1
|
Trippler L, Knopp S, Welsche S, Webster BL, Stothard JR, Blair L, Allan F, Ame SM, Juma S, Kabole F, Ali SM, Rollinson D, Pennance T. The long road to schistosomiasis elimination in Zanzibar: A systematic review covering 100 years of research, interventions and control milestones. ADVANCES IN PARASITOLOGY 2023; 122:71-191. [PMID: 37657854 DOI: 10.1016/bs.apar.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Zanzibar is among the few places in sub-Saharan Africa where interruption of Schistosoma transmission seems an achievable goal. Our systematic review identifies and discusses milestones in schistosomiasis research, control and elimination efforts in Zanzibar over the past 100 years. The search in online databases, libraries, and the World Health Organization Archives revealed 153 records published between May 1928 and August 2022. The content of records was summarised to highlight the pivotal work leading towards urogenital schistosomiasis elimination and remaining research gaps. The greatest achievement following 100 years of schistosomiasis interventions and research is undoubtedly the improved health of Zanzibaris, exemplified by the reduction in Schistosoma haematobium prevalence from>50% historically down to<5% in 2020, and the absence of severe morbidities. Experiences from Zanzibar have contributed to global schistosomiasis guidelines, whilst also revealing challenges that impede progression towards elimination. Challenges include: transmission heterogeneity requiring micro-targeting of interventions, post-treatment recrudescence of infections in transmission hotspots, biological complexity of intermediate host snails, emergence of livestock Schistosoma species complicating surveillance whilst creating the risk for interspecies hybridisation, insufficient diagnostics performance for light intensity infections and female genital schistosomiasis, and a lack of acceptable sanitary alternatives to freshwater bodies. Our analysis of the past revealed that much can be achieved in the future with practical implementation of integrated interventions, alongside operational research. With continuing national and international commitments, interruption of S. haematobium transmission across both islands is within reach by 2030, signposting the future demise of urogenital schistosomiasis across other parts of sub-Saharan Africa.
Collapse
Affiliation(s)
- Lydia Trippler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | | | - Bonnie L Webster
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Fiona Allan
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; University of St Andrews, St Andrews, United Kingdom
| | - Shaali Makame Ame
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Saleh Juma
- Neglected Diseases Programme, Zanzibar Ministry of Health, Mkoroshoni, Pemba, United Republic of Tanzania
| | - Fatma Kabole
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Said Mohammed Ali
- Public Health Laboratory - Ivo de Carneri, Wawi, Chake Chake, Pemba, United Republic of Tanzania
| | - David Rollinson
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Global Schistosomiasis Alliance, London, United Kingdom
| | - Tom Pennance
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Western University of Health Sciences, Lebanon, OR, United States.
| |
Collapse
|
2
|
Montresor A, Mwinzi P, Garba A. Adjustments in case of overweight and obesity to the WHO tablet pole for praziquantel administration. Trans R Soc Trop Med Hyg 2022; 117:255-259. [PMID: 36533552 DOI: 10.1093/trstmh/trac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/07/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
The WHO tablet pole was developed in 2001 to facilitate the distribution of praziquantel in large-scale treatment campaigns for the control of schistosomiasis. Although a number of field studies have confirmed the accuracy of the tool in normal individuals, some studies have demonstrated that overweight and obese individuals are underdosed. This article proposes an adjustment in the number of praziquantel tablets for treatment of individuals who are overweight or obese according to their body mass index. We demonstrate that by adding an extra tablet of praziquantel to that indicated by the WHO tablet pole, the tool provides the appropriate number of tablets for treatment of overweight and obese individuals. We also propose a pictogram be included in the instructions for use of the WHO tablet pole.
Collapse
Affiliation(s)
- Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, 1211 Geneva, Switzerland
| | - Pauline Mwinzi
- Expanded Special Programme for Elimination of Neglected Tropical Diseases, World Health Organization Regional Office for Africa, 00000 Brazzaville, Republic of Congo
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, World Health Organization, 1211 Geneva, Switzerland
| |
Collapse
|
3
|
Akrasi W, Brah AS, Essuman MA, Osei V, Boye A. Adverse drug effects among students following mass de-worming exercise involving administration of Praziquantel and Albendazole in KEEA Municipality, Ghana. PLoS Negl Trop Dis 2022; 16:e0010680. [PMID: 36094964 PMCID: PMC9499283 DOI: 10.1371/journal.pntd.0010680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/22/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background
To manage the deleterious effects of parasitic infections such as lymphatic filariasis (LF) and schistosomiasis among school children, most countries including Ghana make use of mass drug administration (MDA). Although MDA has proven effective in reducing worm burden, unfortunately adverse drug effects (ADEs) post-MDA are derailing the gains and also remain poorly monitored. The study assessed incidence and factors associated with ADEs among students following a school-based mass de-worming exercise involving administration of Praziquantel (PZQT) and Albendazole (ADZ) against LF and SCH at Komenda-Edina-Eguafo-Abirem (KEEA) Municipal.
Methodology
After fulfilling all ethical obligations, a total of 598 students aged 5–20 years who received PZQT or ADZ monotherapy or a combination of the two (PZQT + ADZ) as part of the mass de-worming exercise were recruited through quota and random sampling. Bodyweight and height of students were measured and body mass index (BMI) calculated. Students were orally interviewed to obtain information such as age, sex, intake of diet before taking drugs. Subsequently, students were monitored over 24 hours post-MDA for cases of ADEs. Descriptive statistics and logistic regression analysis using SPSS version 26 was used to describe data collected and to determine associations between incidence of ADEs and predictor variables.
Principal findings
Out of the 598 students, 243 (40.64%) represented by 124 males (51.03%) and 119 females (48.97%) with mean (SD) age of 13.43 (2.74) years experienced one or more forms of ADE. In decreasing order, the detected ADEs included headache (64.6%), Abdominal pain (48.6%), fever (30.0%), diarrhea (21.4%) and itching (12.8%). Multivariable statistical analysis showed that age 5–9 years (OR: 2.01, p = 0.041) and underweight (OR: 2.02, p = 0.038) were associated with incidence of ADEs. Compared with students who received combination therapy, students who received ADZ only (OR: 0.05, p < 0.001) and PZQT only (OR: 0.26, p < 0.001) had low cases of ADEs. Gender and diet intake before MDA were not associated with ADE incidence.
Conclusion
ADE incidence was common among students in the KEEA municipality. Age, underweight, and double dosing were associated with increase in ADE incidence, while gender and food intake were not associated with increase in ADE incidence. The Disease Control Unit of the Ghana Health Service should incorporate stringent ADE monitoring in post-MDA surveillance in the National MDA program in order to be able to detect, manage and report ADEs to inform planning for future MDA programs. Such initiatives will help not only in improving effectiveness of MDA programs but also identify high risk groups and exact strategies to reduce negative influence of ADE on MDA coverage and anthelminthic drug compliance.
Collapse
Affiliation(s)
- Wisdom Akrasi
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Augustine Suurinobah Brah
- Department of Biomedical Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Mainprice Akuoko Essuman
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Viona Osei
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Alex Boye
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| |
Collapse
|
4
|
Asuming-Brempong EK, Ayi I, van der Puije W, Gyan BA, Larbi IA, Ashong Y, Frempong NA, Quartey JK, Otchere J, Jones FM, Wilson S, Dunne DW, Boakye DA. Increased ShTAL1 IgE responses post-Praziquantel treatment may be associated with a reduced risk to re-infection in a Ghanaian S. haematobium-endemic community. PLoS Negl Trop Dis 2022; 16:e0010115. [PMID: 35263327 PMCID: PMC8906586 DOI: 10.1371/journal.pntd.0010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 12/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Evidence from recent studies in Schistosoma mansoni-endemic areas show an age-associated immunity that is positively correlated with IgE titres to Schistosoma mansoni-specific tegumental allergen-like protein 1 (SmTAL1). The structural homology between SmTAL1 and the S. haematobium-specific TAL1 (ShTAL1) has been verified, yet it remains unclear whether similar age- and immune-associated trends characterize ShTAL1. This community-based intervention study was conducted to assess whether ShTAL1IgE responses post-treatment with praziquantel (PZQ) might be associated with a reduced risk to re-infection with S. haematobium. Methodology/Principal findings This study was conducted at Agona Abodom, Central Region, Ghana, and involved 114 participants aged 6 to 55 years. EDTA blood samples were collected at baseline and 7 weeks after PZQ treatment (Follow-up). Baseline and Follow-up titres of specific IgG1, IgG4, and IgE antibodies to the S. haematobium-specific adult worm antigen (ShAWA), the Sh-specific soluble egg antigen (ShSEA), and the Sh-specific tegumental-allergen-like 1 protein (ShTAL1) in plasma samples were measured using sandwich ELISA. Participants at both time points also provided stool and urine for helminth egg detection by microscopy. Prevalence of S. haematobium at baseline was 22.80%, and decreased to 3.50% at Follow-up. The egg reduction rate (ERR) was 99.87%. Overall plasma levels of ShTAL1-IgE increased 7 weeks post-PZQ treatment, and with increasing age; whiles S. haematobium infection prevalence and intensity decreased. For S. haematobium-infected participants who were egg-negative at Follow-up (N = 23), minimal median levels of ShTAL1-IgE were observed for all age groups prior to treatment, whilst median levels increased considerably among participants aged 12 years and older at Follow-up; and remained minimal among participants aged 11 years or less. In the univariate analysis, being aged 12 years or older implied an increased likelihood for ShTAL1-IgE positivity [12–14 years (cOR = 9.64, 95% CI = 2.09–44.51; p = 0.004); 15+ years (cOR = 14.26, 95% CI = 3.10–65.51; p = 0.001)], and this remained significant after adjusting for confounders [12–14 years (aOR = 22.34, 95% CI = 2.77–180.14; p = 0.004); ≥15 years (aOR = 51.82, 95% CI = 6.44–417.17; p < 0.001)]. Conversely, median ShTAL1-IgG4 titres were hardly detectible at Follow-up. Conclusions/Significance These findings demonstrate that increased IgE levels to ShTAL1 7 weeks after PZQ treatment could be associated with a reduced risk to re-infection, and adds to the large body of evidence suggesting a protective role of the treatment-induced ShTAL1 antigen in schistosomiasis infections. It was also quite clear from this work that apart from being persistently S. haematobium-positive, elevated ShTAL1-IgG4 levels at Follow-up could be indicative of susceptibility to re-infection. These outcomes have important implications in vaccine development, and in shifting the paradigm in mass chemotherapy programmes from a ‘one-size-fits-all’ approach to more sub-group-/participant-specific strategies in endemic areas. The current World Health Organization (WHO)—approved strategy for combating schistosomiasis, is the administration of praziquantel (PZQ) to subjects living in endemic communities. Due to concerns of the potential development of resistance to PZQ, there have been extensive studies to find putative candidate antigens capable of eliciting protective immunity particularly against the schistosomulum. One of such family of antigens discovered is the Schistosoma mansoni tegumental allergen-like proteins 1 through 13 (SmTAL1–13), of which the first six have been extensively studied. Although not present in the 3-hour schistosomulum, the SmTAL1 antigen has been found to induce cross-reactive IgEs that also recognize the SmTAL3 and SmTAL5 antigens present on the surface of cercariae and schistosomulae. Various epidemiological studies have indicated IgEs induced by SmTAL1 as potentially good markers/indicators for developing resistance to infection/re-infection. In this community-based intervention study, we sought to determine whether outcomes realized for Schistosoma haematobium TAL1 IgE. 7 weeks-post PZQ treatment would be predictive of protection against re-infection with S. haematobium. Our work not only assesses immune responses associated with ShTAL1, but also explores immune profiles that may characterize participants susceptible or resistant to re-infection with S. haematobium.
Collapse
Affiliation(s)
- Elias K. Asuming-Brempong
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Irene Ayi
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail:
| | - William van der Puije
- Department of Immunology Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ben A. Gyan
- Department of Immunology Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Irene A. Larbi
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Yvonne Ashong
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Naa Adjeley Frempong
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Joseph K. Quartey
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Joseph Otchere
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Frances M. Jones
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Shona Wilson
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - David W. Dunne
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Daniel A. Boakye
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| |
Collapse
|
5
|
Visclosky T, Hashikawa A, Kroner E. Discovery of a Hidden Schistosomiasis Endemic in the Salamat Region of Chad, Africa. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-20-00703. [PMID: 35294372 PMCID: PMC8885350 DOI: 10.9745/ghsp-d-20-00703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 01/05/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Timothy Visclosky
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Andrew Hashikawa
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Eric Kroner
- The Evangelical Alliance Mission, Grapevine, TX, USA
| |
Collapse
|
6
|
Montresor A, Mwinzi PN, Solomon AW, King J, Garba A. Is praziquantel preventive chemotherapy associated with visual disorders in Eritrea? A comment on the case series reported by Debesai and Russom. PLoS Negl Trop Dis 2020; 14:e0008827. [PMID: 33151942 PMCID: PMC7643939 DOI: 10.1371/journal.pntd.0008827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Antonio Montresor
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
- * E-mail:
| | - Pauline N. Mwinzi
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Anthony W. Solomon
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
| | - Jonathan King
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
| | - Amadou Garba
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
| |
Collapse
|
7
|
Debesai M, Russom M. Praziquantel and risk of visual disorders: Case series assessment. PLoS Negl Trop Dis 2020; 14:e0008198. [PMID: 32294081 PMCID: PMC7185715 DOI: 10.1371/journal.pntd.0008198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/27/2020] [Accepted: 03/04/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Praziquantel has been in use by helminthiasis and schistosomiasis control programs for about 30 years. Although deemed to be safe with regard to its adverse drug reaction profile in reference to the product information of Biltricide, the Eritrean Pharmacovigilance Center received reports of visual abnormalities related to the drug. This is a case series assessment of unusual cases of visual abnormalities associated with praziquantel. Methods Search was made in VigiBase by setting praziquantel as a drug substance, Eritrea as the reporting country and all eye disorders, high level term (HLT) to capture all visual disorders associated with Praziquantel. The retrieved dataset was exported into an Excel spreadsheet for descriptive analysis and causality was assessed using Austin Bradford-Hill criteria. Results There are a total of 2579 Individual Case Safety Reports (ICSRs) of various Adverse Drug Reactions (ADRs) of praziquantel reported from Eritrea in VigiBase. The 61 reports of visual abnormalities that arose within the first 24 hours of praziquantel administration are of note. With a strong association as evidenced by the positive IC025 value, the association of praziquantel and blurred vision was consistently reported from different health facilities over a period of three years. It is a specific association in terms of both the exposure (only praziquantel) and the outcome (blurred vision) as reported in majority of the cases. However, experimental evidences for the association are lacking, the underweight profile of the Eritrean population suggests overdosing as a possible risk factor for the occurrence of these reactions. Conclusion The strength, temporal plausibility, consistency and specificity of the association are suggestive of a causal association between praziquantel and visual disorders. The Eritrean Pharmacovigilance centre, since its integration in Mass Drug Administration in 2017, has been receiving large proportion of reports of adverse drug reactions associated with the drug praziquantel administered in mass drug campaigns. Of note were reports of the visual abnormalities namely blurred vision and visual impairment which are not known to be related to the drug. On a probability assessment, the series of 61 cases seems to show a reasonable link between the reported adverse reactions and praziquantel but not an absolute cause and effect relationship. This study suggests inaccuracies in the dose of praziquantel, in reference to some African studies, as a possible root cause, that might have led to overdosing of some subjects and hence the occurrence of the reported reactions in noticeable rates. It also addresses primarily a public health issue, rendering the findings interesting to both the scientific and non-scientific communities in general and disease control programs in particular. It is a driving force to conduct further research, improve our understanding of praziquantel and its safety profile, and the use of the drug in better ways.
Collapse
Affiliation(s)
- Merhawi Debesai
- Eritrean Pharmacovigilance Centre, National Medicines and Food Administration, Asmara, Eritrea
- * E-mail:
| | - Mulugeta Russom
- Eritrean Pharmacovigilance Centre, National Medicines and Food Administration, Asmara, Eritrea
| |
Collapse
|