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MDA programs alone not enough to control schistosomiasis
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Mass drug administration programs are not sufficient on their own to control schistosomiasis, according to researchers from Griffith Health Institute at Griffith University in Australia.
“Despite the commitment to [mass drug administration programs], it is becoming increasingly clear that the sustainable control of schistosomiasis will require an integrated, inter-sectorial approach that goes beyond deworming,” the researchers wrote in the Journal of Infectious Diseases. “While global use of [praziquantel] is being scaled up, there are also growing concerns about inadequate drug coverage, low cure rates, poor drug compliance, lack of baseline information prior to the commencement of [mass drug administration] programs, and their inadequate monitoring and evaluation once commenced.”
The researchers conducted a cross-sectional, parasitological survey of schistosomiasis and soil-transmitted helminths in 22 endemic villages of Northern Samar, the Philippines. More than 18,000 eligible residents completed questionnaires about their exposure to Schistosoma, treatment history and level of morbidity. Stool samples were provided by 10,435 individuals, and 736 individuals who reported symptoms also underwent ultrasound examination.
The prevalence of human schistosomiasis was 27.1% (95% CI, 26.3-28), and the prevalence of any soil-transmitted helminth infection was 77.2% (95% CI, 76.4-78), despite the presence of an active schistosomiasis control program since 1980 and a mass drug administration (MDA) campaign within the past 5 years. Nearly the entire study population (97%) had been treated for schistosomiasis previously, and 75.6% were treated within the past 2 years through the MDA program.
In a subset of 736 individuals who underwent ultrasound examination, 89.3% of the patients had left lobe liver enlargement, 25% had grade II/III liver parenchyma fibrosis and 13% had splenomegaly.
“Fundamental to the problem is, we believe, the use of a suboptimal dose (40 mg/kg) of the drug praziquantel, poor drug compliance (<50%) and the lack of other control measures to interrupt the schistosome life cycle,” the researchers wrote. “Given the zoonotic nature of the disease cause by S. japonicum, a multifaceted integrated approach targeting transmission pathways for the disease should involve [praziquantel] treatment, vaccination of bovines, snail control, health education and improved sanitation as the key to sustainable control and future elimination.”
Disclosure: The researchers report no relevant financial disclosures.
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