TY - JOUR
T1 - Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children
AU - Stothard, J. Russell
AU - Sousa-Figueiredo, Jose C.
AU - Betson, Martha
AU - Green, Helen K.
AU - Seto, Edmund Y. W.
AU - Garba, Amadou
AU - Sacko, Moussa
AU - Mutapi, Francisca
AU - Nery, Susana Vaz
AU - Amin, Mutamad A.
AU - Mutumba-Nakalembe, Margaret
AU - Navaratnam, Annalan
AU - Fenwick, Alan
AU - Kabatereine, Narcis B.
AU - Gabrielli, Albis F.
AU - Montresor, Antonio
PY - 2011/10
Y1 - 2011/10
N2 - 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.
AB - 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.
KW - maternal and child health
KW - preventive chemotherapy
KW - dose pole
KW - morbidity markers
KW - faecal occult blood
KW - GPS dataloggers
UR - http://www.scopus.com/inward/record.url?scp=84855647097&partnerID=8YFLogxK
U2 - 10.1017/S0031182011001235
DO - 10.1017/S0031182011001235
M3 - Article
SN - 0031-1820
VL - 138
SP - 1593
EP - 1606
JO - Parasitology
JF - Parasitology
IS - 12
ER -