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Lipton BA, Oltean HN, Capron RB, Hamlet A, Montgomery SP, Chancey RJ, Konold VJL, Steffl KE. Baylisascaris procyonis Roundworm Infection in Child with Autism Spectrum Disorder, Washington, USA, 2022. Emerg Infect Dis 2023; 29:1232-1235. [PMID: 37209678 DOI: 10.3201/eid2906.230290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
We describe a case of Baylisascaris procyonis roundworm infection in a child in Washington, USA, with autism spectrum disorder. Environmental assessment confirmed nearby raccoon habitation and B. procyonis eggs. B. procyonis infections should be considered a potential cause of human eosinophilic meningitis, particularly among young children and persons with developmental delays.
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Chancey RJ, Edwards MS, Montgomery SP. Congenital Chagas Disease. Pediatr Rev 2023; 44:213-221. [PMID: 37002357 PMCID: PMC10313159 DOI: 10.1542/pir.2022-005857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Rebecca J Chancey
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
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Abstract
Chagas disease, which is caused by infection with the parasite Trypanosoma cruzi, is a leading neglected tropical disease in the United States. An estimated 240 000 to 350 000 persons in the United States are infected, primarily immigrants from Mexico, Central America, and South America, where the disease is endemic. The parasite is transmitted by the triatomine bug but can also be passed through blood transfusion, via organ transplant, or congenitally. Approximately 30% of infected persons later develop cardiac and/or gastrointestinal complications. Health care providers should consider screening at-risk patients with serologic testing. Early diagnosis and treatment with benznidazole or nifurtimox can help prevent complications.
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Affiliation(s)
- Natasha S Hochberg
- Boston University School of Medicine, Boston University School of Public Health, and Boston Medical Center, Boston, Massachusetts (N.S.H.)
| | - Susan P Montgomery
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia (S.P.M.)
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Agudelo Higuita NI, Bronze MS, Smith JW, Montgomery SP. Chagas disease in Oklahoma. Am J Med Sci 2022; 364:521-528. [PMID: 35623395 PMCID: PMC10421564 DOI: 10.1016/j.amjms.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 01/25/2023]
Abstract
Chagas disease, caused by infection with the protozoan Trypanosoma cruzi, is one of the leading public health problems in the Western Hemisphere. The parasite is mainly transmitted by contact with infected insect vectors but other forms of transmission are important in endemic areas. In the United States, while the disease is largely restricted to immigrants from endemic countries in Latin America, there is some risk of local acquisition. T. cruzi circulates in a sylvatic cycle between mammals and local triatomine insects in the southern half of the country, where human residents may be at risk for incidental infection. There are several reported cases of locally-acquired Chagas disease in the United States, but there is a paucity of information in Oklahoma. We present a brief summary of the available data of Chagas disease in Oklahoma to raise awareness and serve as a foundation for future research.
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Affiliation(s)
- Nelson Iván Agudelo Higuita
- Section of Infectious Diseases, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Michael S Bronze
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lynn MK, Dye-Braumuller KC, Beatty NL, Dorn PL, Klotz SA, Stramer SL, Townsend RL, Kamel H, Vannoy JM, Sadler P, Montgomery SP, Rivera HN, Nolan MS. Evidence of likely autochthonous Chagas disease in the southwestern United States: A case series of Trypanosoma cruzi seropositive blood donors. Transfusion 2022; 62:1808-1817. [PMID: 35895440 PMCID: PMC9543114 DOI: 10.1111/trf.17026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Background Chagas disease is a parasitic infection that can insidiously cause non‐ischemic cardiomyopathy. Given the largely silent nature of this progressive disease, asymptomatic blood donors pose potential blood transfusion risk. Blood donation screening has become an unintentional form of Chagas disease surveillance, with thousands of new cases identified since national surveillance was initiated in 2007. Study Design and Methods We recruited T. cruzi‐positive blood donors identified from California and Arizona blood centers for confirmatory blood screening and assessment of lifetime infection risk. Results Among eight suspected cases, we identified four confirmed US autochthonous infections. The current manuscript details the transmission sources, healthcare‐seeking behaviors post‐blood donation resulting, and clinical course of disease among persons without any history of travel to endemic Latin American countries. Discussion This manuscript presents four additional US‐acquired Chagas disease cases and identifies an opportunity for blood centers to assist in confronting barriers surrounding Chagas disease in the US.
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Affiliation(s)
- Mary K Lynn
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kyndall C Dye-Braumuller
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Norman L Beatty
- Division of Infectious Diseases & Global Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA.,Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Patricia L Dorn
- Department of Biological Sciences, Loyola University New Orleans, New Orleans, Louisiana, USA
| | - Stephen A Klotz
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | | | - Hany Kamel
- Corporate Medical Affairs, Vitalant, Scottsdale, Arizona, USA
| | | | - Patrick Sadler
- Central California Blood Center, Fresno, California, USA
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilda N Rivera
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa S Nolan
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Abbott A, Montgomery SP, Chancey RJ. Characteristics and Adverse Events of Patients for Whom Nifurtimox Was Released Through CDC-Sponsored Investigational New Drug Program for Treatment of Chagas Disease - United States, 2001-2021. MMWR Morb Mortal Wkly Rep 2022; 71:371-374. [PMID: 35271563 PMCID: PMC8911997 DOI: 10.15585/mmwr.mm7110a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Glaser MA, Montgomery SP, Vahl CI, Titgemeyer EC, Kubick CS, Glaser GI, Spore TJ, Hollenbeck WR, Wahl RA, Blasi DA. Effects of feeding corn containing an alpha-amylase gene on the performance and digestibility of growing cattle. Transl Anim Sci 2022; 6:txac013. [PMID: 35350468 PMCID: PMC8944310 DOI: 10.1093/tas/txac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Two growth performance studies and two digestibility trials were conducted to evaluate the effects of feeding Enogen® Feed Corn silage and corn grain to growing cattle. In Exp. 1, there were a total of 4 diets offered for ad libitum intake. The 4 diets consisted of 2 varieties of corn (Enogen Feed Corn [EFC] vs. yellow #2 corn [CON]) with two different methods of corn processing (dry-rolled [DR] vs. whole-shelled [WS]) and were formulated to provide 1.13 Mcal NEg/kg dry matter (DM); corn grain was 28.6% of diet DM. Average daily gain (ADG) and ending body weight tended to be greater for calves fed EFC than for those fed CON (P < 0.10). Gain:feed (G:F) was better for calves fed EFC (P < 0.01), improving by 5.5% over calves fed CON. In Exp. 2, a digestibility trial was conducted using 7 cannulated Holstein steers fed the same diets from Exp. 1. Ruminal pH was not affected by corn variety (P > 0.82). Liquid passage rate was greater for CON-fed calves and associated with lower digestibility. Total tract DM and organic matter (OM) digestibilities were greater for EFC-fed calves (P < 0.04). In Exp. 3, there were 4 diets offered for ad libitum intake. Dietary factors were arranged as a 2 × 2 factorial and consisted of two hybrids of corn silage (EFC silage [EFC-S] vs. control silage [CON-S]) and two varieties of corn grain (EFC grain [EFC-G] vs. control [CON-G]; both were dry-rolled). Diets were formulated to provide 1.11 Mcal NEg/kg DM; corn grain was 38.5% of diet DM, and corn silage was 40% of diet DM. ADG was 6.0% greater (P < 0.01) and G:F was numerically (P < 0.14) 3.3% greater for calves fed EFC-S than for those fed CON-S, but substituting EFC-G for CON-G did not affect ADG or G:F. In Exp. 4, a digestibility trial was conducted using 8 cannulated beef steers fed the same diets as Exp. 3. Liquid passage rate (P > 0.20), ruminal pH (P > 0.23), and ruminal total volatile fatty acid concentrations (P > 0.27) were unaffected by treatment. Total tract digestibilities of DM and OM were numerically greater by 2.5 and 2.2%, respectively, for calves fed the EFC-S compared to those fed CON-S. Feeding a corn hybrid containing alpha-amylase enzyme improved G:F of growing calves. Feeding EFC can benefit the beef industry by allowing less processing of grain without sacrificing performance.
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Affiliation(s)
- M A Glaser
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS, United States of America
| | - S P Montgomery
- Corn Belt Livestock Services, Papillion, NE, United States of America
| | - C I Vahl
- Department of Statistics, Kansas State University, Manhattan, KS, United States of America
| | - E C Titgemeyer
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS, United States of America
| | - C S Kubick
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS, United States of America
| | - G I Glaser
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS, United States of America
| | - T J Spore
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS, United States of America
| | - W R Hollenbeck
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS, United States of America
| | - R A Wahl
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS, United States of America
| | - D A Blasi
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS, United States of America
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Straily A, Kavere EA, Wanja D, Wiegand RE, Montgomery SP, Mwaki A, Eleveld A, Secor WE, Odiere MR. Evaluation of the Point-of-Care Circulating Cathodic Antigen Assay for Monitoring Mass Drug Administration in a Schistosoma mansoni Control Program in Western Kenya. Am J Trop Med Hyg 2021; 106:303-311. [PMID: 34749308 PMCID: PMC8733502 DOI: 10.4269/ajtmh.21-0599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
The WHO guidelines for monitoring and evaluating Schistosoma mansoni control programs are based on the Kato-Katz (KK) fecal examination method; however, there are limitations to its use, particularly in low prevalence areas. The point-of-care urine circulating cathodic antigen (POC-CCA) assay has emerged as a useful tool for mapping schistosomiasis prevalence, but its use in monitoring and evaluating control programs has not been evaluated. Before POC-CCA can be used for these programs, it must be determined how previous guidance based on the KK method can be translated to the POC-CCA assay; furthermore, its performance in different endemicity settings must be evaluated. Urine and stool specimens were collected from students attending public primary schools in western Kenya before mass treatment with praziquantel at baseline (51 schools), year 1 (45 schools), year 2 (34 schools), and year 3 (20 schools). Prevalence and infection intensity were determined by the KK method and POC-CCA assay. Changes in prevalence and intensity were compared within the strata of schools grouped according to the baseline prevalence determined by the KK method (0–10%, > 10–20%, > 20%). The prevalence determined by the POC-CCA assay was higher than that determined by the KK method at all time points for all strata. The prevalence determined by the KK method decreased from baseline to 2 and 3 years, as did infection intensity (with one exception). A corresponding decrease was not always replicated by the POC-CCA assay results. The POC-CCA assay did not perform as expected, and the concordance of results of the two tests was poor. Furthermore, there are emerging concerns regarding the specificity of the POC-CCA assay. Therefore, it is impossible to translate historical data and programmatic guidelines based on the KK method results to the POC-CCA assay.
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Affiliation(s)
- Anne Straily
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alex Mwaki
- Safe Water and AIDS Project, Kisumu, Kenya
| | | | - William E Secor
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maurice R Odiere
- Safe Water and AIDS Project, Kisumu, Kenya.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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Abstract
PURPOSE OF REVIEW Lack of recognition of congenital Chagas disease in infants of mothers from endemic regions who are living in countries nonendemic for Trypanosoma cruzi infection suggests a high rate of underdiagnosis. Pregnancy is the optimal access point for identifying Chagas disease in at-risk mothers and their infants. In this review, we update progress toward implementation of pregnancy-based screening for congenital Chagas disease in nonendemic settings. RECENT FINDINGS International organizations have updated recommendations for diagnosis, treatment and prevention of congenital Chagas disease. Reports of successful implementation of pregnancy-based screening at some centers provide a model for optimizing diagnosis of congenital Chagas disease. Screening family members of index patients may identify additional T. cruzi-infected persons. Promising tests to augment current diagnostic modalities for maternal and congenital Chagas disease are in development. Universal or risk-based screening would be cost-effective. More healthcare providers are now aware that treatment of congenital Chagas disease is curative and are promoting efforts to make pregnancy-based screening for congenital Chagas disease a standard of care. SUMMARY Ongoing efforts to implement routine pregnancy-based screening for congenital Chagas disease in nonendemic regions will mutually benefit infants, their mothers and family members and can prevent potentially fatal Chagas cardiomyopathy.
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Affiliation(s)
- Morven S. Edwards
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas and
| | - Susan P. Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Cantey PT, Montgomery SP, Straily A. Neglected Parasitic Infections: What Family Physicians Need to Know-A CDC Update. Am Fam Physician 2021; 104:277-287. [PMID: 34523888 PMCID: PMC9096899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Chagas disease, cysticercosis, and toxoplasmosis affect millions of people in the United States and are considered neglected parasitic diseases. Few resources are devoted to their surveillance, prevention, and treatment. Chagas disease, transmitted by kissing bugs, primarily affects people who have lived in Mexico, Central America, and South America, and it can cause heart disease and death if not treated. Chagas disease is diagnosed by detecting the parasite in blood or by serology, depending on the phase of disease. Antiparasitic treatment is indicated for most patients with acute disease. Treatment for chronic disease is recommended for people younger than 18 years and generally recommended for adults younger than 50 years. Treatment decisions should be individualized for all other patients. Cysticercosis can manifest in muscles, the eyes, and most critically in the brain (neurocysticercosis). Neurocysticercosis accounts for 2.1% of all emergency department visits for seizures in the United States. Diagnosing neurocysticercosis involves serology and neuroimaging. Treatment includes symptom control and antiparasitic therapy. Toxoplasmosis is estimated to affect 11% of people older than six years in the United States. It can be acquired by ingesting food or water that has been contaminated by cat feces; it can also be acquired by eating undercooked, contaminated meat. Toxoplasma infection is usually asymptomatic; however, people who are immunosuppressed can develop more severe neurologic symptoms. Congenital infection can result in miscarriage or adverse fetal effects. Diagnosis is made with serologic testing, polymerase chain reaction testing, or parasite detection in tissue or fluid specimens. Treatment is recommended for people who are immunosuppressed, pregnant patients with recently acquired infection, and people who are immunocompetent with visceral disease or severe symptoms.
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Affiliation(s)
- Paul T Cantey
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Anne Straily
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bradbury RS, Lane M, Arguello I, Handali S, Cooley G, Pilotte N, Williams JM, Jameson S, Montgomery SP, Hellmann K, Tharp M, Haynie L, Galloway R, Brackin B, Kirmse B, Stempak L, Byers P, Williams S, Faruque F, Hobbs CV. Parasitic Disease Surveillance, Mississippi, USA. Emerg Infect Dis 2021; 27:2201-2204. [PMID: 34287125 PMCID: PMC8314824 DOI: 10.3201/eid2708.204318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Surveillance for soil-transmitted helminths, strongyloidiasis, cryptosporidiosis, and giardiasis was conducted in Mississippi, USA. PCR performed on 224 fecal samples for all soil-transmitted helminths and on 370 samples for only Necator americanus and Strongyloides stercoralis identified 1 S. stercoralis infection. Seroprevalences were 8.8% for Toxocara, 27.4% for Cryptosporidium, 5.7% for Giardia, and 0.2% for Strongyloides parasites.
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Nolan MS, Aguilar D, Misra A, Gunter SM, Erickson T, Gorchakov R, Rivera H, Montgomery SP, Murray KO. Trypanosoma cruzi in Nonischemic Cardiomyopathy Patients, Houston, Texas, USA. Emerg Infect Dis 2021; 27:1958-1960. [PMID: 34152952 PMCID: PMC8237890 DOI: 10.3201/eid2707.203244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To investigate possible cardiac manifestations of Chagas disease, we tested 97 Latinx patients with nonischemic cardiomyopathy in Houston, Texas, USA, for Trypanosoma cruzi infection. We noted a high prevalence of underdiagnosed infection and discrepant results in clinical diagnostic assays. Latinx cardiac patients in the United States would benefit from laboratory screening for T. cruzi infection.
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Wiegand RE, Secor WE, Fleming FM, French MD, King CH, Montgomery SP, Evans D, Utzinger J, Vounatsou P, de Vlas SJ. Control and Elimination of Schistosomiasis as a Public Health Problem: Thresholds Fail to Differentiate Schistosomiasis Morbidity Prevalence in Children. Open Forum Infect Dis 2021; 8:ofab179. [PMID: 34307724 PMCID: PMC8297701 DOI: 10.1093/ofid/ofab179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/14/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current World Health Organization guidelines utilize prevalence of heavy-intensity infections (PHIs), that is, ≥50 eggs per 10 mL of urine for Schistosoma haematobium and ≥400 eggs per gram of stool for S. mansoni, to determine whether a targeted area has controlled schistosomiasis morbidity or eliminated schistosomiasis as a public health problem. The relationship between these PHI categories and morbidity is not well understood. METHODS School-age participants enrolled in schistosomiasis monitoring and evaluation cohorts from 2003 to 2008 in Burkina Faso, Mali, Niger, Tanzania, Uganda, and Zambia were surveyed for infection and morbidity at baseline and after 1 and 2 rounds of preventive chemotherapy. Logistic regression was used to compare morbidity prevalence among participants based on their school's PHI category. RESULTS Microhematuria levels were associated with the S. haematobium PHI categories at all 3 time points. For any other S. haematobium or S. mansoni morbidity that was measured, PHI categories did not differentiate morbidity prevalence levels consistently. CONCLUSIONS These analyses suggest that current PHI categorizations do not differentiate the prevalence of standard morbidity markers. A reevaluation of the criteria for schistosomiasis control is warranted.
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Affiliation(s)
- Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Darin Evans
- United States Agency for International Development, Washington, DC, USA
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Wiegand RE, Fleming FM, Straily A, Montgomery SP, de Vlas SJ, Utzinger J, Vounatsou P, Secor WE. Urogenital schistosomiasis infection prevalence targets to determine elimination as a public health problem based on microhematuria prevalence in school-age children. PLoS Negl Trop Dis 2021; 15:e0009451. [PMID: 34115760 PMCID: PMC8221785 DOI: 10.1371/journal.pntd.0009451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/23/2021] [Accepted: 05/07/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Recent research suggests that schistosomiasis targets for morbidity control and elimination as a public health problem could benefit from a reanalysis. These analyses would define evidence-based targets that control programs could use to confidently assert that they had controlled or eliminated schistosomiasis as a public health problem. We estimated how low Schistosoma haematobium infection levels diagnosed by urine filtration in school-age children should be decreased so that microhematuria prevalence was at, or below, a "background" level of morbidity. METHODOLOGY Data obtained from school-age children in Burkina Faso, Mali, Niger, Tanzania, and Zambia who participated in schistosomiasis monitoring and evaluation cohorts were reanalyzed before and after initiation of preventive chemotherapy. Bayesian models estimated the infection level prevalence probabilities associated with microhematuria thresholds ≤10%, 13%, or 15%. PRINCIPAL FINDINGS An infection prevalence of 5% could be a sensible target for urogenital schistosomiasis morbidity control in children as microhematuria prevalence was highly likely to be below 10% in all surveys. Targets of 8% and 11% infection prevalence were highly likely to result in microhematuria levels less than 13% and 15%, respectively. By contrast, measuring heavy-intensity infections only achieves these thresholds at impractically low prevalence levels. CONCLUSIONS/SIGNIFICANCE A target of 5%, 8%, or 11% urogenital schistosomiasis infection prevalence in school-age children could be used to determine whether a geographic area has controlled or eliminated schistosomiasis as a public health problem depending on the local background threshold of microhematuria.
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Affiliation(s)
- Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Anne Straily
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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15
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Abstract
Pregnancy-based screening would identify women with Chagas disease, allowing for treatment of Trypanosoma cruzi-infected women and infants to prevent potentially fatal Chagas cardiomyopathy.
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Affiliation(s)
- Morven S Edwards
- Texas Children's Hospital, Feigin Center, 1102 Bates Avenue, Suite 1120, Houston, TX 77030, USA.
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Northeast, Atlanta, GA 30333, USA
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Wiegand RE, Secor WE, Fleming FM, French MD, King CH, Deol AK, Montgomery SP, Evans D, Utzinger J, Vounatsou P, de Vlas SJ. Associations between infection intensity categories and morbidity prevalence in school-age children are much stronger for Schistosoma haematobium than for S. mansoni. PLoS Negl Trop Dis 2021; 15:e0009444. [PMID: 34033646 PMCID: PMC8183985 DOI: 10.1371/journal.pntd.0009444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/07/2021] [Accepted: 05/04/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND World Health Organization (WHO) guidelines for measuring global progress in schistosomiasis control classify individuals with Schistosoma spp. infections based on the concentration of excreted eggs. We assessed the associations between WHO infection intensity categories and morbidity prevalence for selected S. haematobium and S. mansoni morbidities in school-age children. METHODOLOGY A total of 22,488 children aged 6-15 years from monitoring and evaluation cohorts in Burkina Faso, Mali, Niger, Uganda, Tanzania, and Zambia from 2003-2008 were analyzed using Bayesian logistic regression. Models were utilized to evaluate associations between intensity categories and the prevalence of any urinary bladder lesion, any upper urinary tract lesion, microhematuria, and pain while urinating (for S. haematobium) and irregular hepatic ultrasound image pattern (C-F), enlarged portal vein, laboratory-confirmed diarrhea, and self-reported diarrhea (for S. mansoni) across participants with infection and morbidity data. PRINCIPAL FINDINGS S. haematobium infection intensity categories possessed consistent morbidity prevalence across surveys for multiple morbidities and participants with light infections had elevated morbidity levels, compared to negative participants. Conversely, S. mansoni infection intensity categories lacked association with prevalence of the morbidity measures assessed. CONCLUSIONS/SIGNIFICANCE Current status infection intensity categories for S. haematobium were associated with morbidity levels in school-age children, suggesting urogenital schistosomiasis morbidity can be predicted by an individual's intensity category. Conversely, S. mansoni infection intensity categories were not consistently indicative of childhood morbidity at baseline or during the first two years of a preventive chemotherapy control program.
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Affiliation(s)
- Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Arminder K. Deol
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Darin Evans
- United States Agency for International Development, Washington DC, United States of America
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Czech MM, Nayak AK, Subramanian K, Suarez JF, Ferguson J, Jacobson KB, Montgomery SP, Chang M, Bae GH, Raghavan SS, Wang H, Miranti E, Budvytiene I, Shoor SM, Banaei N, Rieger K, Deresinski S, Holubar M, Blackburn BG. Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature. Open Forum Infect Dis 2021; 8:ofaa642. [PMID: 33575423 PMCID: PMC7863873 DOI: 10.1093/ofid/ofaa642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/08/2021] [Indexed: 12/13/2022] Open
Abstract
Reactivation of Chagas disease has been described in immunosuppressed patients, but there is a paucity of literature describing reactivation in patients on immunosuppressive therapies for the treatment of autoimmune rheumatic diseases. We describe a case of Chagas disease reactivation in a woman taking azathioprine and prednisone for limited cutaneous systemic sclerosis (lcSSc). Reactivation manifested as indurated and erythematous cutaneous nodules. Sequencing of a skin biopsy specimen confirmed the diagnosis of Chagas disease. She was treated with benznidazole with clinical improvement in the cutaneous lesions. However, her clinical course was complicated and included disseminated CMV disease and subsequent septic shock due to bacteremia. Our case and review of the literature highlight that screening for Chagas disease should be strongly considered for patients who will undergo immunosuppression for treatment of autoimmune disease if epidemiologically indicated.
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Affiliation(s)
- Mary M Czech
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ashwin K Nayak
- Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kavitha Subramanian
- Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jose F Suarez
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jessica Ferguson
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Karen Blake Jacobson
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Gordon H Bae
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Shyam S Raghavan
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Hannah Wang
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Eugenia Miranti
- Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Indre Budvytiene
- Clinical Microbiology Laboratory, Stanford Health Care, Stanford, California, USA
| | - Stanford Mervyn Shoor
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Niaz Banaei
- Clinical Microbiology Laboratory, Stanford Health Care, Stanford, California, USA
| | - Kerri Rieger
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Stan Deresinski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Marisa Holubar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Brian G Blackburn
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
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18
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Straily A, Malit AO, Wanja D, Kavere EA, Kiplimo R, Aera R, Momanyi C, Mwangi S, Mukire S, Souza AA, Wiegand RE, Montgomery SP, Secor WE, Odiere M. Use of a Tablet-Based System to Perform Abdominal Ultrasounds in a Field Investigation of Schistosomiasis-Related Morbidity in Western Kenya. Am J Trop Med Hyg 2021; 104:898-901. [PMID: 33432910 PMCID: PMC7941846 DOI: 10.4269/ajtmh.20-1175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/09/2020] [Indexed: 11/07/2022] Open
Abstract
Chronic intestinal schistosomiasis can cause severe hepatosplenic disease and is a neglected tropical disease of public health importance in sub-Saharan Africa, including Kenya. Although the goal of control programs is to reduce morbidity, milestones for program performance focus on reductions in prevalence and intensity of infection, rather than actual measures of morbidity. Using ultrasound to measure hepatosplenic disease severity is an accepted method of determining schistosomiasis-related morbidity; however, ultrasound has not historically been considered a field-deployable tool because of equipment limitations and unavailability of expertise. A point-of-care tablet-based ultrasound system was used to perform abdominal ultrasounds in a field investigation of schistosomiasis-related morbidity in western Kenya; during the study, other pathologies and pregnancies were also identified via ultrasound, and participants referred to care. Recent technological advances may make it more feasible to implement ultrasound as part of a control program and can also offer important benefits to the community.
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Affiliation(s)
- Anne Straily
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Rose Aera
- Safe Water and AIDS Project, Kisumu, Kenya
| | | | | | | | | | - Ryan E Wiegand
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William E Secor
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maurice Odiere
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Safe Water and AIDS Project, Kisumu, Kenya
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19
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Chancey RJ, Sapp SGH, Fox M, Bishop HS, Ndubuisi M, de Almeida M, Montgomery SP, Congeni B. Patent Macracanthorhynchus ingens Infection in a 17-Month-Old Child, Ohio. Open Forum Infect Dis 2020; 8:ofaa641. [PMID: 33553479 DOI: 10.1093/ofid/ofaa641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/17/2020] [Indexed: 11/14/2022] Open
Abstract
Limited data exist on human Macracanthorhynchus infections. We report an asymptomatic 17-month-old who passed eggs and an adult Macracanthorhynchus ingens worm, indicating parasite maturation and reproduction. Macracanthorhynchus ingens may have a greater capacity to mature in humans versus Macracanthorhynchus hirudinaceus.
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Affiliation(s)
- Rebecca J Chancey
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah G H Sapp
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark Fox
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Henry S Bishop
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - MacKevin Ndubuisi
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marcos de Almeida
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Blaise Congeni
- Director, Pediatric Infectious Disease, Akron Children's Hospital, Akron, Ohio, USA
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20
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Bradbury RS, Arguello I, Lane M, Cooley G, Handali S, Dimitrova SD, Nascimento FS, Jameson S, Hellmann K, Tharp M, Byers P, Montgomery SP, Haynie L, Kirmse B, Pilotte N, Williams SA, Hobbs CV. Parasitic Infection Surveillance in Mississippi Delta Children. Am J Trop Med Hyg 2020; 103:1150-1153. [PMID: 32588796 PMCID: PMC7470556 DOI: 10.4269/ajtmh.20-0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Some recent studies suggest ongoing transmission of parasitic diseases in the American South; however, surveys in Mississippi children are lacking. We enrolled 166 children (median age 8 years, range 4-13 years) from the Mississippi Delta region and carried out multi-parallel real-time polymerase chain reaction (PCR) for Necator americanus, Ascaris lumbricoides, and Strongyloides stercoralis on their stool samples. Dried blood spots were obtained for multiplex serology antibody detection. Of 166 children, all reported having flushable toilets, 11% had soil exposure, and 34% had a pet dog or cat. None had prior diagnosis or treatment of parasitic disease. Multi-parallel real-time PCRs were negative on the 89 stool DNA extracts available for testing. Dried blood spot testing of all 166 children determined the seroprevalence of IgG antibodies to Toxocara spp. (3.6%), Cryptosporidium (2.4%), S. stercoralis, Fasciola hepatica, and Giardia duodenalis (all 0%). In conclusion, parasitic infections and exposure were scarce in this population. Larger studies of at-risk populations are needed.
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Affiliation(s)
- Richard S Bradbury
- School of Health and Life Sciences, Federation University, Berwick Campus, Melbourne, Australia.,Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Irene Arguello
- Department of Pediatrics, Division of Infectious Diseases, Children's of Mississippi, Jackson, Mississippi
| | - Meredith Lane
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gretchen Cooley
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sukwan Handali
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Silvia D Dimitrova
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fernanda S Nascimento
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sam Jameson
- Department of Pediatrics, Division of Infectious Diseases, Children's of Mississippi, Jackson, Mississippi
| | - Kathryn Hellmann
- Department of Pediatrics, Division of Infectious Diseases, Children's of Mississippi, Jackson, Mississippi
| | - Michelle Tharp
- The Delta Mercy Project, School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi.,Division of Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Paul Byers
- Mississippi State Department of Health, Jackson, Mississippi
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa Haynie
- The Delta Mercy Project, School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi
| | - Brian Kirmse
- Division of Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Nils Pilotte
- Program in Molecular and Cellular Biology, University of Massachusetts, Amherst, Massachusetts.,Department of Biological Sciences, Smith College, Northampton, Massachusetts
| | - Steven A Williams
- Program in Molecular and Cellular Biology, University of Massachusetts, Amherst, Massachusetts.,Department of Biological Sciences, Smith College, Northampton, Massachusetts
| | - Charlotte V Hobbs
- Department of Microbiology, University of Mississippi Medical Center, Jackson, Mississippi.,Department of Pediatrics, Division of Infectious Diseases, Children's of Mississippi, Jackson, Mississippi
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21
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King CH, Kittur N, Binder S, Campbell CH, N'Goran EK, Meite A, Utzinger J, Olsen A, Magnussen P, Kinung'hi S, Fenwick A, Phillips AE, Gazzinelli-Guimaraes PH, Dhanani N, Ferro J, Karanja DMS, Mwinzi PNM, Montgomery SP, Wiegand RE, Secor WE, Hamidou AA, Garba A, Colley DG. Impact of Different Mass Drug Administration Strategies for Gaining and Sustaining Control of Schistosoma mansoni and Schistosoma haematobium Infection in Africa. Am J Trop Med Hyg 2020; 103:14-23. [PMID: 32400356 PMCID: PMC7351298 DOI: 10.4269/ajtmh.19-0829] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This report summarizes the design and outcomes of randomized controlled operational research trials performed by the Bill & Melinda Gates Foundation–funded Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) from 2009 to 2019. Their goal was to define the effectiveness and test the limitations of current WHO-recommended schistosomiasis control protocols by performing large-scale pragmatic trials to compare the impact of different schedules and coverage regimens of praziquantel mass drug administration (MDA). Although there were limitations to study designs and performance, analysis of their primary outcomes confirmed that all tested regimens of praziquantel MDA significantly reduced local Schistosoma infection prevalence and intensity among school-age children. Secondary analysis suggested that outcomes in locations receiving four annual rounds of MDA were better than those in communities that had treatment holiday years, in which no praziquantel MDA was given. Statistical significance of differences was obscured by a wider-than-expected variation in community-level responses to MDA, defining a persistent hot spot obstacle to MDA success. No MDA schedule led to elimination of infection, even in those communities that started at low prevalence of infection, and it is likely that programs aiming for elimination of transmission will need to add supplemental interventions (e.g., snail control, improvement in water, sanitation and hygiene, and behavior change interventions) to achieve that next stage of control. Recommendations for future implementation research, including exploration of the value of earlier program impact assessment combined with intensification of intervention in hot spot locations, are discussed.
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Affiliation(s)
- Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Eliézer K N'Goran
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Aboulaye Meite
- Programme National de Lutte Contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CP), Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Annette Olsen
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Alan Fenwick
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Anna E Phillips
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | | | - Neerav Dhanani
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Josefo Ferro
- Catholic University of Mozambique, Beira, Mozambique
| | - Diana M S Karanja
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N M Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Ryan E Wiegand
- Centers for Disease Control and Prevention, Atlanta, Georgia.,University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Amina A Hamidou
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, Preventive Chemotherapy and Transmission Control Unit, World Health Organization, Geneva, Switzerland
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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22
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King CH, Binder S, Shen Y, Whalen CC, Campbell CH, Wiegand RE, Olsen A, Secor WE, Montgomery SP, Musuva R, Mwinzi PNM, Magnussen P, Kinung'hi S, Andrade GN, Ezeamama AE, Colley DG. SCORE Studies on the Impact of Drug Treatment on Morbidity due to Schistosoma mansoni and Schistosoma haematobium Infection. Am J Trop Med Hyg 2020; 103:30-35. [PMID: 32400348 PMCID: PMC7351303 DOI: 10.4269/ajtmh.19-0830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The Schistosomiasis Consortium for Operational Research (SCORE) was funded in 2008 to improve the evidence base for control and elimination of schistosomiasis—better understanding of the systemic morbidities experienced by children in schistosomiasis-endemic areas and the response of these morbidities to treatment, being essential for updating WHO guidelines for mass drug administration (MDA) in endemic areas. This article summarizes the SCORE studies that aimed to gauge the impact of MDA-based treatment on schistosomiasis-related morbidities. Morbidity cohort studies were embedded in the SCORE’s larger field studies of gaining control of schistosomiasis in Kenya and Tanzania. Following MDA, cohort children had less undernutrition, less portal vein dilation, and increased quality of life in Year 5 compared with baseline. We also conducted a pilot study of the Behavioral Assessment System for Children (BASC-2) in conjunction with the Kenya gaining control study, which demonstrated beneficial effects of treatment on classroom behavior. In addition, the SCORE’s Rapid Answers Project performed systematic reviews of previously available data, providing two meta-analyses related to morbidity. The first documented children’s infection-related deficits in school attendance and achievement and in formal tests of learning and memory. The second showed that greater reductions in egg output following drug treatment correlates significantly with reduced odds of most morbidities. Overall, these SCORE morbidity studies provided convincing evidence to support the use of MDA to improve the health of school-aged children in endemic areas. However, study findings also support the need to use enhanced metrics to fully assess and better control schistosomiasis-associated morbidity.
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Affiliation(s)
- Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Ye Shen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - Christopher C Whalen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Ryan E Wiegand
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Annette Olsen
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - William Evan Secor
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rosemary Musuva
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N M Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Safari Kinung'hi
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Gisele N Andrade
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Amara E Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan.,Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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23
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Perez-Zetune V, Bialek SR, Montgomery SP, Stillwaggon E. Congenital Chagas Disease in the United States: The Effect of Commercially Priced Benznidazole on Costs and Benefits of Maternal Screening. Am J Trop Med Hyg 2020; 102:1086-1089. [PMID: 32100696 PMCID: PMC7204569 DOI: 10.4269/ajtmh.20-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. An estimated 30% of infected persons will develop lifelong, potentially fatal cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and mortality due to lack of treatment or late treatment. We constructed a decision-analytic model, using one tree that shows the combined costs for every possible mother–child pairing. Savings per birth in a targeted screening program are $1,314, and with universal screening, $105 per birth. At current screening costs, universal screening results in $420 million in lifetime savings per birth-year cohort. We found that a congenital Chagas screening program in the United States is cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence greater than 0.06% compared with no screening program.
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Affiliation(s)
| | - Stephanie R Bialek
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Secor WE, Wiegand RE, Montgomery SP, Karanja DMS, Odiere MR. Comparison of School-Based and Community-Wide Mass Drug Administration for Schistosomiasis Control in an Area of Western Kenya with High Initial Schistosoma mansoni Infection Prevalence: A Cluster Randomized Trial. Am J Trop Med Hyg 2020; 102:318-327. [PMID: 31802733 PMCID: PMC7008345 DOI: 10.4269/ajtmh.19-0626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We conducted a cluster randomized trial comparing the target population and timing of mass drug administration (MDA) with praziquantel for control of schistosomiasis in villages in western Kenya with high initial prevalence (> 25%) according to a harmonized protocol developed by the Schistosomiasis Consortium for Operational Research and Evaluation. A total of 150 villages were randomized into six treatment arms (25 villages per arm), were assessed at baseline, and received two or four rounds of MDA using community-wide (CWT) or school-based (SBT) treatment over 4 years. In the fifth year, a final evaluation was conducted. The primary outcomes were prevalence and intensity of Schistosoma mansoni infections in children aged 9–12 years, each year their village received MDA. Baseline and year 5 assessments of first-year students and adults were also performed. Using Poisson and negative binomial regression with generalized estimating equations, we found similar effects of CWT and SBT MDA treatment strategies in children aged 9–12 years: significant reductions of prevalence of infection in all arms and of heavy-intensity (≥ 400 eggs/gram) infections in most arms but no significant differences between arms. Combined arms of villages that received four rounds of treatment had greater reduction than villages in arms that only received two rounds of treatment. Surprisingly, we also found benefits of SBT for first-year primary students and adults, who never received treatment in those arms. Our data support the use of annual SBT for control programs when coupled with attention to infections in younger children and occasional treatment of adults.
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Affiliation(s)
- W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana M S Karanja
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Maurice R Odiere
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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25
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Binder S, Campbell CH, Castleman JD, Kittur N, Kinung'hi SM, Olsen A, Magnussen P, Karanja DMS, Mwinzi PNM, Montgomery SP, Secor WE, Phillips AE, Dhanani N, Gazzinelli-Guimaraes PH, Clements MN, N'Goran EK, Meite A, Utzinger J, Hamidou AA, Garba A, Fleming FM, Whalen CC, King CH, Colley DG. Lessons Learned in Conducting Mass Drug Administration for Schistosomiasis Control and Measuring Coverage in an Operational Research Setting. Am J Trop Med Hyg 2020; 103:105-113. [PMID: 32400352 PMCID: PMC7351302 DOI: 10.4269/ajtmh.19-0789] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was created to conduct research that could inform programmatic decision-making related to schistosomiasis. SCORE included several large cluster randomized field studies involving mass drug administration (MDA) with praziquantel. The largest of these were studies of gaining or sustaining control of schistosomiasis, which were conducted in five African countries. To enhance relevance for routine practice, the MDA in these studies was coordinated by or closely aligned with national neglected tropical disease (NTD) control programs. The study protocol set minimum targets of at least 90% for coverage among children enrolled in schools and 75% for all school-age children. Over the 4 years of intervention, an estimated 3.5 million treatments were administered to study communities. By year 4, the median village coverage was at or above targets in all studies except that in Mozambique. However, there was often a wide variation behind these summary statistics, and all studies had several villages with very low or high coverage. In studies where coverage was estimated by comparing the number of people treated with the number eligible for treatment, denominator estimation was often problematic. The SCORE experiences in conducting these studies provide lessons for future efforts that attempt to implement strong research designs in real-world contexts. They also have potential applicability to country MDA campaigns against schistosomiasis and other NTDs, most of which are conducted with less logistical and financial support than was available for the SCORE study efforts.
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Affiliation(s)
- Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Jennifer D Castleman
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Safari M Kinung'hi
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Annette Olsen
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Diana M S Karanja
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N M Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna E Phillips
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Neerav Dhanani
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | | | - Michelle N Clements
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Eliézer K N'Goran
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Aboulaye Meite
- Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Amina A Hamidou
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, Preventive Chemotherapy and Transmission Control Unit, World Health Organization, Geneva, Switzerland
| | - Fiona M Fleming
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Christopher C Whalen
- Department of Epidemiology and Biostatistics, Global Health Institute, University of Georgia, Athens, Georgia
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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26
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Shen Y, Wiegand RE, Olsen A, King CH, Kittur N, Binder S, Zhang F, Whalen CC, Secor WE, Montgomery SP, Mwinzi PNM, Magnussen P, Kinung'hi S, Campbell CH, Colley DG. Five-Year Impact of Different Multi-Year Mass Drug Administration Strategies on Childhood Schistosoma mansoni-Associated Morbidity: A Combined Analysis from the Schistosomiasis Consortium for Operational Research and Evaluation Cohort Studies in the Lake Victoria Regions of Kenya and Tanzania. Am J Trop Med Hyg 2020; 101:1336-1344. [PMID: 31407653 PMCID: PMC6896894 DOI: 10.4269/ajtmh.19-0273] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The WHO recommends mass treatment with praziquantel as the primary approach for Schistosoma mansoni-related morbidity control in endemic populations. The Schistosomiasis Consortium for Operational Research and Evaluation implemented multi-country, cluster-randomized trials to compare effectiveness of community-wide and school-based treatment (SBT) regimens on prevalence and intensity of schistosomiasis. To assess the impact of two different treatment schedules on S. mansoni-associated morbidity in children, cohort studies were nested within the randomized trials conducted in villages in Kenya and Tanzania having baseline prevalence ≥ 25%. Children aged 7-8 years were enrolled at baseline and followed to ages 11-12 years. Infection intensity and odds of infection were reduced both in villages receiving four years of annual community-wide treatment (CWT) and those who received biennial SBT over 4 years. These regimens were also associated with reduced odds of undernutrition and reduced odds of portal vein dilation at follow-up. However, neither hemoglobin levels nor the prevalence of the rare abnormal pattern C liver scores on ultrasound improved. For the combined cohorts, growth stunting worsened in the areas receiving biennial SBT, and maximal oxygen uptake as estimated by fitness testing scores declined under both regimens. After adjusting for imbalance in starting prevalence between study arms, children in villages receiving annual CWT had significantly greater decreases in infection prevalence and intensity than those villages receiving biennial SBT. Although health-related quality-of-life scores improved in both study arms, children in the CWT villages gained significantly more. We conclude that programs using annual CWT are likely to achieve better overall S. mansoni morbidity control than those implementing only biennial SBT.
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Affiliation(s)
- Ye Shen
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia
| | - Ryan E Wiegand
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Annette Olsen
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charles H King
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia.,Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Feng Zhang
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia
| | - Christopher C Whalen
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia
| | - William Evan Secor
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline N M Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Safari Kinung'hi
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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27
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Kittur N, King CH, Campbell CH, Kinung'hi S, Mwinzi PNM, Karanja DMS, N'Goran EK, Phillips AE, Gazzinelli-Guimaraes PH, Olsen A, Magnussen P, Secor WE, Montgomery SP, Utzinger J, Walker JW, Binder S, Colley DG. Persistent Hotspots in Schistosomiasis Consortium for Operational Research and Evaluation Studies for Gaining and Sustaining Control of Schistosomiasis after Four Years of Mass Drug Administration of Praziquantel. Am J Trop Med Hyg 2020; 101:617-627. [PMID: 31287046 PMCID: PMC6726953 DOI: 10.4269/ajtmh.19-0193] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Control of schistosomiasis presently relies largely on preventive chemotherapy with praziquantel through mass drug administration (MDA) programs. The Schistosomiasis Consortium for Operational Research and Evaluation has concluded five studies in four countries (Côte d’Ivoire, Kenya, Mozambique, and Tanzania) to evaluate alternative approaches to MDA. Studies involved four intervention years, with final evaluation in the fifth year. Mass drug administration given annually or twice over 4 years reduced average prevalence and intensity of schistosome infections, but not all villages that were treated in the same way responded similarly. There are multiple ways by which responsiveness to MDA, or the lack thereof, could be measured. In the analyses presented here, we defined persistent hotspots (PHS) as villages that achieved less than 35% reduction in prevalence and/or less than 50% reduction in infection intensity after 4 years of either school-based or community-wide MDA, either annually or twice in 4 years. By this definition, at least 30% of villages in each of the five studies were PHSs. We found no consistent relationship between PHSs and the type or frequency of intervention, adequacy of reported MDA coverage, and prevalence or intensity of infection at baseline. New research is warranted to identify PHSs after just one or a few rounds of MDA, and new adaptive strategies need to be advanced and validated for turning PHSs into responder villages.
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Affiliation(s)
- Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Safari Kinung'hi
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Pauline N M Mwinzi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Diana M S Karanja
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eliezer K N'Goran
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Anna E Phillips
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research, Imperial College London, London, United Kingdom
| | - Pedro H Gazzinelli-Guimaraes
- Department of Infectious Disease Epidemiology, Schistosomiasis Control Initiative, Imperial College London, London, United Kingdom
| | - Annette Olsen
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - W Evan Secor
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Juerg Utzinger
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Joseph W Walker
- Odum School of Ecology, University of Georgia, Athens, Georgia.,Department of Epidemiology, College of Public Health, University of Georgia, Athens, Georgia
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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28
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Turabelidze G, Vasudevan A, Rojas-Moreno C, Montgomery SP, Baker M, Pratt D, Enyeart S. Autochthonous Chagas Disease - Missouri, 2018. MMWR Morb Mortal Wkly Rep 2020; 69:193-195. [PMID: 32078594 PMCID: PMC7043387 DOI: 10.15585/mmwr.mm6907a4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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29
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Edwards MS, Stimpert KK, Bialek SR, Montgomery SP. Evaluation and Management of Congenital Chagas Disease in the United States. J Pediatric Infect Dis Soc 2019; 8:461-469. [PMID: 31016324 PMCID: PMC10186111 DOI: 10.1093/jpids/piz018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/26/2019] [Indexed: 01/18/2023]
Abstract
Chagas disease is underappreciated as a health concern in the United States. Approximately 40 000 women of childbearing age living in the United States have chronic Chagas disease. Most of them are unaware that they have an infection that is transmissible to their offspring. The estimated US maternal-to-infant transmission rate of Trypanosoma cruzi is 1% to 5%. Ten percent to 40% of neonates with congenital T cruzi infection have clinical signs consistent with a congenital infection but no findings are unique to Chagas disease. If left untreated, 20% to 40% of infants with Chagas disease will later develop potentially fatal cardiac manifestations. Molecular testing can confirm the diagnosis in neonates. Treatment is well tolerated in infancy and usually results in cure. Screening of at-risk women during pregnancy can identify maternal infection and allow early assessment and treatment for congenital T cruzi infection.
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Affiliation(s)
- Morven S Edwards
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Kelly K Stimpert
- IHRC, Inc, Atlanta, Georgia.,Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie R Bialek
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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30
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Arvelo W, Hall AJ, Henao O, Lopez B, Bernart C, Moir JC, Reyes L, Montgomery SP, Morgan O, Estevez A, Parsons MB, Lopez MR, Gomez G, Vinje J, Gregoricus N, Parashar U, Mintz ED, McCracken J, Bryan JP, Lindblade KA. Incidence and etiology of infectious diarrhea from a facility-based surveillance system in Guatemala, 2008-2012. BMC Public Health 2019; 19:1340. [PMID: 31640646 PMCID: PMC6805345 DOI: 10.1186/s12889-019-7720-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data are limited. We conducted laboratory-based diarrhea surveillance in Guatemala. METHODS A diarrhea case was defined as ≥3 loose stools in a 24-h period in a person presenting to the surveillance facilities. Epidemiologic data and stool specimens were collected. Specimens were tested for bacterial, parasitic, and viral pathogens. Yearly incidence was adjusted for healthcare seeking behaviors determined from a household survey conducted in the surveillance catchment area. RESULTS From November 2008 to December 2012, the surveillance system captured 5331 diarrhea cases; among these 1381 (26%) had specimens tested for all enteric pathogens of interest. The adjusted incidence averaged 659 diarrhea cases per 10,000 persons per year, and was highest among children aged < 5 years, averaging 1584 cases per 10,000 children per year. Among 1381 (26%) specimens tested for all the pathogens of interest, 235 (17%) had a viral etiology, 275 (20%) had a bacterial, 50 (4%) had parasites, and 86 (6%) had co-infections. Among 827 (60%) specimens from children aged < 5 years, a virus was identified in 196 (23%) patients; 165 (20%) had norovirus and 99 (12%) rotavirus, including co-infections. Among 554 patients aged ≥5 years, 103 (19%) had a bacterial etiology, including diarrheagenic Escherichia coli in 94 (17%) cases, Shigella spp. in 31 (6%), Campylobacter spp. in 5 (1%), and Salmonella spp. in 4 (1%) cases. Detection of Giardia and Cryptosporidium was infrequent (73 cases; 5%). CONCLUSIONS There was a substantial burden of viral and bacterial diarrheal diseases in Guatemala, highlighting the importance of strengthening laboratory capacity for rapid detection and control and for evaluation of public health interventions.
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Affiliation(s)
- Wences Arvelo
- Center for Global Health, US Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop V24-5, Atlanta, GA 30333 USA
| | - Aron J. Hall
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, USA
| | - Olga Henao
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA
| | - Beatriz Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Chris Bernart
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Juan C. Moir
- Ministry of Public Health and Welfare, Guatemala City, Guatemala
| | - Lissette Reyes
- Ministry of Public Health and Welfare, Guatemala City, Guatemala
| | - Susan P. Montgomery
- Center for Global Health, US Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop V24-5, Atlanta, GA 30333 USA
| | - Oliver Morgan
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA
| | - Alejandra Estevez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Michele B. Parsons
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA
| | - Maria R. Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Gerry Gomez
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA
| | - Jan Vinje
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, USA
| | - Nicole Gregoricus
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, USA
| | - Umesh Parashar
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, USA
| | - Eric D. Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA
| | - John McCracken
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Joe P. Bryan
- Center for Global Health, US Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop V24-5, Atlanta, GA 30333 USA
| | - Kim A. Lindblade
- Center for Global Health, US Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop V24-5, Atlanta, GA 30333 USA
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Eggers P, Offutt-Powell TN, Lopez K, Montgomery SP, Lawrence GG. Notes from the Field: Identification of a Triatoma sanguisuga "Kissing Bug" - Delaware, 2018. MMWR Morb Mortal Wkly Rep 2019; 68:359. [PMID: 30998670 PMCID: PMC6476055 DOI: 10.15585/mmwr.mm6815a5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Sapp SGH, Bradbury RS, Bishop HS, Montgomery SP. Regarding: A Common Source Outbreak of Anisakidosis in the United States and Postexposure Prophylaxis of Family Collaterals. Am J Trop Med Hyg 2019; 100:762. [PMID: 30843503 PMCID: PMC6402927 DOI: 10.4269/ajtmh.18-1019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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33
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Gray EB, La Hoz RM, Green JS, Vikram HR, Benedict T, Rivera H, Montgomery SP. Reactivation of Chagas disease among heart transplant recipients in the United States, 2012-2016. Transpl Infect Dis 2018; 20:e12996. [PMID: 30204269 DOI: 10.1111/tid.12996] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non-endemic countries. METHODS We present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012 to 2016. Patients were monitored following a standard schedule. RESULTS Of the 31 patients, 19 (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow-up (median: 60 weeks). CONCLUSIONS Transplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a preemptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed.
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Affiliation(s)
- Elizabeth B Gray
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jaime S Green
- Division of Infectious Disease and International Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | | | - Theresa Benedict
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hilda Rivera
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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34
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Valice EM, Wiegand RE, Mwinzi PNM, Karanja DMS, Williamson JM, Ochola E, Samuels A, Verani JR, Leon JS, Secor WE, Montgomery SP. Relative Contribution of Schistosomiasis and Malaria to Anemia in Western Kenya. Am J Trop Med Hyg 2018; 99:713-715. [PMID: 29988002 PMCID: PMC6169184 DOI: 10.4269/ajtmh.18-0069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/04/2018] [Indexed: 02/04/2023] Open
Abstract
Because anemia is one of the markers of morbidity associated with schistosomiasis, it has been proposed as a potential measure to evaluate the impact of control programs. However, anemia is also a common consequence of malaria, and schistosomiasis and malaria are often co-endemic. To estimate the attributable fraction of anemia due to Schistosoma mansoni and Plasmodium falciparum infections, we applied a log-binomial model to four studies measuring these parameters of a combined 5,849 children in western Kenya. In our studies, malaria contributed 23.3%, schistosomiasis contributed 6.6%, and co-infection contributed 27.6% of the anemia. We conclude that in areas where S. mansoni and P. falciparum are co-endemic, the contribution of schistosomiasis to anemia is masked by anemia resulting from malaria, thus limiting anemia as a useful measure for schistosomiasis control programs in these settings.
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Affiliation(s)
- Emily M. Valice
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline N. M. Mwinzi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Diana M. S. Karanja
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - John M. Williamson
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Ochola
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Aaron Samuels
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R. Verani
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Juan S. Leon
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Liu EW, Schwartz BS, Hysmith ND, DeVincenzo JP, Larson DT, Maves RC, Palazzi DL, Meyer C, Custodio HT, Braza MM, Al Hammoud R, Rao S, Qvarnstrom Y, Yabsley MJ, Bradbury RS, Montgomery SP. Rat Lungworm Infection Associated with Central Nervous System Disease - Eight U.S. States, January 2011-January 2017. MMWR Morb Mortal Wkly Rep 2018; 67:825-828. [PMID: 30070981 PMCID: PMC6072054 DOI: 10.15585/mmwr.mm6730a4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sircar AD, Mwinzi PNM, Onkanga IO, Wiegand RE, Montgomery SP, Secor WE. Schistosoma mansoni Mass Drug Administration Regimens and Their Effect on Morbidity among Schoolchildren over a 5-Year Period-Kenya, 2010-2015. Am J Trop Med Hyg 2018; 99:362-369. [PMID: 29893197 PMCID: PMC6090338 DOI: 10.4269/ajtmh.18-0067] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/22/2018] [Indexed: 12/24/2022] Open
Abstract
Schistosomiasis control programs are designed to reduce morbidity by providing mass drug administration (MDA) of praziquantel to at-risk populations. We compared morbidity markers between two cohorts of Kenyan schoolchildren that initially had high prevalence of Schistosoma mansoni infections. One cohort (N = 416 at year 1) received four rounds of annual MDA in a community-wide treatment (CWT) strategy. The other cohort (N = 386 at year 1) received school-based treatment (SBT) every other year over the 4-year period. We measured infection with S. mansoni and soil-transmitted helminths (STH) as well as subtle morbidity markers at year 1, year 3, and year 5 and compared cohorts with mixed models after controlling for age and gender. At year 5, neither overall S. mansoni prevalence nor the prevalence of high infection-intensity S. mansoni infection was significantly reduced compared with baseline in either the CWT cohort (N = 277 remaining) or the SBT cohort (N = 235 remaining). Nevertheless, by year 5, children in both cohorts demonstrated significant decreases in wasting, ultrasound-detected organomegaly, and STH infection along with significantly improved pediatric quality-of-life scores compared with year 1. Stunting did not change over time, but children who were S. mansoni egg-positive at year 5 had significantly more stunting than children without schistosomiasis. The only significant difference between arms at year 5 was a lower prevalence of STH infections in the CWT group.
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Affiliation(s)
- Anita D. Sircar
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline N. M. Mwinzi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Isaac O. Onkanga
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Graciaa DS, Cope JR, Roberts VA, Cikesh BL, Kahler AM, Vigar M, Hilborn ED, Wade TJ, Backer LC, Montgomery SP, Evan Secor W, Hill VR, Beach MJ, Fullerton KE, Yoder JS, Hlavsa MC. Outbreaks Associated with Untreated Recreational Water - United States, 2000-2014. Am J Transplant 2018. [DOI: 10.1111/ajt.15002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel S. Graciaa
- Department of Family and Preventive Medicine; Emory University School of Medicine; Atlanta GA USA
| | - Jennifer R. Cope
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Virginia A. Roberts
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Bryanna L. Cikesh
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
- Oak Ridge Institute for Science and Education; Oak Ridge TN USA
| | - Amy M. Kahler
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Marissa Vigar
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | | | | | - Lorraine C. Backer
- Division of Environmental Hazards and Health Effects; National Center for Environmental Health, CDC; Atlanta GA USA
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria; Center for Global Health; CDC; Atlanta GA USA
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria; Center for Global Health; CDC; Atlanta GA USA
| | - Vincent R. Hill
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Michael J. Beach
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Kathleen E. Fullerton
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Jonathan S. Yoder
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
| | - Michele C. Hlavsa
- Division of Foodborne; Waterborne, and Environmental Diseases; National Center for Emerging and Zoonotic Infectious Diseases; CDC; Atlanta GA USA
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Bennett C, Straily A, Haselow D, Weinstein S, Taffner R, Yaglom H, Komatsu K, Venkat H, Brown C, Byers P, Dunn J, Moncayo A, Mayes BC, Montgomery SP. Chagas Disease Surveillance Activities - Seven States, 2017. MMWR Morb Mortal Wkly Rep 2018; 67:738-741. [PMID: 29975678 PMCID: PMC6048980 DOI: 10.15585/mmwr.mm6726a2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Graciaa DS, Cope JR, Roberts VA, Cikesh BL, Kahler AM, Vigar M, Hilborn ED, Wade TJ, Backer LC, Montgomery SP, Secor WE, Hill VR, Beach MJ, Fullerton KE, Yoder JS, Hlavsa MC. Outbreaks Associated with Untreated Recreational Water - United States, 2000-2014. MMWR Morb Mortal Wkly Rep 2018; 67:701-706. [PMID: 29953425 PMCID: PMC6023190 DOI: 10.15585/mmwr.mm6725a1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Outbreaks associated with untreated recreational water can be caused by pathogens, toxins, or chemicals in fresh water (e.g., lakes, rivers) or marine water (e.g., ocean). During 2000-2014, public health officials from 35 states and Guam voluntarily reported 140 untreated recreational water-associated outbreaks to CDC. These outbreaks resulted in at least 4,958 cases of disease and two deaths. Among the 95 outbreaks with a confirmed infectious etiology, enteric pathogens caused 80 (84%); 21 (22%) were caused by norovirus, 19 (20%) by Escherichia coli, 14 (15%) by Shigella, and 12 (13%) by Cryptosporidium. Investigations of these 95 outbreaks identified 3,125 cases; 2,704 (87%) were caused by enteric pathogens, including 1,459 (47%) by norovirus, 362 (12%) by Shigella, 314 (10%) by Cryptosporidium, and 155 (5%) by E. coli. Avian schistosomes were identified as the cause in 345 (11%) of the 3,125 cases. The two deaths were in persons affected by a single outbreak (two cases) caused by Naegleria fowleri. Public parks (50 [36%]) and beaches (45 [32%]) were the leading settings associated with the 140 outbreaks. Overall, the majority of outbreaks started during June-August (113 [81%]); 65 (58%) started in July. Swimmers and parents of young swimmers can take steps to minimize the risk for exposure to pathogens, toxins, and chemicals in untreated recreational water by heeding posted advisories closing the beach to swimming; not swimming in discolored, smelly, foamy, or scummy water; not swimming while sick with diarrhea; and limiting water entering the nose when swimming in warm freshwater.
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Stillwaggon E, Perez-Zetune V, Bialek SR, Montgomery SP. Congenital Chagas Disease in the United States: Cost Savings through Maternal Screening. Am J Trop Med Hyg 2018; 98:1733-1742. [PMID: 29714163 PMCID: PMC6086189 DOI: 10.4269/ajtmh.17-0818] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors through transfusions, transplants, insect feces in food, and from mother to child during gestation. Congenital infection could perpetuate Chagas disease indefinitely, even in countries without vector transmission. An estimated 30% of infected persons will develop lifelong, potentially fatal, cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment of Chagas disease in the United States. We constructed a decision-analytic model to find the lower cost option, comparing costs of testing and treatment, as needed, for mothers and infants with the lifetime societal costs without testing and the consequent morbidity and mortality due to lack of treatment or late treatment. We found that maternal screening, infant testing, and treatment of Chagas disease in the United States are cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence above 0.06% compared with no screening program. Newly approved diagnostics make universal screening cost saving with maternal prevalence as low as 0.008%. The present value of lifetime societal savings due to screening and treatment is about $634 million saved for every birth year cohort. The benefits of universal screening for T. cruzi as part of routine prenatal testing far outweigh the program costs for all U.S. births.
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Affiliation(s)
| | - Victoria Perez-Zetune
- International Finance Division, Board of Governors of the Federal Reserve System, Washington, District of Columbia
| | - Stephanie R Bialek
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Weinstein SB, Lake CM, Chastain HM, Fisk D, Handali S, Kahn PL, Montgomery SP, Wilkins PP, Kuris AM, Lafferty KD. Seroprevalence of Baylisascaris procyonis Infection among Humans, Santa Barbara County, California, USA, 2014-2016. Emerg Infect Dis 2018; 23:1397-1399. [PMID: 28726612 PMCID: PMC5547801 DOI: 10.3201/eid2308.170222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Baylisascaris procyonis (raccoon roundworm) infection is common in raccoons and can cause devastating pathology in other animals, including humans. Limited information is available on the frequency of asymptomatic human infection. We tested 150 adults from California, USA, for B. procyonis antibodies; 11 were seropositive, suggesting that subclinical infection does occur.
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Abanyie FA, Valice E, Delli Carpini KW, Gray EB, McAuliffe I, Chin-Hong PV, Handali S, Montgomery SP, Huprikar S. Organ donor screening practices for Strongyloides stercoralis infection among US organ procurement organizations. Transpl Infect Dis 2018; 20:e12865. [PMID: 29512242 DOI: 10.1111/tid.12865] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/30/2017] [Accepted: 12/03/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Targeted donor screening for strongyloidiasis performed at the time of organ procurement can prevent this life-threatening donor-derived infection. METHOD The Association of Organ Procurement Organizations surveyed members to determine the number of US organ procurement organizations (OPOs) performing donor screening for Strongyloides infection and their screening practices. RESULTS All 58 OPOs responded to the survey. Only 6 (10%) currently screen donors for strongyloidiasis; most OPOs started 6-36 months before the survey and one started 6 years prior. All used risk-based criteria to determine which donors to screen, though the criteria varied among OPOs. A median of 56 donors have been screened at each OPO since initiating their screening programs, with a median of 2 infected donors (range 0-13) identified. Overall, 53 organs have been transplanted from 22 infected donors, including hearts, lungs, kidneys, and livers. Of 52 OPOs not currently screening, 20 had considered screening and one plans to start screening in the near future. Of those considering risk-based screening, most had not decided on the criteria. Uncertainty about the benefits of and guidelines for screening and misconceptions about the interpretation of test results were concerns shared by non-screening OPOs. CONCLUSION Continued education and advocacy on the importance of targeted donor screening are needed.
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Affiliation(s)
- Francisca A Abanyie
- Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Valice
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Elizabeth B Gray
- Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Isabel McAuliffe
- Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter V Chin-Hong
- Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | - Sukwan Handali
- Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan P Montgomery
- Center for Global Health, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shirish Huprikar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Gunter SM, Murray KO, Gorchakov R, Beddard R, Rossmann SN, Montgomery SP, Rivera H, Brown EL, Aguilar D, Widman LE, Garcia MN. Likely Autochthonous Transmission of Trypanosoma cruzi to Humans, South Central Texas, USA. Emerg Infect Dis 2018; 23:500-503. [PMID: 28221110 PMCID: PMC5382766 DOI: 10.3201/eid2303.161157] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is a major neglected tropical disease affecting the Americas. The epidemiology of this disease in the United States is incomplete. We report evidence of likely autochthonous vectorborne transmission of T. cruzi and health outcomes in T. cruzi–seropositive blood donors in south central Texas, USA.
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Sapp SGH, Rascoe LN, Wilkins PP, Handali S, Gray EB, Eberhard M, Woodhall DM, Montgomery SP, Bailey KL, Lankau EW, Yabsley MJ. Baylisascaris procyonis Roundworm Seroprevalence among Wildlife Rehabilitators, United States and Canada, 2012-2015. Emerg Infect Dis 2018; 22:2128-2131. [PMID: 27869612 PMCID: PMC5189140 DOI: 10.3201/eid2212.160467] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Baylisascaris procyonis roundworms can cause potentially fatal neural larva migrans in many species, including humans. However, the clinical spectrum of baylisascariasis is not completely understood. We tested 347 asymptomatic adult wildlife rehabilitators for B. procyonis antibodies; 24 were positive, suggesting that subclinical baylisascariasis is occurring among this population.
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Wiegand RE, Mwinzi PNM, Montgomery SP, Chan YL, Andiego K, Omedo M, Muchiri G, Ogutu MO, Rawago F, Odiere MR, Karanja DMS, Secor WE. A Persistent Hotspot of Schistosoma mansoni Infection in a Five-Year Randomized Trial of Praziquantel Preventative Chemotherapy Strategies. J Infect Dis 2017; 216:1425-1433. [PMID: 28968877 PMCID: PMC5913648 DOI: 10.1093/infdis/jix496] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/13/2017] [Indexed: 12/28/2022] Open
Abstract
Background Persistent hotspots have been described after mass drug administration (MDA) for the control of schistosomiasis, but they have not been studied during the course of a multiyear MDA program. Methods In data from a 5-year study of school-based and village-wide preventive chemotherapy strategies for Schistosoma mansoni, spatial scan statistics were used to find infection hotspots in 3 populations: 5- to 8-year-olds, 9- to 12-year-olds, and adults. Negative binomial regression was used to analyze changes from baseline, and receiver operating characteristic analyses were used to predict which villages would reach prevalence and intensity endpoints. Results We identified a persistent hotspot, not associated with study arm, where S. mansoni infection prevalence and intensity did not decrease as much as in villages outside the hotspot. Significant differences from baseline were realized after 1 year of MDA: we did not identify factors that moderated this relationship. Villages meeting specified endpoints at year 5 were predicted from prior year data with moderately high sensitivity and specificity. Conclusions The MDA strategies were less effective at reducing prevalence and intensity in the hotspot compared with other villages. Villages that reached year 5 endpoints could be detected earlier, which may provide the opportunity to amend intervention strategies.
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Affiliation(s)
- Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline N M Mwinzi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kennedy Andiego
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Martin Omedo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Geoffrey Muchiri
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Michael O Ogutu
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Fredrick Rawago
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Maurice R Odiere
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Diana M S Karanja
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Karanja DMS, Awino EK, Wiegand RE, Okoth E, Abudho BO, Mwinzi PNM, Montgomery SP, Secor WE. Cluster randomized trial comparing school-based mass drug administration schedules in areas of western Kenya with moderate initial prevalence of Schistosoma mansoni infections. PLoS Negl Trop Dis 2017; 11:e0006033. [PMID: 29059190 PMCID: PMC5667887 DOI: 10.1371/journal.pntd.0006033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/02/2017] [Accepted: 10/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background Mass drug administration (MDA) using praziquantel is the WHO-recommended approach for control of schistosomiasis. However, few studies have compared the impact of different schedules of MDA on the resultant infection levels. We wished to evaluate whether annual MDA was more effective than less frequent treatments for reducing community-level prevalence and intensity of Schistosoma mansoni infections. Methods We performed a cluster randomized trial (ISRCTN 14849830) of 3 different MDA frequencies over a 5 year period in 75 villages with moderate (10%-24%) initial prevalence of S. mansoni in school children in western Kenya. Praziquantel was distributed by school teachers to students either annually, the first 2 years, or every other year over a 4 year period. Prevalence and intensity of infection were measured by stool examination in 9–12 year old students using the Kato-Katz method at baseline, each treatment year, and for the final evaluation at year 5. S. mansoni prevalence and intensity were also measured in first year students at baseline and year 5. Results Twenty-five schools were randomly assigned to each arm. S. mansoni prevalence and infection intensity in 9–12 year old students significantly decreased within each arm from baseline to year 5 but there were no differences between arms. There were no differences in infection levels in first year students either within or between arms. Conclusions Strategies employing 2 or 4 rounds of MDA had a similar impact in schools with moderate initial prevalence, suggesting that schistosomiasis control can be sustained by school-based MDA, even if provided only every other year. The World Health Organization (WHO) guidelines recommend mass drug administration (MDA) of praziquantel for control of schistosomiasis. The target group for and the frequency of treatment are based on infections levels in school age children at the initiation of the control program. However, these guidelines have not been rigorously evaluated. Through the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), we had the opportunity to compare the impact of school-based treatment in an area of western Kenya with moderate (10%-24%) initial prevalence of Schistosoma mansoni infections. We found that providing MDA every year or every other year over a 4 year period provided similar benefits for reducing prevalence and intensity of infection in the final evaluation at year 5. Annual or biennial MDA moved villages from the “moderate risk” to the “low risk category” prescribed in the WHO guidelines. The results from this study and parallel SCORE studies in other African countries should provide the evidence base necessary for improved WHO guidelines for schistosomiasis.
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Affiliation(s)
- Diana M. S. Karanja
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Emmy K. Awino
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Edward Okoth
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Bernard O. Abudho
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N. M. Mwinzi
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
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Shen Y, King CH, Binder S, Zhang F, Whalen CC, Evan Secor W, Montgomery SP, Mwinzi PNM, Olsen A, Magnussen P, Kinung’hi S, Phillips AE, Nalá R, Ferro J, Aurelio HO, Fleming F, Garba A, Hamidou A, Fenwick A, Campbell CH, Colley DG. Protocol and baseline data for a multi-year cohort study of the effects of different mass drug treatment approaches on functional morbidities from schistosomiasis in four African countries. BMC Infect Dis 2017; 17:652. [PMID: 28962552 PMCID: PMC5622450 DOI: 10.1186/s12879-017-2738-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/14/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) focus is on randomized trials of different approaches to mass drug administration (MDA) in endemic countries in Africa. Because their studies provided an opportunity to evaluate the effects of mass treatment on Schistosoma-associated morbidity, nested cohort studies were developed within SCORE's intervention trials to monitor changes in a suite of schistosomiasis disease outcomes. This paper describes the process SCORE used to select markers for prospective monitoring and the baseline prevalence of these morbidities in four parallel cohort studies. METHODS In July 2009, SCORE hosted a discussion of the potential impact of MDA on morbidities due to Schistosoma infection that might be measured in the context of multi-year control. Candidate markers were reviewed and selected for study implementation. Baseline data were then collected from cohorts of children in four country studies: two in high endemic S. mansoni sites (Kenya and Tanzania), and two in high endemic S. haematobium sites (Niger and Mozambique), these cohorts to be followed prospectively over 5 years. RESULTS At baseline, 62% of children in the S. mansoni sites had detectable eggs in their stool, and 10% had heavy infections (≥ 400 eggs/g feces). Heavy S. mansoni infections were found to be associated with increased baseline risk of anemia, although children with moderate or heavy intensity infections had lower risk of physical wasting. Prevalence of egg-positive infection in the combined S. haematobium cohorts was 27%, with 5% of individuals having heavy infection (≥50 eggs/10 mL urine). At baseline, light intensity S. haematobium infection was associated with anemia and with lower scores in the social domain of health-related quality-of-life (HRQoL) assessed by Pediatric Quality of Life Inventory. CONCLUSIONS Our consensus on practical markers of Schistosoma-associated morbidity indicated that height, weight, hemoglobin, exercise tolerance, HRQoL, and ultrasound abnormalities could be used as reference points for gauging treatment impact. Data collected over five years of program implementation will provide guidance for future evaluation of morbidity control in areas endemic for schistosomiasis. TRIAL REGISTRATION These cohort studies are registered and performed in conjunction with the International Standard Randomised Controlled Trial Registry trials ISRCTN16755535 , ISRCTN14117624 , ISRCTN95819193 , and ISRCTN32045736 .
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Affiliation(s)
- Ye Shen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA USA
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH USA
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases and Department of Microbiology, University of Georgia, Athens, GA USA
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases and Department of Microbiology, University of Georgia, Athens, GA USA
| | - Feng Zhang
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA USA
| | | | - W. Evan Secor
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Susan P. Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Pauline N. M. Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Annette Olsen
- Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Safari Kinung’hi
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Anna E. Phillips
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Rassul Nalá
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Josefo Ferro
- Universidade Católica de Moçambique, Beira, Mozambique
| | - H. Osvaldo Aurelio
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Fiona Fleming
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Amadou Garba
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Amina Hamidou
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Carl H. Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases and Department of Microbiology, University of Georgia, Athens, GA USA
| | - Daniel G. Colley
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases and Department of Microbiology, University of Georgia, Athens, GA USA
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Woodhall DM, Garcia AP, Shapiro CA, Wray SL, Shane AL, Mani CS, Stimpert KK, Fox LM, Montgomery SP. Assessment of U.S. Pediatrician Knowledge of Toxocariasis. Am J Trop Med Hyg 2017; 97:1243-1246. [PMID: 28820703 DOI: 10.4269/ajtmh.17-0232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Toxocariasis, one of a group of parasitic diseases known as neglected parasitic infections, is a disease caused by the larvae of two species of Toxocara roundworms, Toxocara canis, from dogs, and less commonly Toxocara cati, from cats. Although most infected individuals are asymptomatic, clinical manifestations may include fever, fatigue, coughing, wheezing, or abdominal pain (visceral toxocariasis) or vision loss, retina damage, or eye inflammation (ocular toxocariasis). To assess U.S. pediatrician knowledge of toxocariasis, we conducted an electronic survey of American Academy of Pediatrics members. Of the 2,684 respondents, 1,120 (47%) pediatricians correctly selected toxocariasis as the diagnosis in an unknown case presentation with findings typical for toxocariasis; overall 1,695 (85%) stated they were not confident that their knowledge of toxocariasis was current. This knowledge gap suggests a need for improved toxocariasis awareness and education for U.S. pediatricians, especially those caring for children at risk for infection.
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Affiliation(s)
- Dana M Woodhall
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda P Garcia
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Craig A Shapiro
- Pediatric Infectious Diseases, Children's Healthcare of Atlanta, Atlanta, Georgia.,Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Shequenta L Wray
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andi L Shane
- Pediatric Infectious Diseases, Children's Healthcare of Atlanta, Atlanta, Georgia.,Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | | | - Kelly K Stimpert
- IHRC Inc., Atlanta, Georgia.,Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - LeAnne M Fox
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Musuva R, Shen Y, Wei X, Binder S, Ivy JA, Secor WE, Montgomery SP, King CH, Mwinzi PNM. Change in children's school behavior after mass administration of praziquantel for Schistosoma mansoni infection in endemic areas of western Kenya: A pilot study using the Behavioral Assessment System for Children (BASC-2). PLoS One 2017; 12:e0181975. [PMID: 28746403 PMCID: PMC5528892 DOI: 10.1371/journal.pone.0181975] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/10/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Schistosomiasis is a parasite-related chronic inflammatory condition that can cause anemia, decreased growth, liver abnormalities, and deficits in cognitive functioning among children. METHODOLOGY/PRINCIPAL FINDINGS This study used the Behavior Assessment System for Children (BASC-2) to collect data on thirty-six 9-12 year old school-attending children's behavioral profiles in an Schistosoma mansoni-endemic area of western Kenya, before and after treatment with praziquantel for S. mansoni infection. BASC-2 T scores were significantly reduced post-treatment (p < 0.05) for each of the 'negative' behavior categories including externalizing problems (hyperactivity, aggression, and conduct problems that are disruptive in nature), internalizing problems (anxiety, depression, somatization, atypicality, and withdrawal), school problems (academic difficulties, included attention problems and learning problems), and the composite behavioral symptoms index (BSI), signifying improved behavior. While the observed improvement in the 'positive' behavior category of adaptive skills (adaptability, functional communication, social skills, leadership, and study skills) was not statistically significant, there were significant improvements in two adaptive skills subcategories: social skills and study skills. CONCLUSION/SIGNIFICANCE Results of this study suggest that children have better school-related behaviors without heavy S. mansoni infection, and that infected children's behaviors, especially disruptive problem behaviors, improve significantly after praziquantel treatment.
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Affiliation(s)
- Rosemary Musuva
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ye Shen
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, United States of America
| | - Xianjue Wei
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, United States of America
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, University of Georgia, Athens, Georgia, United States of America
| | - Julianne A. Ivy
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - W. Evan Secor
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Susan P. Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Charles H. King
- Schistosomiasis Consortium for Operational Research and Evaluation, University of Georgia, Athens, Georgia, United States of America
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Pauline N. M. Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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50
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Meymandi SK, Forsyth CJ, Soverow J, Hernandez S, Sanchez D, Montgomery SP, Traina M. Prevalence of Chagas Disease in the Latin American-born Population of Los Angeles. Clin Infect Dis 2017; 64:1182-1188. [PMID: 28329123 PMCID: PMC5399937 DOI: 10.1093/cid/cix064] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/10/2017] [Indexed: 11/13/2022] Open
Abstract
Background According to an estimate from the Centers for Disease Control and Prevention (CDC), Chagas disease (CD) may affect 1.31% of Latin American immigrants in the United States, with >300 000 cases. However, there is a lack of real-world data to support this estimate. Little is known about the actual prevalence of this neglected tropical disease in the United States, and the bulk of those infected are undiagnosed. Methods From April 2008 to May 2014, we screened 4,755 Latin American-born residents of Los Angeles County. Blood samples were tested for serologic evidence of CD. We collected demographic data and assessed the impact of established risk factors on CD diagnosis, including sex, country of origin, housing materials, family history of CD, and awareness of CD. Results There were 59 cases of CD, for an overall prevalence of 1.24%. Prevalence was highest among Salvadorans (3.45%). Of the 3,182 Mexican respondents, those from Oaxaca (4.65%) and Zacatecas (2.2%) had the highest CD prevalence. Salvadoran origin (aOR = 6.2; 95% CI = 2.8-13.5; P < .001), prior knowledge of CD (aOR = 2.4; 95% CI = 1.0-5.8; P = .047), and exposure to all 3 at-risk housing types (adobe, mud, and thatched roof) (aOR = 2.5; 95% CI = 1.0-6.4; P = .048) were associated with positive diagnosis. Conclusions In the largest screening of CD in the United States to date outside of blood banks, we found a CD prevalence of 1.24%. This implies >30 000 people infected in Los Angeles County alone, making CD an important public health concern. Efficient, targeted surveillance of CD may accelerate diagnosis and identify candidates for early treatment.
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Affiliation(s)
- Sheba K Meymandi
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center. Sylmar, California, USA
| | - Colin J Forsyth
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center. Sylmar, California, USA
| | - Jonathan Soverow
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center. Sylmar, California, USA
| | - Salvador Hernandez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center. Sylmar, California, USA
| | - Daniel Sanchez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center. Sylmar, California, USA
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Mahmoud Traina
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center. Sylmar, California, USA
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