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Mazigo HD, Ambrose EE, Mwingira UJ. Where will pediatric praziquantel be needed in Tanzania? Geographical variation in prevalence, and risk factors of Schistosoma mansoni in pre-school aged children in southern and north-western Tanzania. Parasite Epidemiol Control 2024; 24:e00337. [PMID: 38323193 PMCID: PMC10844104 DOI: 10.1016/j.parepi.2024.e00337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
Background Pediatric schistosomiasis has been recognized as a public health concern in schistosomiasis endemic areas of sub-Saharan Africa, including Tanzania. However, there is limited epidemiological information relating to pediatric schistosomiasis in Tanzania. Therefore, this current focused on assessing the geographical prevalence of S. mansoni infection and its associated risk factors in pre-school children (PreSAC) in southern and north-western Tanzania. Methods A total of 1585 PreSAC aged 1-6 years were enrolled in a cross-sectional study. A single urine and stool sample were obtained from each child and processed using point-of-care circulating cathodic (POC-CCA) antigen and Kato Katz (K-K) technique. The overall prevalence of S. mansoni infection based on K-K technique and POC-CCA test were 18.6% (95%CI:16.7-20.6) and 28.3% (95%CI:26.1-30.6), respectively. The overall geometrical mean eggs per gram of faeces was 110.38epg (95% CI:97.3-125.3). The age group 4-6 years had the highest prevalence (P < 0.01) of S. mansoni in both diagnostic tests and infection intensity (t = -2.8398, P < 0.005) using K-K technique. On multivariable analysis, only Ukerewe district was associated with S. mansoni infection based on K-K technique (aOR = 2.8 (95%CI:2.1-3.9), P < 0.001). Based on POC-CCA test, age group (4-6 years), aOR = 1.7, 95%CI:1.3-2.2, P < 0.001), Nyasa (aOR = 6.2, 95%CI:3.0-12.5, P < 0.001), Geita (aOR = 4.2, 95%CI:2.1-8.2, P < 0.001) and Ukerewe (aOR = 28.9, 95%CI:15.0-55.8, P < 0.001) districts remained independently associated with S. mansoni infection. Conclusion Schistosoma mansoni is a public health concern among PreSAC in the study districts and its prevalence varies from one geographical setting to another. These findings strongly support the need to include pre-school aged in preventive chemotherapy.
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Affiliation(s)
- Humphrey D. Mazigo
- Department of Medical Parasitology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Emmanuela E. Ambrose
- Department of Paediatrics and Child Health, Bugando Medical Centre, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Upendo J. Mwingira
- National Neglected Tropical Diseases Control Programme, National Institute for Medical Research, P.O. Box 9653, 3 Barack Obama Drive, 11101 Dar-Es-Salaam, Tanzania
- RTI International, 701 13 Street NW, Washington, DC 20005, USA
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Isaiah PM, Sólveig Palmeirim M, Steinmann P. Epidemiology of pediatric schistosomiasis in hard-to-reach areas and populations: a scoping review. Infect Dis Poverty 2023; 12:37. [PMID: 37069632 PMCID: PMC10108517 DOI: 10.1186/s40249-023-01088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/24/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Schistosomiasis affects over 250 million people worldwide. Despite children and the poor being key risk groups, limited research and control activities target pre-school aged children (PSAC) and hard-to-reach populations. As endemic countries shift the goals of their schistosomiasis programs from morbidity control to disease elimination, there is a need for inclusive planning to cover all affected age groups from all geographical areas and populations to achieve sustainable impact and health equity. METHODS We conducted searches in MEDLINE, Web of Science, Embase (Ovid), and LILACS per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) guidelines. Quality assessment of identified articles was done using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Relevant study data were extracted from the articles and entered into Microsoft Excel 2016 for descriptive analysis. RESULTS From the 17,179 screened articles, we identified 13 eligible studies on schistosomiasis in PSAC living in hard-to-reach areas and populations. All identified studies were from sub-Saharan Africa. The mean sample size of the retained studies was 572, with a balanced sex distribution among the young children sampled in each study. Ten studies investigated Schistosoma mansoni, one investigated Schistosoma haematobium, while two covered both S. mansoni and S. haematobium in the target population. The prevalence of S. mansoni among PSAC in the included studies was estimated at 12.9% in Ghana, 80.3-90.5% in Kenya, 35.0% in Madagascar, 9.6-78.0% in Senegal, 11.2-35.4% in Sierra Leone, 44.4-54.9% in Tanzania and 39.3-74.9% in Uganda. Out of the three studies that investigated S. haematobium, the presence of the infection was reported in only one study carried out in Nigeria. Schistosome infections reported in nearly all studies included in this review were of light intensity. Only one study conducted in Nigeria documented visible hematuria in 17.7% of the PSAC studied. CONCLUSIONS The findings document the high prevalence of schistosomiasis among PSAC in hard-to-reach populations and underscore the need to consider this population subgroup when designing the expansion of preventive chemotherapy and schistosomiasis control activities.
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Affiliation(s)
- Phyllis Munyiva Isaiah
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Marta Sólveig Palmeirim
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Lo NC, Bezerra FSM, Colley DG, Fleming FM, Homeida M, Kabatereine N, Kabole FM, King CH, Mafe MA, Midzi N, Mutapi F, Mwanga JR, Ramzy RMR, Satrija F, Stothard JR, Traoré MS, Webster JP, Utzinger J, Zhou XN, Danso-Appiah A, Eusebi P, Loker ES, Obonyo CO, Quansah R, Liang S, Vaillant M, Murad MH, Hagan P, Garba A. Review of 2022 WHO guidelines on the control and elimination of schistosomiasis. THE LANCET. INFECTIOUS DISEASES 2022; 22:e327-e335. [PMID: 35594896 DOI: 10.1016/s1473-3099(22)00221-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 01/13/2023]
Abstract
Schistosomiasis is a helminthiasis infecting approximately 250 million people worldwide. In 2001, the World Health Assembly (WHA) 54.19 resolution defined a new global strategy for control of schistosomiasis through preventive chemotherapy programmes. This resolution culminated in the 2006 WHO guidelines that recommended empirical treatment by mass drug administration with praziquantel, predominately to school-aged children in endemic settings at regular intervals. Since then, school-based and community-based preventive chemotherapy programmes have been scaled-up, reducing schistosomiasis-associated morbidity. Over the past 15 years, new scientific evidence-combined with a more ambitious goal of eliminating schistosomiasis and an increase in the global donated supply of praziquantel-has highlighted the need to update public health guidance worldwide. In February, 2022, WHO published new guidelines with six recommendations to update the global public health strategy against schistosomiasis, including expansion of preventive chemotherapy eligibility from the predominant group of school-aged children to all age groups (2 years and older), lowering the prevalence threshold for annual preventive chemotherapy, and increasing the frequency of treatment. This Review, written by the 2018-2022 Schistosomiasis Guidelines Development Group and its international partners, presents a summary of the new WHO guideline recommendations for schistosomiasis along with their historical context, supporting evidence, implications for public health implementation, and future research needs.
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Affiliation(s)
- Nathan C Lo
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA, USA.
| | | | - Daniel G Colley
- Department of Microbiology, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
| | | | - Mamoun Homeida
- Academy of Medical Sciences and Technology, Khartoum, Sudan
| | - Narcis Kabatereine
- Accelerating Resilient, Innovative, and Sustainable Elimination of NTDs, Vector Control Division, Kampala, Uganda
| | | | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Francisca Mutapi
- Institute of Immunology and Infection Research, Tackling Infections to Benefit Africa Partnership, University of Edinburgh, Edinburgh, UK
| | - Joseph R Mwanga
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Reda M R Ramzy
- National Nutrition Institute, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt
| | - Fadjar Satrija
- School of Veterinary Medicine and Biomedicine, IPB University, Bogor, Indonesia
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Joanne P Webster
- Department of Pathobiology and Population Science, Royal Veterinary College, University of London, London, UK
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Paolo Eusebi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eric S Loker
- Department of Biology, University of New Mexico, Albuquerque, NM, USA
| | - Charles O Obonyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Michel Vaillant
- Competence Centre for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, NY, USA
| | - Paul Hagan
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
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Ncube MV, Kabuyaya M, Chimbari MJ. Patient journey and resources mapping to implement a praziquantel mass drug administration program for children aged 5 years and below in resource-limited settings. Syst Rev 2022; 11:227. [PMID: 36271455 PMCID: PMC9585827 DOI: 10.1186/s13643-022-02087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/28/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The early childhood development of millions of children in some low- and medium-income countries may be compromised by schistosomiasis infections contracted at the age of 5 years and below. Currently, there are no standard guidelines for treating schistosomiasis in children that are 5 years and younger using praziquantel (PZQ), the only drug that the World Health Organization (WHO) recommends for treating schistosomiasis. The review is on processes and resources involved in the treatment of schistosomiasis in children aged 5 years and below. METHODS An electronic search for peer-reviewed articles published in the period from January 2011 to August 2021 was done in the Academic Search Complete, CINAHL with Full Text, Health Source: Nursing/Academic Edition, and MEDLINE databases via EBSCOHost and Google Scholar databases. The search targeted journals that described the treatment of schistosomiasis in children 5 years and below using praziquantel. RESULTS Thirteen studies met the inclusion criteria. The patient journey for treating schistosomiasis in children aged 5 years old and below using PZQ included the following activities: enrolment of the children into the treatment program; clinical examination; diagnosis; taking anthropometric measurements; feeding the children, making the PZQ palatable to the children; administration of PZQ; and monitoring of side effects. There was also a variation in the resources used to treat children aged 5 and below for schistosomiasis. CONCLUSIONS A PZQ mass drug administration program for children aged 5 years old and below in endemic areas should exclude the diagnosis of schistosomiasis before treatment. The resources required in the treatment process should be affordable, and should not require skills and maintenance resources that are beyond those that are available at the primary healthcare level.
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Affiliation(s)
- Mhlengi Vella Ncube
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. .,Medical Affairs Institute, Johannesburg, South Africa.
| | - Muhubiri Kabuyaya
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Moses John Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Raj E, Calvo-Urbano B, Heffernan C, Halder J, Webster JP. Systematic review to evaluate a potential association between helminth infection and physical stunting in children. Parasit Vectors 2022; 15:135. [PMID: 35443698 PMCID: PMC9022337 DOI: 10.1186/s13071-022-05235-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
Background Despite considerable public health efforts over the past 20 years, childhood stunting (physical and/or cognitive) levels globally remain unacceptably high—at 22% amongst children under 5 years old in 2020. The aetiology of stunting is complex and still largely unknown. Helminths can cause significant mortality and morbidity and have often been cited as major causative agents for stunting, although their actual role in childhood stunting remains unclear. Our aim was to systematically review the current evidence to help support or refute the hypothesis that helminths cause physical stunting in children. Methods Inclusion criteria were as follows: infected with (and/or exposed to) helminths (soil-transmitted helminths, schistosomes or food-borne trematodes), children, pregnant or breastfeeding women as study participants (children included infants 0–1 year old, preschool-age children 1–5 years and school-age children > 5 years old), anthelmintic treatment intervention, stunting-related variables reported (e.g. height, height-for-age z-score, birth weight), helminth infection reported in relation to stunting, any geographic location, any date, peer-reviewed literature only. Exclusion criteria were: non-primary research, study protocols, studies with no new data, non-English language papers and animal (non-human) helminth studies. Seven databases were searched on 28 May 2021. Risk of bias was assessed for included studies and GRADE was used for studies included in RCT subgroup meta-analyses (in preschool-age children and pregnant women). This systematic review was registered with PROSPERO (CRD42021256201). Results Eighty studies were included in the analyses. No significant overall evidence was found in support of the hypothesis that helminths cause physical stunting in children, although there was some association with wasting. Conclusions Whilst analyses of the available literature to date failed to support a direct association between helminth infection and childhood stunting, there was significant heterogeneity between studies, and many had follow-up periods which may have been too short to detect impacts on growth. Most apparent was a lack of available data from key demographic groups wherein one may predict the greatest association of helminth infection with stunting—notably that of infants, preschool-age children, and pregnant or nursing women. Thus this review highlights the urgent need for further targeted empirical research amongst these potentially most vulnerable demographic groups. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05235-5.
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Affiliation(s)
- E Raj
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.
| | - B Calvo-Urbano
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.,London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK
| | - C Heffernan
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.,London International Development Centre, London, WC1A 2NS, UK
| | - J Halder
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.,London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK
| | - J P Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK. .,London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK.
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Fungal allergic sensitisation in young rural Zimbabwean children: Gut mycobiome and seroreactivity characteristics. CURRENT RESEARCH IN MICROBIAL SCIENCES 2022; 2:100082. [PMID: 35028627 PMCID: PMC8714770 DOI: 10.1016/j.crmicr.2021.100082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of allergic diseases has increased over the last few decades, with sensitisation to fungal allergens and gut microbiome dysbiosis implicated in this trend. The fungal community in the gut (mycobiome) has yet to be characterised and related to fungal allergic sensitisation. Thus, we characterised the gut mycobiome and related it to fungal sensitisation and seroreactivity among Zimbabwean children. We further determined the effect of host age, sex, Schistosoma haematobium infection and mycobiome composition on fungal sensitisation and seroreactivity. Methods Using shotgun metagenomic sequencing, we characterised the gut microbiome of stool samples of 116 preschool aged children (PSAC) (≤5 years old, 57(49.1%) male and 59 (50.9%) female). Sensitisation to common fungi in Zimbabwe was assessed using skin prick tests (SPTs). Allergen-specific IgM, IgA, IgG, IgE and IgG4 antibodies were quantified by ELISA. We analysed the relationship between fungal genera and SPT reactivity by ANOVA; fungal genera and IgE antibody reactivity by linear regression; variation in mycobiome abundance with host and environmental factors by PERMANOVA; SPT reactivity and host and environmental factors by logistic regression; seroreactivity and host and environmental factors by ANOVA. Results The mycobiome formed <1% of the sequenced gut microbiome and 228 fungal genera were identified. The most abundant genera detected were Protomyces, Taphrina, and Aspergillus. S.haematobium infection had a significant effect on fungal genera. Prevalence of SPT sensitisation to ≥1 fungal species was 96%, and individuals were frequently sensitised to Saccharomyces cerevisiae. Antibodies were detected in 100% of the population. There was no relationship between mycobiome abundance and IgE titres or IgE/IgG4 ratios for each fungal species; no significant differences between SPT reactivity and abundance of fungal species except for S. cerevisiae; and fungal seroreactivity did not significantly differ with age. There were some sex (m>f for, Epicoccum nigrum and Penicillium chrysogenum) and SPT reactivity -related differences in seroreactivity. Conclusion This is the first comprehensive characterisation of gut mycobiome and fungal allergic sensitisation of rural children in Zimbabwe. Although reported allergic disease is low there is a high percentage of sensitisation. Further studies with larger populations are required to understand the role of the mycobiome in allergic diseases.
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Mduluza-Jokonya TL, Vengesai A, Midzi H, Kasambala M, Jokonya L, Naicker T, Mduluza T. Algorithm for diagnosis of early Schistosoma haematobium using prodromal signs and symptoms in pre-school age children in an endemic district in Zimbabwe. PLoS Negl Trop Dis 2021; 15:e0009599. [PMID: 34339415 PMCID: PMC8360514 DOI: 10.1371/journal.pntd.0009599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 08/12/2021] [Accepted: 06/27/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Prompt diagnosis of acute schistosomiasis benefits the individual and provides opportunities for early public health intervention. In endemic areas schistosomiasis is usually contracted during the first 5 years of life, thus it is critical to look at how the infection manifests in this age group. The aim of this study was to describe the prodromal signs and symptoms of early schistosomiasis infection, correlate these with early disease progression and risk score to develop an easy to use clinical algorithm to identify early Schistosoma haematobium infection cases in resource limited settings. Methodology Two hundred and four, preschool age children who were lifelong residence of a schistosomiasis endemic district and at high risk of acquiring schistosomiasis were followed up from July 2019 to December 2019, during high transmission season. The children received interval and standard full clinical evaluations and laboratory investigations for schistosomiasis by clinicians blinded from their schistosomiasis infection status. Diagnosis of S. haematobium was by urine filtration collected over three consecutive days. Signs and symptoms of schistosomiasis at first examination visit were compared to follow-up visits. Signs and symptoms common on the last schistosomiasis negative visit (before a subsequent positive) were assigned as early schistosomiasis infection (ESI), after possible alternative causes were ruled out. Logistic regression identified clinical predictors. A model based score was assigned to each predictor to create a risk for every child. An algorithm was created based on the predictor risk scores and validated on a separate cohort of 537 preschool age children. Results Twenty-one percent (42) of the participants were negative for S. haematobium infection at baseline but turned positive at follow-up. The ESI participants at the preceding S. haematobium negative visit had the following prodromal signs and symptoms in comparison to non-ESI participants; pruritic rash adjusted odds ratio (AOR) = 21.52 (95% CI 6.38–72.66), fever AOR = 82 (95% CI 10.98–612), abdominal pain AOR = 2.6 (95% CI 1.25–5.43), pallor AOR = 4 (95% CI 1.44–11.12) and a history of facial/body swelling within the previous month AOR = 7.31 (95% CI 3.49–15.33). Furthermore 16% of the ESI group had mild normocytic anaemia, whilst 2% had moderate normocytic anaemia. A risk score model was created using a rounded integer from the relative risks ratios. The diagnostic algorithm created had a sensitivity of 81% and a specificity of 96.9%, Positive predictive value = 87.2% and NPV was 95.2%. The area under the curve for the algorithm was 0.93 (0.90–0.97) in comparison with the urine dipstick AUC = 0.58 (0.48–0.69). There was a similar appearance in the validation cohort as in the derivative cohort. Conclusion This study demonstrates for the first time prodromal signs and symptoms associated with early S. haematobium infection in pre-school age children. These prodromal signs and symptoms pave way for early intervention and management, thus decreasing the harm of late diagnosis. Our algorithm has the potential to assist in risk-stratifying pre-school age children for early S. haematobium infection. Independent validation of the algorithm on another cohort is needed to assess the utility further. Schistosoma haematobium causes urogenital infection and in endemic areas schistosomiasis is usually contracted during the first 5 years of life, thus it is critical to look at how the infection manifests in this age group. Prompt diagnosis of acute schistosomiasis is required to benefit the individuals and provide opportunities for early treatment and public health intervention. The study examined symptoms that correlated with early disease progression and risk scored to develop an easy to use clinical algorithm to identify early S. haematobium infection cases. The children received standard full clinical evaluations by clinicians who were blinded from schistosomiasis diagnosis by parasitological examination. An algorithm was created based on the predictor risk scores and participants had the following prodromal signs and symptoms; pruritic rash, abdominal pain, pallor, abdominal pain, inguinal lymphadenopathy and a history of facial/body swelling within the previous month. A risk score model, diagnostic algorithm, was created that compared to urine dipstick and parasitology. This study demonstrates the clinical signs and symptoms associated with early S. haematobium infection in pre-school age children. These prodromal signs and symptoms pave way for early intervention and management, thus decreasing the harm of late diagnosis common in populations from endemic areas.
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Affiliation(s)
- Tariro L. Mduluza-Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Arthur Vengesai
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
| | - Herald Midzi
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Maritha Kasambala
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Luxwell Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Thajasvarie Naicker
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
| | - Takafira Mduluza
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
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Cavalcanti MG, Engel DC, de Araujo Cunha AF, Peralta JM. Case Report: Diagnosis and Assessment of Cure Approaches for Acute Schistosomiasis in Pre-School Children. Front Immunol 2021; 12:624736. [PMID: 34054799 PMCID: PMC8149760 DOI: 10.3389/fimmu.2021.624736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/27/2021] [Indexed: 02/02/2023] Open
Abstract
Acute schistosomiasis (AS) manifests with a broad spectrum of clinical features in pediatric populations. Diagnosis may be difficult in the absence of detectable numbers of eggs. As a result, new approaches may be required to achieve an accurate diagnosis. Optimal praziquantel (PZQ) treatment regimen for young children is debatable. Also, the post-treatment response is still poorly evaluated due to the lack of reliable markers. A group of 6 children (a toddler and 5 pre-school children) and one pre-adolescent were investigated for AS clinical manifestations and followed-up for two years after treatment. Ova detection was performed by Kato-Katz (KK) and presence of Schistosoma mansoni DNA was assessed by real-time PCR (rt-PCR) in stool samples. IgG and IgE anti-Schistosoma levels and urinary antigen were detected by ELISA and point-of-care circulating cathodic antigen (POC-CCA) testing in serum and urine, respectively. AS clinical symptoms were present in 5/7 (71.4%) of the infected children, and hypereosinophilia was detected in all of them. Ova detection and serology were positive in only 3/7 (44.9%) and 4/7 (57.1%), respectively. However, real-time PCR (rt-PCR) showed the presence of Schistosoma DNA in 6/7 (85.7%) of the cases, and urinary antigen was detected in all infected children. The long-term follow-up after treatment with three doses of PZQ (80mg/kg/dose), showed high cure rates (CR) as demonstrated by the DNA-based assay as well as reduced levels of side effects. CR based on urinary antigen detection ranged from 28.6 to 100%, being the highest CR due to double testing the 2-year post-treatment samples. The results suggest that high dose and repeated treatment with PZQ might be effective for AS in young children. Also, new laboratory markers should be considered to diagnosis and monitor the drug response.
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Affiliation(s)
- Marta G Cavalcanti
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Departmento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Délia Celser Engel
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aline Fernandes de Araujo Cunha
- Departmento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Mauro Peralta
- Departmento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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9
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Sumbele IUN, Otia OV, Bopda OSM, Ebai CB, Kimbi HK, Nkuo-Akenji T. Polyparasitism with Schistosoma haematobium, Plasmodium and soil-transmitted helminths in school-aged children in Muyuka-Cameroon following implementation of control measures: a cross sectional study. Infect Dis Poverty 2021; 10:14. [PMID: 33597042 PMCID: PMC7890808 DOI: 10.1186/s40249-021-00802-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/29/2021] [Indexed: 01/04/2023] Open
Abstract
Background Despite the ubiquity of polyparasitism, its health impacts have been inadequately studied. The aim of this study was to determine the prevalence and determinants of polyparasitism with Schistosoma haematobium, Plasmodium and soil-transmitted helminths (STH) following sustained control measures, as well as evaluate the outcomes and clinical correlates of infection in school-aged children (SAC) living in the schistosomiasis endemic focus of Muyuka-Cameroon. Methods In a cross-sectional study, urine, blood and stool samples were each collected from SAC (4–14 years) selected at random between March and June 2015. Microhaematuria in urine was detected using reagent strip and S. haematobium ova by filtration/microscopy methods. Plasmodium was detected using Giemsa-stained blood films and complete blood count was obtained using an auto-haematology analyser. STH in stool was detected by the Kato-Katz method. Categorical and continuous variables were compared as required, Kappa value estimated and the adjusted odds ratio (aOR) in the multivariate analysis was used to evaluate association of the risk factors with infection. Results Out of the 638 SAC examined, single infection was prevalent in 33.4% while polyparasitism was 19.9%. Prevalence of S. haematobium + Plasmodium was 7.8%; S. haematobium + STH was 0.8%; Plasmodium + STH was 0.8%; while S. haematobium + Plasmodium + STH was 0.9%. Higher preponderance of S. haematobium + Plasmodium infection occurred in females, those from Likoko, did not use potable water, practiced bathing in stream and carried out open defecation than their equivalents. However, being female (aOR = 2.38, P = 0.009) was the only significant risk factor identified. Anaemia was a common morbidity (74.3%) with a slight agreement with microscopy in predicting S. haematobium and Plasmodium infections. The sensitivity and specificity of haematuria (13.0%) in predicting S. haematobium infection was 46.5% and 100% with a moderate agreement with microscopy. Co-infection with S. haematobium and malaria parasite was significantly associated with threefold odds of history of fever in the last three days. Conclusions Polyparasitism is a public health problem in Muyuka with females most at risk. Anaemia prevalence is exacerbated in co- and triple-infections and together with a history of fever are of value in predicting polyparasitism.![]()
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Affiliation(s)
- Irene Ule Ngole Sumbele
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon. .,Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
| | - Ofon Vitalis Otia
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon
| | - Orelien Sylvain Mtopi Bopda
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.,Department of Medical Laboratory Sciences, University of Buea, Buea, Cameroon
| | - Calvin Bisong Ebai
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.,Department of Medical Laboratory Science, University of Bamenda, Bambili, Cameroon
| | - Helen KuoKuo Kimbi
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.,Department of Medical Laboratory Science, University of Bamenda, Bambili, Cameroon
| | - Theresa Nkuo-Akenji
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
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10
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Kalinda C, Mindu T, Chimbari MJ. A systematic review and meta-analysis quantifying schistosomiasis infection burden in pre-school aged children (PreSAC) in sub-Saharan Africa for the period 2000-2020. PLoS One 2020; 15:e0244695. [PMID: 33373405 PMCID: PMC7771669 DOI: 10.1371/journal.pone.0244695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Following the adoption of the World Health Assembly Resolution WHA 65.21 and Neglected Tropical Diseases road map 2021-2030, schistosomiasis control programmes have shifted from morbidity control to disease elimination. However, several gaps continue to be observed in the implementation of control programmes with certain age groups omitted from these campaigns increasing health inequalities and risks of reinfections to previously treated groups. We used the Inverse Variance Heterogeneity (IVhet) model to estimate the prevalence of schistosomiasis infection among preschool-aged children. METHODS We did a systematic review of peer-reviewed literature on schistosomiasis in sub-Saharan Africa for the period January 1, 2000 to November 30, 2020. Quantitative data for cases of schistosomiasis infection were extracted, including country and region where the studies were done, year of publication and specific schistosome species observed. The IVhet model was used to estimate the pooled prevalence estimate (PPE), the heterogeneity and publication bias. RESULTS We screened 2601 articles to obtain 47 eligible studies containing quantitative data on preschool-aged children. Of the selected studies, 44.7% (n = 22) were from East Africa while the least number of studies obtained (2.1%, n = 1) was from Central Africa. 21712 subjects were screened for infection due to Schistosoma spp; 13924 for S. mansoni and 7788 for S. haematobium. The PPE for schistosomiasis among PreSAC was 19% (95% CI: 11-28). Infection due to S. mansoni (IVhet PPE: 22% (95% CI: 9-36) was higher than that due to S. haematobium (15%; 95% CI: 6-25). A Luis Furuya-Kanamori index of 1.83 indicated a lack of publication bias. High level of heterogeneity was observed (I2 > 90%) and this could not be reduced through subgroup analysis. CONCLUSION Schistosomiasis infection among pre-school aged children 6 years old and below is high. This indicates the importance of including this age group in treatment programmes to reduce infection prevalence and long-term morbidities associated with prolonged schistosome infection.
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Affiliation(s)
- Chester Kalinda
- University of Namibia, Katima Mulilo, Namibia
- Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tafadzwa Mindu
- Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Moses John Chimbari
- Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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11
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Osakunor DNM, Mduluza T, Osei-Hyiaman D, Burgess K, Woolhouse MEJ, Mutapi F. Schistosoma haematobium infection is associated with alterations in energy and purine-related metabolism in preschool-aged children. PLoS Negl Trop Dis 2020; 14:e0008866. [PMID: 33315875 PMCID: PMC7735607 DOI: 10.1371/journal.pntd.0008866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/08/2020] [Indexed: 12/17/2022] Open
Abstract
Helminths are parasitic worms that infect over a billion people worldwide. The pathological consequences from infection are due in part, to parasite-induced changes in host metabolic pathways. Here, we analyse the changes in host metabolic profiles, in response to the first Schistosoma haematobium infection and treatment in Zimbabwean children. A cohort of 83 schistosome-negative children (2-5 years old) as determined by parasitological examination, guardian interviews and examination of medical records, was recruited at baseline. Children were followed up after three months for parasitological diagnosis of their first S. haematobium infection, by detection of parasite eggs excreted in urine. Children positive for infection were treated with the antihelminthic drug praziquantel, and treatment efficacy checked three months after treatment. Blood samples were taken at each time point, and capillary electrophoresis mass spectrometry in conjunction with multivariate analysis were used to compare the change in serum metabolite profiles in schistosome-infected versus uninfected children. Following baseline at the three-month follow up, 11 children had become infected with S. haematobium (incidence = 13.3%). Our results showed that infection with S. haematobium was associated with significant increases (>2-fold) in discriminatory metabolites, linked primarily with energy (G6P, 3-PG, AMP, ADP) and purine (AMP, ADP) metabolism. These observed changes were commensurate with schistosome infection intensity, and levels of the affected metabolites were reduced following treatment, albeit not significantly. This study demonstrates that early infection with S. haematobium is associated with alterations in host energy and purine metabolism. Taken together, these changes are consistent with parasite-related clinical manifestations of malnutrition, poor growth and poor physical and cognitive performance observed in schistosome-infected children.
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Affiliation(s)
- Derick N. M. Osakunor
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
- * E-mail:
| | - Takafira Mduluza
- Biochemistry Department, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Douglas Osei-Hyiaman
- Laboratory of Physiologic Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, United States of America
- Metabolomics Research Division, Human Metabolome Technologies Inc., Tsuruoka, Yamagata, Japan
- Department of Systems Neurophysiology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Bunkyo City, Tokyo, Japan
| | - Karl Burgess
- Centre for Synthetic and Systems Biology, University of Edinburgh, CH Waddington Building, King’s Buildings, Edinburgh, United Kingdom
| | - Mark E. J. Woolhouse
- Usher Institute, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
| | - Francisca Mutapi
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
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12
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Mduluza-Jokonya TL, Naicker T, Jokonya L, Midzi H, Vengesai A, Kasambala M, Choto E, Rusakaniko S, Sibanda E, Mutapi F, Mduluza T. Association of Schistosoma haematobium infection morbidity and severity on co-infections in pre-school age children living in a rural endemic area in Zimbabwe. BMC Public Health 2020; 20:1570. [PMID: 33076903 PMCID: PMC7574170 DOI: 10.1186/s12889-020-09634-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022] Open
Abstract
Background Individuals living in Schistosoma haematobium endemic areas are often at risk of having other communicable diseases simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking of schistosomiasis infection. In this study we investigated the prevalence and severity of coinfections in pre-school age children and further investigated associations between S. haematobium prevalence and under 5 mortality. Methods A community based cross-sectional survey was conducted in Shamva District, Zimbabwe. Using random selection, 465 preschool age children (1–5 years of age) were enrolled through clinical examination by two independent clinicians for the following top morbidity causing conditions: respiratory tract infections, dermatophytosis, malaria and fever of unknown origin. The conditions and their severe sequels were diagnosed as per approved WHO standards. S. haematobium infection was diagnosed by urine filtration and the children were screened for conditions common in the study area which included HIV, tuberculosis, malnutrition and typhoid. Data was analysed using univariate and multinomial regression analysis and relative risk (RR) calculated. Results Prevalence of S. haematobium was 35% (145). The clinical conditions assessed had the following prevalence in the study population: upper respiratory tract infection 40% (229), fever of unknown origin 45% (189), dermatophytosis 18% and malaria 18% (75). The odds of co-infections observed with S. haematobium infection were: upper respiratory tract infection aOR = 1.22 (95% CI 0.80 to 1.87), dermatophytosis aOR = 4.79 (95% CI 2.78 to 8.25), fever of unknown origin aOR = 10.63 (95% CI 6.48–17.45) and malaria aOR = 0.91 (95% CI 0.51 to1.58). Effect of schistosomiasis coinfection on disease progression based on the odds of the diseases progressing to severe sequalae were: Severe pneumonia aOR = 8.41 (95% CI 3.09–22.93), p < 0.0001, complicated malaria aOR = 7.09 (95% CI 1.51–33.39), p = 0.02, severe dermatophytosis aOR = 20.3 (95% CI 4.78–83.20):p = 0.03, and fever of unknown origin aOR = 1.62 (95%CI 1.56–4.73), p = 0.02. Conclusion This study revealed an association between schistosomiasis and the comorbidity conditions of URTI, dermatophytosis, malaria and FUO in PSAC living in a schistosomiasis endemic area. A possible detrimental effect where coinfection led to severe sequels of the comorbidity conditions was demonstrated. Appropriate clinical diagnostic methods are required to identify associated infectious diseases and initiate early treatment of schistosomiasis and co-infections in PSAC.
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Affiliation(s)
- Tariro L Mduluza-Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa. .,Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe.
| | - Thajasvarie Naicker
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Luxwell Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.,Department of Surgery, College of Health Sciences, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Herald Midzi
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Arthur Vengesai
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Maritha Kasambala
- Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Emilia Choto
- Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Elopy Sibanda
- Twin Palms Medical Centre, 113 Kwame Nkrumah Avenue, Harare, Zimbabwe
| | - Francisca Mutapi
- Institute for Immunology and Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Rd., Edinburgh, EH9 3JT, UK
| | - Takafira Mduluza
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.,Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
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13
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Lim RM, Woolhouse MEJ, Mduluza T, Chase-Topping M, Osakunor DNM, Chitsulo L, Mutapi F. Investigating a strategy for quantifying schistosome infection levels in preschool-aged children using prevalence data from school-aged children. PLoS Negl Trop Dis 2020; 14:e0008650. [PMID: 33001969 PMCID: PMC7529243 DOI: 10.1371/journal.pntd.0008650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022] Open
Abstract
In 2012, the World Health Organisation (WHO) set out a roadmap for eliminating schistosomiasis as a public health problem by 2025. To achieve this target, preschool-aged children (PSAC; aged 6 years and below) will need to be included in schistosomiasis treatment programmes. As the global community discusses the tools and approaches for treating this group, one of the main questions that remains unanswered is how to quantify infection in this age group to inform treatment strategies. The aim of this study was thus to determine whether a relationship exists between levels of schistosome infection in PSAC and school-aged children (SAC), that can be used to determine unknown schistosome infection prevalence levels in PSAC. A systematic search of publications reporting schistosomiasis prevalence in African PSAC and SAC was conducted. The search strategy was formulated using the PRISMA guidelines and SPIDER search strategy tool. The published data was subjected to regression analysis to determine if a relationship exists between infection levels in PSAC and SAC. The interaction between SAC and community treatment history was also entered in the regression model to determine if treatment history significantly affected the relationship between PSAC and SAC prevalence. The results showed that a significant positive relationship exists between infection prevalence levels in PSAC and SAC for Schistosoma mansoni (r = 0.812, df (88, 1), p = <0.0001) and S. haematobium (r = 0.786, df (53, 1), p = <0.0001). The relationship was still significant after allowing for diagnostic method, treatment history, and the African sub-region where the study was conducted (S. mansoni: F = 25.63, df (88, 9), p = <0.0001; S. haematobium: F = 10.20, df (53, 10), p = <0.0001). Using the regression equation for PSAC and SAC prevalence, over 90% of the PSAC prevalence studies were placed in the correct WHO classifications category based on the SAC levels, regardless of treatment history. The study indicated that schistosome prevalence in SAC can be extended as a proxy for infection levels in PSAC, extending on its current use in the adult population. SAC prevalence data could identify where there is a need to accelerate and facilitate the treatment of PSAC for schistosomiasis in Africa. Preschool-aged children (PSAC), i.e. aged ≤ 6 years, are not included in preventative chemotherapy programmes, currently advocated by the WHO for the treatment of schistosomiasis. This is due to the lack of a paediatric formulation of the drug of choice, praziquantel, and the current guidelines which requires diagnosis before treatment. As the global community prepares for the deployment of a new paediatric formulation of praziquantel, there is a need to find a strategy to quantify infection in this age group. In schistosome endemic areas, infection levels in school-aged children (SAC) are already used to inform infection levels in the community. Thus, we investigated the relationship between SAC and PSAC schistosome prevalence levels within the same community, to determine if data from SAC could be used to predict infection levels in PSAC. Our results show that PSAC prevalence levels are significantly correlated with SAC prevalence levels. Our findings are applicable to communities that have received preventative chemotherapy in SAC or in SAC and adults, as well as those that have not received any. Our study indicates that it is possible to extrapolate PSAC prevalence levels from SAC prevalence, and to make a treatment decision on that basis.
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Affiliation(s)
- Rivka M. Lim
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- * E-mail:
| | - Mark E. J. Woolhouse
- Usher Institute, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Margo Chase-Topping
- Usher Institute, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- Roslin Institute, Easter Bush, Midlothian, United Kingdom
| | - Derick N. M. Osakunor
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | | | - Francisca Mutapi
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
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14
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Faust CL, Osakunor DNM, Downs JA, Kayuni S, Stothard JR, Lamberton PHL, Reinhard-Rupp J, Rollinson D. Schistosomiasis Control: Leave No Age Group Behind. Trends Parasitol 2020; 36:582-591. [PMID: 32430274 DOI: 10.1016/j.pt.2020.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Christina L Faust
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Derick N M Osakunor
- Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh EH9 3FL, UK
| | - Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Sekeleghe Kayuni
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Poppy H L Lamberton
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | | | - David Rollinson
- Global Schistosomiasis Alliance, Natural History Museum, London SW7 5BD, UK
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15
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Osakunor DNM, Munk P, Mduluza T, Petersen TN, Brinch C, Ivens A, Chimponda T, Amanfo SA, Murray J, Woolhouse MEJ, Aarestrup FM, Mutapi F. The gut microbiome but not the resistome is associated with urogenital schistosomiasis in preschool-aged children. Commun Biol 2020; 3:155. [PMID: 32242065 PMCID: PMC7118151 DOI: 10.1038/s42003-020-0859-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
Helminth parasites have been shown to have systemic effects in the host. Using shotgun metagenomic sequencing, we characterise the gut microbiome and resistome of 113 Zimbabwean preschool-aged children (1-5 years). We test the hypothesis that infection with the human helminth parasite, Schistosoma haematobium, is associated with changes in gut microbial and antimicrobial resistance gene abundance/diversity. Here, we show that bacteria phyla Bacteroidetes, Firmicutes, Proteobacteria, and fungi phyla Ascomycota, Microsporidia, Zoopagomycota dominate the microbiome. The abundance of Proteobacteria, Ascomycota, and Basidiomycota differ between schistosome-infected versus uninfected children. Specifically, infection is associated with increases in Pseudomonas, Stenotrophomonas, Derxia, Thalassospira, Aspergillus, Tricholoma, and Periglandula, with a decrease in Azospirillum. We find 262 AMR genes, from 12 functional drug classes, but no association with individual-specific data. To our knowledge, we describe a novel metagenomic dataset of Zimbabwean preschool-aged children, indicating an association between urogenital schistosome infection and changes in the gut microbiome.
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Affiliation(s)
- Derick N M Osakunor
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK.
| | - Patrick Munk
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Takafira Mduluza
- Biochemistry Department, University of Zimbabwe, P.O. Box MP167, Mount Pleasant, Harare, Zimbabwe
| | - Thomas N Petersen
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Christian Brinch
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Alasdair Ivens
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
| | - Theresa Chimponda
- Biochemistry Department, University of Zimbabwe, P.O. Box MP167, Mount Pleasant, Harare, Zimbabwe
| | - Seth A Amanfo
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Ashworth Laboratories, Kings Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
| | - Janice Murray
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
| | - Mark E J Woolhouse
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Ashworth Laboratories, Kings Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
| | - Frank M Aarestrup
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Francisca Mutapi
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
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16
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Kalinda C, Mutengo M, Chimbari M. A meta-analysis of changes in schistosomiasis prevalence in Zambia: implications on the 2020 elimination target. Parasitol Res 2019; 119:1-10. [PMID: 31773307 DOI: 10.1007/s00436-019-06534-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/28/2019] [Indexed: 12/18/2022]
Abstract
Schistosomiasis affects more than 4 million school-aged children in Zambia, mostly in rural communities due to unsafe water and inadequate sanitation facilities. Although several studies were done in Zambia between 1976 and 2019, empirical estimates of the disease burden remain unavailable. Therefore, appraisal of the current schistosomiasis burden is pertinent in the re-evaluation of schistosomiasis-control strategies in Zambia. A random-effect model was used to estimate the prevalence of schistosomiasis infection in Zambia across different age groups for the period between 1976 and 2019. A literature search was done in the following databases: PubMed, ISI Web of Science, Google Scholar, CINAHL, and African Journals Online. Twenty-eight studies with relevant prevalence data were identified and included in the analysis. The pooled prevalence estimate of Schistosoma haematobium and Schistosoma mansoni across studies for the entire period was 35.5% (95% CI: 25.8-45.9) and 34.9% (95% CI: 20.7-50.6), respectively. Prevalence estimates among school-aged children for S. haematobium and S. mansoni were 32.2% (95% CI: 21.1-44.7) and 18.1% (95% CI: 3.0-38.4), respectively. The reported pooled prevalence estimate for S. haematobium among the adults was 54% (95% CI: 23.2-83.7). Only two studies collected information from preschool aged children. Substantial heterogeneity (I2 = 100%, p < 0.0001) was observed among the studies. Although a reduction in disease prevalence was observed from 1990 to 2010, this was not sustained after 2010. In this meta-analysis, S. haematobium was more prevalent compared to S. mansoni, with more cases observed among school-aged children (SAC). Thus, control programs should target age groups that are highly infected or are at high risk of infection.
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Affiliation(s)
- Chester Kalinda
- University of Namibia, Katima Mulilo Campus, Box 1096, Katima Mulilo, Namibia. .,Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, South Africa.
| | - Mable Mutengo
- Institute of Basic and Biomedical Sciences, Levy Mwanawasa Medical University, P.O Box 33991, Lusaka, Zambia
| | - Moses Chimbari
- Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, South Africa
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Mutsaka-Makuvaza MJ, Matsena-Zingoni Z, Katsidzira A, Tshuma C, Chin'ombe N, Zhou XN, Webster B, Midzi N. Urogenital schistosomiasis and risk factors of infection in mothers and preschool children in an endemic district in Zimbabwe. Parasit Vectors 2019; 12:427. [PMID: 31477172 PMCID: PMC6721289 DOI: 10.1186/s13071-019-3667-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/13/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To design appropriate schistosomiasis control programmes that include women and preschool-aged children (PSAC) it is essential to assess their disease profile and the risk factors predisposing them to infection. This study aimed to determine the prevalence of urogenital schistosomiasis and the risk factors of infection among PSAC and their caregivers in an endemic area of Zimbabwe. METHODS A cross-sectional study involving screening for urogenital schistosomiasis infections and treatment of 860 participants [535 children aged ≤ 5 years and 325 caregivers (≥ 15 years)] was carried out in five communities, namely Chihuri, Mupfure, Chakondora, Nduna and Kaziro, in February 2016. Haematuria was recorded for each participant and urine filtration was performed to determine the presence and infection intensity of Schistosoma haematobium. A pre-tested questionnaire was administered to the caregivers seeking knowledge, practices and perceptions regarding schistosomiasis. Data analysis was performed using descriptive statistics and logistic regression. RESULTS Overall 132 (15.4%) of the 860 participants had S. haematobium infections. Among these, 61 (18.7%) of the 325 caregivers and 71 (13.3%) of the 535 children were infected. The infection prevalence was significantly different between caregivers and PSAC (χ2 = 4.7040, df = 1, P = 0.030). Children whose caregivers used river water for bathing were more likely to be infected compared to children whose caregivers used protected well water (OR: 2.2, 95% CI: 1.3-3.7). The risks of being infected with schistosomiasis were higher in children whose caregivers were infected compared to children whose caregivers had no infection (AOR: 3.9, 95% CI: 1.7-8.6). In caregivers, those who bathed in river water were at higher risk of schistosomiasis infection compared to those who used water from a protected well (AOR: 3.0, 95% CI: 1.4-6.4). CONCLUSIONS According to the World Health Organization guidelines, the observed overall prevalence of urogenital schistosomiasis qualifies this area as a moderate risk area requiring mass chemotherapy once every two years. Water contact practices of caregivers, and their perceptions and knowledge regarding schistosomiasis are risk factors for infection in both themselves and PSAC. Thus, disease control efforts targeting caregivers or PSAC should include health education and provision of alternative clean and safe water sources.
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Affiliation(s)
- Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe
| | - Zvifadzo Matsena-Zingoni
- National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 27 St Andrews' Road, Parktown, Johannesburg, 2193, South Africa
| | - Agnes Katsidzira
- Harare Central Hospital, P.O Box ST 14, Southerton, Harare, Zimbabwe
| | - Cremance Tshuma
- Mashonaland Central Provincial Health Office, Ministry of Health and Child Care, Bindura, Mashonaland Central, Zimbabwe
| | - Nyasha Chin'ombe
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, 200025, China
| | - Bonnie Webster
- Department of Life Sciences, Natural History Museum, 14 Cromwell Road, London, SW7 5BD, UK
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.
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Exum NG, Kibira SPS, Ssenyonga R, Nobili J, Shannon AK, Ssempebwa JC, Tukahebwa EM, Radloff S, Schwab KJ, Makumbi FE. The prevalence of schistosomiasis in Uganda: A nationally representative population estimate to inform control programs and water and sanitation interventions. PLoS Negl Trop Dis 2019; 13:e0007617. [PMID: 31412023 PMCID: PMC6709927 DOI: 10.1371/journal.pntd.0007617] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 08/26/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background To improve schistosomiasis control programs in Uganda, where intestinal schistosomiasis is a widespread public health problem, a country-wide assessment of the disease prevalence among all age ranges is needed. Few studies have aimed to quantify the relationships between disease prevalence and water and sanitation characteristics across Uganda to understand the potential to interrupt disease transmission with an integrated package of interventions. Methodology/Principal findings A nationally representative survey was undertaken that included a household and individual questionnaire followed by disease testing based on detection of worm antigens (circulating cathodic antigen–CCA), diagnosis and treatment. A comprehensive set of questions was asked of randomly sampled individuals, two years of age and above, to understand their water and sanitation infrastructure, open defecation behaviors, exposure to surface water bodies, and knowledge of schistosomiasis. From a set of 170 randomly sampled, geographically diverse enumeration areas, a total of 9,183 study participants were included. After adjustment with sample weights, the national prevalence of schistosomiasis was 25.6% (95% confidence interval (CI): 22.3, 29.0) with children ages two to four most at risk for the disease with 36.1% infected (95% CI: 30.1, 42.2). The defecation behaviors of an individual were more strongly associated with infection status than the household water and sanitation infrastructure, indicating the importance of incorporating behavior change into community-led total sanitation coverage. Conclusions/Significance Our results highlight the importance of incorporating monitoring and evaluation data into control programs in Uganda to understand the geographic distribution of schistosomiasis prevalence outside of communities where endemicity is known to be high. The high prevalence of schistosomiasis among the youngest age group, ineligible to receive drug treatment, shows the imperative to develop a child-appropriate drug protocol that can be safely administered to preschool-aged children. Water and sanitation interventions should be considered an essential investment for elimination alongside drug treatment. Schistosomiasis is a neglected tropical disease in sub-Saharan Africa that has remained intractable despite efforts to eliminate it through mass drug administration. The transmission cycle is perpetuated when sanitation infrastructure does not adequately capture infected urine or feces and local water bodies, with snail vectors, are contaminated. Schistosomiasis has been linked with stunting and cognitive deficits and there is particular concern for the most vulnerable age group under five years old who are undergoing critical intestinal development but are ineligible to receive drug treatment. Efforts to reduce the disease have focused on children and young adolescents in endemic areas, near water bodies where transmission is known to be high. In Uganda, where fresh water bodies are abundant and intestinal schistosomiasis is endemic, very little is understood about the disease prevalence at a national level. We conducted a large, nationally representative survey and found a national prevalence of 25.6% where the 2–4 year old children had the highest prevalence for schistosomiasis with 36.1% infected. The most significant risk-factor for the disease was an individual’s open defecation behaviors in surface waters. This emphasizes the need to include water and sanitation investments alongside drug treatment and behavior change to control schistosomiasis in Uganda.
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Affiliation(s)
- Natalie G. Exum
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Simon P. S. Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Julien Nobili
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Alexandra K. Shannon
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - John C. Ssempebwa
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Kellogg J. Schwab
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Fredrick E. Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
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19
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Ondigo BN, Muok EMO, Oguso JK, Njenga SM, Kanyi HM, Ndombi EM, Priest JW, Kittur N, Secor WE, Karanja DMS, Colley DG. Impact of Mothers' Schistosomiasis Status During Gestation on Children's IgG Antibody Responses to Routine Vaccines 2 Years Later and Anti-Schistosome and Anti-Malarial Responses by Neonates in Western Kenya. Front Immunol 2018; 9:1402. [PMID: 29967622 PMCID: PMC6015899 DOI: 10.3389/fimmu.2018.01402] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/06/2018] [Indexed: 02/04/2023] Open
Abstract
The potential consequences of parasitic infections on a person’s immune responsiveness to unrelated antigens are often conjectured upon in relationship to allergic responses and autoimmune diseases. These considerations sometimes extend to whether parasitic infection of pregnant women can influence the outcomes of responses by their offspring to the immunizations administered during national Expanded Programs of Immunization. To provide additional data to these discussions, we have enrolled 99 close-to-term pregnant women in western Kenya and determined their Schistosoma mansoni and Plasmodium falciparum infection status. At 2 years of age, when the initial immunization schedule was complete, we determined their children’s IgG antibody levels to tetanus toxoid, diphtheria toxoid, and measles nucleoprotein (N-protein) antigens using a multiplex assay. We also monitored antibody responses during the children’s first 2 years of life to P. falciparum MSP119 (PfMSP119), S. mansoni Soluble Egg Antigen (SEA), Ascaris suum hemoglobin (AsHb), and Strongyloides stercoralis (SsNIE). Mothers’ infections with either P. falciparum or S. mansoni had no impact on the level of antibody responses of their offspring or the proportion of offspring that developed protective levels of antibodies to either tetanus or diphtheria antigens at 2 years of age. However, children born of S. mansoni-positive mothers and immunized for measles at 9 months of age had significantly lower levels of anti-measles N-protein antibodies when they were 2 years old (p = 0.007) and a lower proportion of these children (62.5 vs. 90.2%, OR = 0.18, 95% CI = 0.04–0.68, p = 0.011) were considered positive for measles N-protein antibodies. Decreased levels of measles antibodies may render these children more susceptible to measles infection than children whose mothers did not have schistosomiasis. None of the children demonstrated responses to AsHb or SsNIE during the study period. Anti-SEA and anti-PfMSP119 responses suggested that 6 and 70% of the children acquired schistosomes and falciparum malaria, respectively, during the first 2 years of life.
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Affiliation(s)
- Bartholomew N Ondigo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.,Department of Biochemistry and Molecular Biology, Egerton University, Nakuru, Kenya
| | - Erick M O Muok
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - John K Oguso
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Henry M Kanyi
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Eric M Ndombi
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.,Department of Pathology, Kenyatta University, Nairobi, Kenya
| | - Jeffrey W Priest
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nupur Kittur
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - William Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Diana M S Karanja
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Daniel G Colley
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States.,Department of Microbiology, University of Georgia, Athens, GA, United States
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