Parasitology

  • Parasitology / Volume 138 / Special Issue 12 / October 2011, pp 1593-1606
  • Copyright © Cambridge University Press 2011. The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <http://creativecommons.org/licenses/by-nc-sa/2.5/>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: http://dx.doi.org/10.1017/S0031182011001235 (About DOI), Published online: 24 August 2011
  • OPEN ACCESS

Research Article

Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children

J. RUSSELL STOTHARDa1 c1, JOSÉ C. SOUSA-FIGUEIREDOa1a2, MARTHA BETSONa1, HELEN K. GREENa1, EDMUND Y. W. SETOa3, AMADOU GARBAa4, MOUSSA SACKOa5, FRANCISCA MUTAPIa6, SUSANA VAZ NERYa7, MUTAMAD A. AMINa8, MARGARET MUTUMBA-NAKALEMBEa9, ANNALAN NAVARATNAMa9, ALAN FENWICKa9, NARCIS B. KABATEREINEa10, ALBIS F. GABRIELLIa11 and ANTONIO MONTRESORa11

a1 Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, London, SW7 5BD, UK

a2 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

a3 School of Public Health, University of California, Berkeley, CA 94720, USA

a4 Programme National de Lutte contre la Bilharziose et les Géohelminthes, Ministère de la Santé Publique, 2648 Boulevard du Zarmaganda, B.P. 13724, Niamey, Niger

a5 Institut National de Recherche en Santé Publique (INRSP), BP 1771, Bamako, Mali

a6 Institute for Immunology and Infection Research, Ashworth Laboratories, University of Edinburgh, Edinburgh, EH9 3JT, UK

a7 CISA Project (Health Research Center, Angola), Bengo General Hospital, Caxito, Angola

a8 Ahfad University for Women, PO Box 167, Omdurman, Khartoum, Sudan

a9 Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, UK

a10 Vector Control Division, Ministry of Health, PO Box 1661, Kampala, Uganda

a11 Department of Control of Neglected Tropical Diseases, World Health Organization, CH-1211 Geneva 27, Switzerland

SUMMARY

Where very young children come into contact with water containing schistosome cercariae, infections occur and schistosomiasis can be found. In high transmission environments, where mothers daily bathe their children with environmentally drawn water, many infants and preschool-aged children have schistosomiasis. This ‘new’ burden, inclusive of co-infections with Schistosoma haematobium and Schistosoma mansoni, is being formally explored as infected children are not presently targeted to receive praziquantel (PZQ) within current preventive chemotherapy campaigns. Thus an important PZQ treatment gap exists whereby infected children might wait up to 4–5 years before receiving first treatment in school. International treatment guidelines, set within national treatment platforms, are presently being modified to provide earlier access to medication(s). Although detailed pharmacokinetic studies are needed, to facilitate pragmatic dosing in the field, an extended ‘dose pole’ has been devised and epidemiological monitoring has shown that administration of PZQ (40 mg/kg), in either crushed tablet or liquid suspension, is both safe and effective in this younger age-class; drug efficacy, however, against S. mansoni appears to diminish after repeated rounds of treatment. Thus use of PZQ should be combined with appropriate health education/water hygiene improvements for both child and mother to bring forth a more enduring solution.

(Received January 27 2011)

(Revised June 09 2011)

(Revised July 07 2011)

(Accepted July 08 2011)

(Online publication August 24 2011)

Correspondence:

c1 Corresponding author: J. Russell Stothard, Centre for Tropical and Infectious Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. Tel.: +44 0151 7053724; E-mail: jrstoth@liv.ac.uk

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