across hosts, treatment regimens, and the spatial landscape, our results to date illustrate key transmission processes over and above that which could be achieved through standard parasitological monitoring of prevalence and intensity alone, as well as adding to our understanding of Schistosoma spp. life history strategies in general.


Assuntos
Genética Populacional , Schistosoma/genética , Esquistossomose/transmissão , África ao Sul do Saara/epidemiologia , Animais , Anti-Helmínticos/uso terapêutico , Humanos , Hibridização Genética , Estágios do Ciclo de Vida , Administração Massiva de Medicamentos , Prevalência , Schistosoma/efeitos dos fármacos , Schistosoma/fisiologia , Schistosoma haematobium/efeitos dos fármacos , Schistosoma haematobium/genética , Schistosoma haematobium/fisiologia , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia
15.
Am J Trop Med Hyg ; 103(1_Suppl): 24-29, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32400365

RESUMO

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) conducted large field studies on schistosomiasis control and elimination in Africa. All of these studies, carried out in low-, moderate-, and high-prevalence areas, resulted in a reduction in prevalence and intensity of Schistosoma infection after repeated mass drug administration (MDA). However, in all studies, there were locations that experienced minimal or no decline or even increased in prevalence and/or intensity. These areas are termed persistent hotspots (PHS). In SCORE studies in medium- to high-prevalence areas, at least 30% of study villages were PHS. There was no consistent relationship between PHS and the type or frequency of intervention, adequacy of reported MDA coverage, and prevalence or intensity of infection at baseline. In a series of small studies, factors that differed between PHS and villages that responded to repeated MDA as expected included sources of water for personal use, sanitation, and hygiene. SCORE studies comparing PHS with villages that responded to MDA suggest the potential for PHS to be identified after a few years of MDA. However, additional studies in different social-ecological settings are needed to develop generalizable approaches that program managers can use to identify and address PHS. This is essential if goals for schistosomiasis control and elimination are to be achieved.


Assuntos
Administração Massiva de Medicamentos , Esquistossomose , África/epidemiologia , Animais , Anti-Helmínticos/uso terapêutico , Feminino , Humanos , Higiene , Masculino , Praziquantel/uso terapêutico , Prevalência , População Rural , Saneamento , Schistosoma haematobium/efeitos dos fármacos , Schistosoma mansoni/efeitos dos fármacos , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Esquistossomose/transmissão , Água/parasitologia
16.
Am J Trop Med Hyg ; 103(1): 485-493, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32372751

RESUMO

Tropical splenomegaly is often associated with malaria and schistosomiasis. In 2014 and 2015, 145 Congolese refugees in western Uganda diagnosed with splenomegaly during predeparture medical examinations underwent enhanced screening for various etiologies. After anecdotal reports of unresolved splenomegaly and complications after U.S. arrival, patients were reassessed to describe long-term clinical progression after arrival in the United States. Post-arrival medical information was obtained through medical chart abstraction in collaboration with state health partners in nine participating states. We evaluated observed splenomegaly duration and associated clinical sequelae between 130 case patients from eastern Congo and 102 controls through adjusted hierarchical Poisson models, accounting for familial clustering. Of the 130 case patients, 95 (73.1%) had detectable splenomegaly after arrival. Of the 85 patients with records beyond 6 months, 45 (52.9%) had persistent splenomegaly, with a median persistence of 14.7 months (range 6.0-27.9 months). Of the 112 patients with available results, 65 (58.0%) patients had evidence of malaria infection, and the mean splenomegaly duration did not differ by Plasmodium species. Refugees with splenomegaly on arrival were 43% more likely to have anemia (adjusted relative risk [aRR]: 1.43, 95% CI: 1.04-1.97). Those with persistent splenomegaly were 60% more likely (adjusted relative risk [aRR]: 1.60, 95% CI: 1.15-2.23) to have a hematologic abnormality, particularly thrombocytopenia (aRR: 5.53, 95% CI: 1.73-17.62), and elevated alkaline phosphatase (aRR: 1.57, 95% CI: 1.03-2.40). Many patients experienced persistent splenomegaly, contradicting literature describing resolution after treatment and removal from an endemic setting. Other possible etiologies should be investigated and effective treatment, beyond treatment for malaria and schistosomiasis, explored.


Assuntos
Anemia/epidemiologia , Eosinofilia/epidemiologia , Malária/epidemiologia , Refugiados , Esquistossomose/epidemiologia , Esplenomegalia/epidemiologia , Trombocitopenia/epidemiologia , Adolescente , Adulto , Fosfatase Alcalina/sangue , Anemia/sangue , Anti-Helmínticos/uso terapêutico , Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , República Democrática do Congo/etnologia , Progressão da Doença , Eosinofilia/sangue , Feminino , Hepatite A/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Imunoglobulina M , Lactente , Malária/complicações , Malária/diagnóstico , Malária/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Praziquantel/uso terapêutico , Esquistossomose/complicações , Esquistossomose/tratamento farmacológico , Esplenomegalia/sangue , Esplenomegalia/etiologia , Trombocitopenia/sangue , Estados Unidos/epidemiologia , Adulto Jovem
17.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(3): 230-235, 2020 May 07.
Artigo em Chinês | MEDLINE | ID: mdl-32468783

RESUMO

OBJECTIVE: To examine the effect of the integrated schistosomiasis control measures in Hunan Province from 2004 to 2019, so as to provide insights into the development of the schistosomiasis elimination strategy. METHODS: The integrated schistosomiasis control measures implemented by the health, agriculture, water resources, forestry, land and resources sectors were retrospectively collected in Hunan Province from 2004 to 2019, and the completion of each measure, cost of control measures, Schistosoma japonicum infections in humans and bovines, and snail status were analyzed each year. An index system for assessing the integrated schistosomiasis control effect was constructed using the Delphi method to calculate the integrated schistosomiasis control effect index. In addition, a cost-effect analysis was performed in terms of the decline in the prevalence of S. japonicum infections in humans and bovines, areas with snails in inner embankments, and areas with infected snails. RESULTS: A total of 7 110 926 500 Yuan were invested into the integrated schistosomiasis control program of Hunan Province from 2004 to 2019. During the 16-year period, a total of 277 437.12 hm2 snail habitats received molluscicidal treatments, 6 927 230 person-times given expanded chemotherapy, 2 116 247 bovine-times given expanded chemotherapy, 954 850 harmless toilets built, 290 359 bovines fenced, 136 666 bovines eliminated, 141 905 machines used to replace bovines, 39 048.63 hm2 water lands improved as dry lands, 724.12 km irrigation regions improved, 3 994 300 populations covered with safe water, 191 102.89 hm2 forests planted and 38 535.27 hm2 lands leveled. The prevalence of S. japonicum infections was 4.29% in humans and 4.48% in bovines in Hunan Province in 2004, with 2 449.37 hm2 snail habitats in inner embankments and 3 423.74 hm2 infected snail areas. In 2019, the prevalence of S. japonicum infections reduced to 0 in both humans and bovines, and areas of snail habitats reduced to 540.92 hm2 (77.92% reductions), while the areas with infected snails reduced to 0. The overall integrated schistosomiasis control effect index appeared a tendency towards a rise over years since 2004, and the integrated schistosomiasis control effect index was 97.35 in 2019; the annual mean costs for a 1% reduction in the prevalence of S. japonicum infections in 100 populations and 100 bovines were 70.11 Yuan and 4 204.78 Yuan, and the annual mean costs for a 1% reduction in the snail areas in inner embankments and infected snail areas were 2 010.20 Yuan and 1 298.09 Yuan, respectively. CONCLUSIONS: The integrated control measures achieve remarkable effectiveness for schistosomiasis control in Hunan Province, with a remarkable decline in the prevalence of S. japonicum infections in humans and bovines and great shrinking of snail areas in inner embankments and infected snail areas. Adequate fund investment is required to improve the integrated schistosomiasis control measures and consolidate the control achievements.


Assuntos
Serviços Preventivos de Saúde , Esquistossomose , Animais , Anti-Helmínticos/economia , Anti-Helmínticos/uso terapêutico , Bovinos , Doenças dos Bovinos/tratamento farmacológico , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/prevenção & controle , China/epidemiologia , Humanos , Moluscocidas/economia , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/métodos , Estudos Retrospectivos , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Caramujos/parasitologia
18.
Infect Dis Poverty ; 9(1): 31, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32241298

RESUMO

BACKGROUND: Schistosomiasis is one of the neglected tropical diseases (NTDs) selected for worldwide elimination in the near future. Egypt has made strong progress against its two endemic species of Schistosoma mansoni and S. haematobium. The former is prevalent in the Nile Delta with the latter dominating in the Nile south of Cairo. Innovative efforts are needed to reach the goal as further reduction of the prevalence has stalled due to ongoing transmission. In this study we aimed to explore the difference between low and high prevalence villages with regard to knowledge attitude and practice about schistosomiasis, utilization of health services, infection and transmission indices. METHODS: A hybrid cross-sectional longitudinal study was conducted with three annual follow-ups conducted during 1994-1996. We used a representative systematic random sampling technique investigating 993 individuals from the high prevalence village and 614 from the low prevalence village. Data were analyzed using SPSS, comparing proportions with the Chi square test and means with the Student t test, and ANOVA. RESULTS: Compliance of faecal sampling and chemotherapy was above 70% in both villages over the whole study period. Selective praziquantel treatment resulted in a significant reduction of prevalence and intensity of infection in both villages, dropping from 35.8% prevalence to 20.6%, in the low-prevalence village, and from 69.5 to 45.9% in the high-prevalence one. Intensity of infection at the base line was 30 eggs per gram (EPG) of stool in the low-prevalence village versus 105 EPG in the high-prevalence village. However, after the second round, reinfection rebounded by 22% in the high-prevalence village, while a slight improvement of the infection indices was demonstrated in the low-prevalence one. The level of knowledge was modest in both villages: people knew about self-protection and treatment, but not much about the role of human excreta for schistosomiasis transmission. While all participants maintained that using the water from the canals was inevitable, inhabitants in the high-prevalence village showed significantly lower scores reflecting higher water contact compared to the low-prevalence one. Many of them (67%) did not utilize the health centre at all compared to 26% of the people in the low-prevalence village. Interestingly, private clinics were seen as the primary source of health care by both villages, but more frequently so in the high-prevalence village (used by 87.2% of the inhabitants) compared to the low-prevalence one (59.8%). CONCLUSIONS: Even if chemotherapy works well as reflected by the observed downregulation of intensity of infection in both villages, reinfection continued due to difficulties to avoid water contact. Efforts must be made to make people understand the role of human excreta for transmission. There is also a need to make people better trust the medical services available.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde/estatística & dados numéricos , Schistosoma haematobium/isolamento & purificação , Schistosoma mansoni/isolamento & purificação , Esquistossomose/diagnóstico , Adolescente , Adulto , Animais , Anti-Helmínticos/uso terapêutico , Criança , Estudos Transversais , Egito/epidemiologia , Fezes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Praziquantel/uso terapêutico , Prevalência , Saúde da População Rural , Schistosoma haematobium/efeitos dos fármacos , Schistosoma mansoni/efeitos dos fármacos , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Esquistossomose/transmissão , Resultado do Tratamento
19.
Int J Parasitol ; 50(3): 217-225, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32135180

RESUMO

Polyparasitism, involving soil-transmitted helminths. and Schistosoma blood flukes, is common in low to middle income countries. These helminths impact on the gut environment and can cause changes to the gut microbiome composition. Here we examined the gut microbiome in individuals with polyparasitism from two human cohorts in the Philippines utilising DNA sequencing-based profiling. Multiple helminth species infections were high with 70.3% of study participants harbouring at least two parasite species, and 16% harbouring at least five species. Increased numbers of helminth co-infections, in particular with the gut-resident soil-transmitted helminths, were significantly associated with increased bacterial diversity; however no significant parasite-gut microbiome associations were evident for individuals infected only with Schistosoma japonicum. In general, a healthy gut is associated with high bacterial diversity, which in these human cohorts may be the result of helminth-mediated immune modulation, or due to changes in the gut environment caused by these parasitic helminths.


Assuntos
Coinfecção , Microbioma Gastrointestinal/genética , Helmintíase/epidemiologia , Helmintos/isolamento & purificação , Esquistossomose/epidemiologia , Adolescente , Adulto , Albendazol/uso terapêutico , Ancylostoma/isolamento & purificação , Ancylostomatoidea/isolamento & purificação , Animais , Ascaris/isolamento & purificação , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Criança , Pré-Escolar , Estudos de Coortes , Coinfecção/microbiologia , Coinfecção/parasitologia , Fezes/microbiologia , Fezes/parasitologia , Feminino , Genes Bacterianos , Helmintíase/tratamento farmacológico , Helmintos/genética , Interações Hospedeiro-Parasita , Humanos , Masculino , Metagenômica , Interações Microbianas , Pessoa de Meia-Idade , Patologia Molecular , Filipinas/epidemiologia , Schistosoma/isolamento & purificação , Esquistossomose/tratamento farmacológico , Solo/parasitologia , Trichuris/isolamento & purificação , Adulto Jovem
20.
PLoS Negl Trop Dis ; 14(1): e0007860, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31999695

RESUMO

In the past two decades there has been a significant expansion in the number of new therapeutic monoclonal antibodies (mAbs) that are approved by regulators. The discovery of these new medicines has been driven primarily by new approaches in inflammatory diseases and oncology, especially in immuno-oncology. Other recent successes have included new antibodies for use in viral diseases, including HIV. The perception of very high costs associated with mAbs has led to the assumption that they play no role in prophylaxis for diseases of poverty. However, improvements in antibody-expression yields and manufacturing processes indicate this is a cost-effective option for providing protection from many types of infection that should be revisited. Recent technology developments also indicate that several months of protection could be achieved with a single dose. Moreover, new methods in B cell sorting now enable the systematic identification of high-quality antibodies from humanized mice, or patients. This Review discusses the potential for passive immunization against schistosomiasis, fungal infections, dengue, and other neglected diseases.


Assuntos
Anticorpos Monoclonais/farmacologia , Doenças Negligenciadas/tratamento farmacológico , Animais , Dengue/tratamento farmacológico , Desenvolvimento de Medicamentos , Humanos , Imunização Passiva , Camundongos , Micoses/tratamento farmacológico , Esquistossomose/tratamento farmacológico , Medicina Tropical
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