Intestinal parasitic infections in a population of BaAka Pygmies inhabiting the Congo Basin in the Central African Republic

INTRODUCTION

Pygmy tribes inhabit tropical environment of Central Africa. After expulsion from their original habitat by the Bantu people, they settled in a local forest ecosystem where they live with very low sanitary standards. Their actual morbidity remains unknown.

OBJECTIVE

The aim of the study was to analyze the prevalence of intestinal parasitic infections in BaAka Pygmies inhabiting the Congo Basin in the Central African Republic.

MATERIAL AND METHODS

The study was conducted in 2015, and involved a group of 950 Pygmies living inthe Sangha-Mbaere and Lobaye prefectures. Single stool samples were collected from study participants, fixed in 10% formalin, transported from Africa to Europe, and analyzed by light microscopy using 5 different diagnostic methods (direct smear, decantation with distilled water, Fülleborne's flotation, Kato-Miura thick smear, DiaSyS/PARASYS system sedimentation) at the Military Institute of Medicine in Warsaw, Poland.

RESULTS

Microscopic examination revealed infections with 14 different species of intestinal nematodes, cestodes, trematodes and protozoa. According to the study findings, 90.5% of BaAka Pygmies were found to be infected with intestinal parasites, and 70.8% had mixed infections. Most of the pathogenic intestinal parasites were nematodes (85.0%), with Asrcaris lumbricoides (29.8%), hookworm (29.4%) and Trichuris trichiura (10.7%) being predominant.

CONCLUSIONS

Poor sanitation, limited the high prevalence of intestinal parasitic infections in the community of Pygmies. The negative test results may prove the effectiveness of periodic deworming campaigns chich, implemented by non-governmental organizations, are voluntary with respect to the informed consent principle.

Prevalence of Intestinal Parasites in a Low-Income Texas Community

Strongyloidiasis affects an estimated hundreds of millions of people worldwide, with infection possibly persisting for life without appropriate therapy because of the helminth's unique autoinfection cycle. Like other soil-transmitted helminths, because of the environmental conditions required for the life cycle of Strongyloides stercoralis, this parasite is endemic to tropical, subtropical, and temperate countries and areas with inadequate sanitation infrastructure. Given continued poverty and that nearly one in five American homes are lacking proper sanitation systems, many U.S. regions are at risk for intestinal parasites. A central Texas community was chosen as the study site, given previous reports of widespread sanitation failure, degree of poverty, and community willingness to participate. A total of 92 households were surveyed and residents tested for nine intestinal parasites using a multi-parallel quantitative real-time polymerase chain reaction and ELISA serology. From 43 stool samples, 27 (62.8%) tested positive for Blastocystis spp. and one (2.3%) for Giardia lamblia. From 97 serum samples, Strongyloides serology detected 16 (16.5%) positive individuals. These high rates of heterokont and helminthic laboratory findings in a peri-urban central Texas community suggest several key policy implications, including that strongyloidiasis should be added to the Texas notifiable conditions list, that clinical suspicion for this infection should be heightened in the region, and that residents without access to functioning and sustainable sanitation infrastructure should be provided that access as a basic human right and to promote public health.

Identification of a Short DNA Bar Code in the 18S rDNA for Improved Differentiation of Common Eimeria Species Infecting Chickens

The coccidian species Eimeria is a parasitic protozoan that causes the gastrointestinal disease coccidiosis in numerous vertebrate species. Incidence of the disease in commercial chickens produces drastic economic losses. Traditionally, detection of Eimeria has been performed using classical methods such as observation of oocyst morphology. However, molecular methods to detect and speciate Eimeria are becoming more prevalent. The 18S ribosomal gene, in particular, has been a widely used DNA amplification target for detection of Eimeria. Although the full-length gene is typically used for this purpose, newer research targeting shorter regions of the gene is being performed. This study investigated the suitability of a 120-base pair (bp) DNA bar code within the 18S gene for species differentiation. When comparing sequence variation from the Eimeria species infecting chickens, shortening the 18S gene to the 120-bp highly variable region provided increased species differentiation, while also reducing intraspecies variation. This DNA bar code is useful for distinction of the Eimeria species infecting chickens and should be considered for future molecular detection assays and metagenomic sequencing.

Improved methods to capture the total societal benefits of zoonotic disease control: Demonstrating the cost-effectiveness of an integrated control programme for Taenia solium, soil transmitted helminths and classical swine fever in northern Lao PDR

BACKGROUND

Control and elimination of zoonotic diseases requires robust information about their effect on both human and livestock health in order to enable policy formulation and the allocation of resources. This study aimed to evaluate the cost-effectiveness of controlling Taenia solium taeniasis/cysticercosis in both humans and pigs, and soil-transmitted helminths (STH) in humans by integrating their control to on-going human and animal health control programmes in northern Lao People's Democratic Republic.

METHOD

A cross-sectional study was carried out in 49 households, focusing on the prevalence of T. solium taenias/cysticercosis and soil transmitted helminths before and after a twelve month intervention. The village data was collected using a semi-structured questionnaire through a door-to-door survey. The village data was then projected to the wider northern Lao PDR population using stochastic modelling and cost-effectiveness ratio (after aggregating the net cost to capture both human and animal health parameters) and GDP per capita as a threshold, to determine the cost-effectiveness of the integrated control of T. solium taeniasis/ cysticercosis and STH, assuming linear scaling out of the intervention. The zoonotic DALY (zDALY) approach was also used as an alternative method of estimating the cost-effectiveness ratio of controlling T. solium taeniasis/cysticercosis in humans and pigs.

FINDINGS

Using cost-effectiveness analysis after aggregating the net cost and control of T. solium taeniasis/cysticercosis alone as the base case, the study found that simultaneous control of T. solium taeniasis/cysticercosis in humans and pigs, STH in humans and Classical Swine Fever (CSF) in pigs was USD 14 per DALY averted and USD 234 per zDALY averted using zDALY method hence considered highly cost-effective whereas controlling T. solium taeniasis/cysticercosis without incorporating STH and CSF was the least cost-effective (USD 3,672 per DALY averted). Additionally, the cost-effectiveness of controlling T. solium taeniasis/cysticercosis in people and pigs using zDALY as an alternative method was USD 3,662 per zDALY averted which was quite close to our findings using the aggregate net cost method.

CONCLUSION

The study showed that control of T. solium taeniasis/cysticercosis alone in humans and pigs is not cost-effective in northern Lao PDR whereas control of STH is. Consequently, integrating T. solium taeniasis/cysticercosis control with other cost-effective programmes such as STH and CSF markedly improved the cost-effectiveness of the intervention. This is especially important in low resource countries where control of zoonotic neglected tropical diseases could be integrated with the human and animal health sectors to optimize use of the limited resources.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614001067662.

Economic Considerations for Moving beyond the Kato-Katz Technique for Diagnosing Intestinal Parasites As We Move Towards Elimination

While the need for more sensitive diagnostics for intestinal helminths is well known, the cost of developing and implementing new tests is considered relatively high compared to the Kato-Katz technique. Here, we review the reported costs of performing the Kato-Katz technique. We also outline several economic arguments we believe highlight the need for further investment in alternative diagnostics, and considerations that should be made when comparing their costs. In our opinion, we highlight that, without new diagnostic methods, it will be difficult for policy makers to make the most cost-effective decisions and that the potentially higher unit costs of new methods can be outweighed by the long-term programmatic benefits they have (such as the ability to detect the interruption of transmission).

Economic Analysis of the Impact of Overseas and Domestic Treatment and Screening Options for Intestinal Helminth Infection among US-Bound Refugees from Asia

BACKGROUND

Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis) are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program.

METHODS

An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1) "No Program," 2) U.S. "Domestic Screening and Treatment," 3) "Overseas Albendazole and Ivermectin" presumptive treatment, and 4) "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites) included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs).

RESULTS

The "No Program" option is the least expensive ($165,923 per cohort) and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort). The "Overseas Albendazole and Ivermectin" option ($418,824) is less expensive than "Domestic Screening and Treatment" ($3,832,572) or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483). According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program".

DISCUSSION

Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as domestic screening and treatment programs. The addition of ivermectin to albendazole reduces the prevalence of chronic strongyloidiasis and the probability of rare, but potentially fatal, disseminated strongyloidiasis.

Ongoing deterioration of the nutritional status of Palestinian preschool children in Gaza under the Israeli siege

This cross-sectional, community-based, household survey was carried out in Gaza City, Palestine during the first half of 2009 to study the nutritional status of Palestinian preschool children aged 2-5 years under blockade. The response rate was 95.2% from a total sample of 770. The majority (94.4%) of households faced difficulties accessing food, the main cause was the siege and the shortage of food products; and the majority (85.5%) were food insecure households. Just over 50% of the preschoolers were anaemic, 26.8% of those who had a stool test had parasitic infections, and 15.0 were stunted. Food insecurity was the first predictor of stunting andd underweight, and malnutrition indicators indicate the worst situation in the Gaza Strip for several decades.

[Influencing factors on infections of human intestinal helminthes in suburb of Shangyu City]

The infections of human intestinal helminthes and socioeconomic status were investigated in suburb of Shangyu City in 1990 and 2005, respectively. The results showed that the economic status, the save drinking water and latrines, working environment, and health habits and consciousness of the residents improved obviously. The infection rate of intestinal helminthes decreased significantly and the prevalence of intestinal helminthosis was controlled effectively.

The costs and cost-effectiveness of mass treatment for intestinal nematode worm infections using different treatment thresholds

Background

It is estimated that almost a half of all of people living in developing countries today are infected with roundworms, hookworms, or whipworms or combinations of these types of intestinal nematode worms. They can all be treated using safe, effective, and inexpensive single-dose generic drugs costing as little as USD 0.03 per person treated when bought in bulk. The disease caused by intestinal nematodes is strongly related to the number of worms in the gut, and it is typical to find that worms tend to be aggregated or clumped in their distribution so that <20% of people may harbour >80% of all worms. This clumping of worms is greatest when the prevalence is low. When the prevalence rises above 50%, the mean worm burden increases exponentially, worms are less clumped, and more people are likely to have moderate to heavy infections and may be diseased. Children are most at risk. For these reasons, the World Health Organization (WHO) currently recommends mass treatment of children ≥1 year old without prior diagnosis when the prevalence is ≥20% and treatment twice a year when the prevalence is ≥50%.

Methods and Findings

The risk of moderate to heavy infections with intestinal nematodes was estimated by applying the negative binomial probability distribution, then the drug cost of treating diseased individuals was calculated based on different threshold numbers of worms. Based on this cost analysis, a new three-tier treatment regime is proposed: if the combined prevalence is >40%, treat all children once a year; >60% treat twice a year; and >80% treat three times a year. Using average data on drug and delivery costs of USD 0.15 to treat a school-age child and USD 0.25 to treat a pre-school child (with provisos) the cost of treating children aged 2–14 years was calculated for 105 low- and low-middle-income countries and for constituent regions of India and China based on estimates of the combined prevalence of intestinal nematode worms therein. The annual cost of the three-tier threshold was estimated to be USD 224 million compared with USD 276 million when the current WHO recommendations for mass treatment were applied.

Conclusion

The three-tier treatment thresholds were less expensive and more effective as they allocated a greater proportion of expenditures to treating infected individuals when compared with the WHO thresholds (73% compared with 61%) and treated a larger proportion of individuals with moderate to heavy worm burdens, arbitrarily defined as more than 10 worms per person (31% compared with 21%).

Almost one in every two people in the developing world is infected with one or more types of intestinal nematode worms. When fewer than 50% of people are infected, most carry only a few worms; but when more than 50% are infected, the number carrying moderate to heavy numbers increases markedly, as does the risk of disease. The WHO recommends annual mass deworming of children when 20% or more are infected and twice a year if 50% or more are infected. We estimated the cost of this to treat children with 10+ worms, an arbitrary moderate to heavy infection. We concluded that it is not cost-effective to mass treat children when fewer than 40% are infected because the majority are uninfected and few are likely be diseased. We propose annual treatment when 40% or more children are infected, twice a year at 60%, and three times a year at 80% or more. This would cost USD 224 million annually to treat all children aged 2–14 years in 107 developing countries compared with USD 276 million using current WHO guidelines. The new three-tier guidelines also treat a larger proportion of infected children and treat children with moderate to heavy worm burdens more often.

Economic efficacy of anthelmintic treatments in dairy sheep naturally infected by gastrointestinal strongyles

The aim of the present paper was to assess benefit of strategic anthelmintic treatments on milk production in six commercial dairy sheep farms, located in southern Italy, whose animals were naturally infected with gastrointestinal strongyles. On each farm, two similar groups were formed, one untreated control group and one treated group. In all the treated groups, the strategic anthelmintic schemes were based on: (i) only one treatment with moxidectin in the periparturient period (February, Farm No. 6), or; (ii) two treatments, i.e. the first with moxidectin performed in the periparturient period (February, Farms Nos. 1, 2, 3 and 4) or in the postparturient period (April, Farm No. 5), and the second with netobimin at the mid/end of lactation (June, Farms Nos. 1, 2, 3, 4 and 5). Faecal egg count reduction (FECR) tests were performed on each farm in order to asses the anthelmintic efficacy of the drugs used. In addition, milk yield measurements for each animal fortnightly in each farm for the lactation period were performed. In terms of FECR, both moxidectin and netobimin were effective in all the 6 studied farms. Regarding milk production, overall in the 6 study farms the mean daily milk productions of the treated groups were higher than those of the control group. However, there were important differences between the 6 farms, i.e. the increase of milk production in the treated groups versus the control groups was as follows: +18.9% (Farm 1), +30.4% (Farm 2), +4.0% (Farm 3), +37.0% (Farm 4), +5.5% (Farm 5) and +40.8% (Farm 6). The results of the study showed that the economic efficacy of an anthelmintic treatment is not a cause-effect issue, but is a multifactorial issue which depends upon the quali-quantitative parasitological status of the animals, the pathogenesis of the species of parasites, the virulence of the strains of parasites, the local epidemiology, the timing of treatment, the breed of animal in terms of genetics and production types, nutrient supply.

Gastrointestinal Nematode Control Programs with an Emphasis on Cattle

Control strategies for nematode parasites rely on knowledge of the relationships between the parasites and their hosts. Specifically, these programs are based on identifying crucial points of interaction in the environment provided by the host, including genetics and the immune response, and critical periods in the physical environment in which the eggs and larval stages must develop. When these targets are identified and the interactions understood, cost-effective sustainable programs can be developed using currently available antiparasitic compounds. Resistance to the major classes of anthelmintic compounds requires consideration of new approaches, such as immunity or genetics of the host. Additionally, the efficacy of these compounds can be expanded with combined or concomitant use. Increased study of the use of novel approaches, including fungi, elements such as copper, and plant products, has also occurred. This article explores each of these areas to allow readers to appreciate how various approaches may be developed and incorporated into an effective parasite control program.

[An insight into the epidemiology and economic impact of gastro-intestinal nematodes in small ruminants]

Milk production has been a distinguishing characteristic of sheep breeding since antiquity in the Mediterranean area, including Italy, where prehistoric findings confirm this particular husbandry activity. In Homer's Odyssey, the description of Polifemo's sheep flock organization is remarkably similar to current production systems. The ancient roots of this tradition have grown into an important economic reality, with excellent levels of milk production and apporoximately 65 typical cheeses. It is interesting to note that the Italian word "pecora" (sheep) is believed to have originated from the Latin "pecunia" (money). Although heavy production losses are due to parasitic infections, only 250 papers have been published in the last 50 years in Italy on sheep parasites. Differences in climate, environmental factors and production tecniques may influence infection prevalence, load and pathogenesis. For this reason, prevention must be aimed at the particular epidemiological situation and not simply adapted from current schemes used abroad. The aim of this paper is to illustrate the epidemiology of ovine gastrointestinal nematodes in Italy and to evaluate the economic importance of their control.

Prevalence of intestinal parasitic infections and their relation with socio-economic factors and hygienic habits in Tehran primary school students

School age children carry the heaviest burden of morbidity due to intestinal parasitic infections. Our objective was to determine the prevalence of these infections in primary school children living in Tehran and their association with socio-economic factors and hygienic habits. In September 1998, a total of 19,213 subjects were invited to participate. Data on health and socio-economic status and health-related behaviours, collected via questionnaires, physical examinations and stool sample analyses, were available for 19,209 persons, with a participation rate greater than 99.99%. All participants were subjected to three methods of microscopic examinations on the stool sample and an adhesive cellophane tape slide evaluation. The prevalence rate of intestinal parasitic infection among the students was 18.4%. Coinfection with two or three parasites was seen in 2%. With increase in educational level of parents (especially mothers), the infection rate of children was decreased. Girls showed a significantly higher positive rate than boys. Using piped water, correct method of washing vegetables and increase in the economic score of the family, resulted in a decrease in the infection rate. According to the results, low level of education and consequently poor socio-economic and hygienic condition of families appear to be powerful determinants of infection.

[Intestinal helminthiasis among school children: preliminary results of a prospective study in Agboville in Southern Côte d'Ivoire]

Intestinal helminthiasis affects the health and academic performance of children in developing countries. To highlight a few socio-economic factors that impact the presence and upholding of intestinal helminthiasis, a cohort study was performed from February to June 2001. This study took place in Agboville in Southern Côte d'Ivoire on 363 children, under the age of 15, regularly enrolled in school and selected by two-step clustered sampling. After the survey was completed, their stools were examined using 3 methods: direct exam, Kato's technique, and Graham's anal scotch-test. Infected students received an appropriate anti-helminthic treatment. After performing a test two weeks later, a new sample of 348 parasite-free children was made up and re-examined after three months, through the aforementioned techniques. In this sample, we assumed that students who were infested in the initial exam were "exposed", while those who were not infested in the first place were deemed to be "not exposed". The results showed that 135 students out of the 360 admitted for the first exam were infested; or a 37.5% of intestinal helminthiasis prevalence (IC95%=30.5-45). The prevalent parasite species were Necator americanus (15%), Trichuris trichiura (13.6%), Schistosoma mansoni (10%). Twenty-eight per cent of 135 infested students were infected by more than one parasite. After three months, the incidence rate of intestinal helminthiasis calculated out of the remaining 336 students was 7.7% (IC95%=4.4-13.1). The likelihood of re-infestation amounted to 3.4 (IC95%=1.5-7.3). The pattern of re-infestation rates according to socio-economic factors differed from that of infested prevalence. The prevalent parasites in re-infested patients were Trichuris trichiura (16.3%), Schistosoma mansoni (12.5%). All intestinal nematodes and Schistosoma mansoni were observed. The most frequent parasites species where those transmitted cutaneously. The high re-infestation rate suggests that intestinal helminthiasis in this region affects roughly the same children. These results show the necessity to continue our investigations in order to highlight essential hygienic factors in our long-term fight against intestinal helminthiasis.

Current research and future prospects in the development of vaccines against gastrointestinal nematodes in cattle

Vaccination is being considered as the most feasible alternative for anthelmintic drugs to control gastrointestinal nematode infections in cattle. However, despite the identification of several candidate protective antigens, no vaccines against gastrointestinal nematode parasites are currently available. The main problems that hamper the development of nematode vaccines in ruminants are that vaccination with recombinant nematode proteins produced in bacterial or eukaryotic expression systems did not induce a protective immune response and no suitable antigen delivery system is available for presentation of protective worm antigens to the bovine mucosal immune system. The present review will focus on recent advances and remaining obstacles in vaccine development against gastrointestinal nematodes in cattle, in particular against the abomasal parasite Ostertagia ostertagi.

Gastrointestinal nematodes of cattle in the northeastern US: results of a producer survey

A questionnaire covering management practices and producer perception of the effects of gastrointestinal nematode infections was sent to dairy and beef producers in the northeastern US. The mailing list was derived from membership in grazing groups and attendance at grazing events. A final total of 474 responses were suitable for analyses. These responses covered 14 states, but for the purpose of analysis were broken into five groups: New England (NE), Vermont (VT), New York (NY), Pennsylvania (PA), and south and west (S and W) of Pennsylvania. Two-thirds of the responses were from dairy producers. The average number of animals for the farms was 50 cows, 27 heifers, and 20 calves. The average acreage used for grazing was 70 acres, and about two-thirds of the responses used rotational grazing for at least the cows. About one-half of the rotational grazers had been practicing rotational grazing for more than 5 years. Most rotational programs for cows involved a daily rotation, but the rotational interval for other age groups was longer. There was a difference of about 2 months (5.25-7.27) in the length of the grazing season as one moved from New England to south and west of Pennsylvania. Parasite control practices varied greatly by location and animal class. Most producers used anthelmintics one to two times per year, but 10-30% of responses said they did not deworm their cattle. The most common time to deworm was in the spring, and the second most common time was the fall. Between 10 and 20% of respondents reported deworming as a response to decreased productivity or body condition. The use of anthelmintics increased as the location moved from New England to south and west of Pennsylvania. Producer perception of parasite effects was closely related to their anthelmintic use, and also increased as the location moved to the south, and is most likely the result of the increased length of the grazing season. Of producers who ascribed estimated a cost of the parasite, the majority estimated this cost to be between US$ 5 and 20 per animal per year.

Do intestinal nematodes affect productivity in adulthood?

Intestinal nematode infections have been associated with many physical and mental developmental insults. These include anaemia, wasting, stunting, cognitive impairment and lowered educational achievement, all of which have in turn been shown to interfere with productivity and wage-earning capacity in adults. Although there is no direct evidence for an effect of intestinal nematodes on productivity, circumstantial evidence suggests such an effect. Here, Helen Guyatt reviews the indirect evidence for an effect of intestinal nematodes on productivity in adults through current infection and associated morbidity, and on early ill-health in children, which might affect productivity later in life.

The cost of large-scale school health programmes which deliver anthelmintics to children in Ghana and Tanzania. The Partnership for Child Development

It has been argued that the delivery of anthelmintics to school-children through existing education infrastructure can be one of the most cost-effective approaches to controlling parasitic worm infection. This paper examines the actual costs of a combination of mass and selective treatment for schistosomiasis using praziquantel and mass treatment for intestinal nematodes using albendazole, as an integral part of school health programmes reaching 80442 pupils in 577 schools in Volta Region, Ghana, and reaching 109099 pupils in 350 schools in Tanga Region, Tanzania. The analysis shows that financial delivery costs per child treated using praziquantel, which involved a dose related to body mass and a prior screening at the school level, were US$ 0.67 in Ghana and US$ 0.21 in Tanzania, while the delivery costs for albendazole, which was given as a fixed dose to all children, were US$ 0.04 in Ghana and US$ 0.03 in Tanzania. The higher unit costs in Ghana reflect the epidemiology of infection; overall, fixed costs were similar in both countries, but fewer children required treatment in Ghana. Analysis of economic costs-which includes the cost of unpaid days of labour--indicates that the financial costs are increased in Ghana by 78% and in Tanzania by 44%. It is these additional costs which are avoided by integration into an existing infrastructure. It is concluded that: the base cost of delivering a universal, standard, school-based health intervention can be as low as US$ 0.03 per child treated; that even a slight increase in the complexity of delivery can have a significant impact on the cost of intervention; and that the use of the education infrastructure does indeed offer significant savings in delivery costs.

The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants

BACKGROUND

Currently, more than 600,000 immigrants enter the United States each year from countries where intestinal parasites are endemic. At entry persons with parasitic infections may be asymptomatic, and stool examinations are not a sensitive method of screening for parasitosis. Albendazole is a new, broad-spectrum antiparasitic drug, which was approved recently by the Food and Drug Administration. International trials have shown albendazole to be safe and effective in eradicating many parasites. In the United States there is now disagreement about whether to screen all immigrants for parasites, treat all immigrants presumptively, or do nothing unless they have symptoms.

METHODS

We compared the costs and benefits of no preventive intervention (watchful waiting) with those of universal screening or presumptive treatment with 400 mg of albendazole per day for five days. Those at risk were defined as immigrants to the United States from Asia, the Middle East, sub-Saharan Africa, Eastern Europe, and Latin America and the Caribbean. Cost effectiveness was expressed both in terms of the cost of treatment per disability-adjusted life-year (DALY) averted (one DALY is defined as the loss of one year of healthy life to disease) and in terms of the cost per hospitalization averted.

RESULTS

As compared with watchful waiting, presumptive treatment of all immigrants at risk for parasitosis would avert at least 870 DALYs, prevent at least 33 deaths and 374 hospitalizations, and save at least $4.2 million per year. As compared with watchful waiting, screening would cost $159,236 per DALY averted.

CONCLUSIONS

Presumptive administration of albendazole to all immigrants at risk for parasitosis would save lives and money. Universal screening, with treatment of persons with positive stool examinations, would save lives but is less cost effective than presumptive treatment.

Control strategies for human intestinal nematode infections

In recent years significant progress has been made in understanding the ecology, epidemiology and related morbidity and development of new tools for the control of soil-transmitted helminths. Such knowledge has recognized the impact of helminth infections on the health of infected groups and has created a rational basis for their control. Schoolchildren harbour some of the most intense helminthic infections, which produce adverse effects on health, growth and scholastic performance. However, although great effort has been put into targeting school-age children, women of child-bearing age and pre-school children are two other groups at high risk of morbidity due to intestinal nematode infections. Highly effective and safety-tested, single-dose anthelminthic drugs are now available, permitting periodical deworming of schoolchildren and other high-risk groups at affordable prices. Four anthelminthics against all intestinal nematodes are included in the WHO Essential Drug List (albendazole, levamisole, mebendazole and pyrantel). Recently ivermectin has also been registered for use against Strongyloides stercoralis in humans. Several well-monitored country experiences have shown that chemotherapy-based control of morbidity due to soil-transmitted helminths is possible and highly cost-effective.

A study of the cost effectiveness of selective health interventions for the control of intestinal parasites in rural Bangladesh

The study examined the cost effectiveness of 4 different regimens in reducing the prevalence and intensity of infection of Ascaris lumbricoides, Trichuris trichiura, and hookworm over an 18-mo period in randomized community samples of children aged 2-8 yr living in rural Bangladesh. The household was the unit of randomization in each community. The 4 regimens were (1) only chemotherapy to all household members at the commencement of the study (i.e., at an interval of 18 mo), (2) same as group (1) and regular health education throughout the study period, (3) chemotherapy to all household members at the commencement of the study and subsequent chemotherapy to all children at intervals of 6 mo, and (4) same as group 3 with the addition of regular health education throughout the study period. Health education (through home and school visits and focus group discussions) was aimed at increasing awareness of worm transmission and the disabilities caused by intestinal helminths. Simple ways of improving personal hygiene and sanitation through hand washing, nail trimming, wearing of shoes, and use of a latrine and clean water supplies were encouraged. Because albendazole is a broad spectrum anthelmintic, the cost effectiveness of the 4 interventions were compared by the weighted percentage reduction in prevalence and the weighted percentage reduction in intensities of infection as measured by geometric mean egg loads of all 3 worms combined. The most cost-effective strategy was the single albendazole mass chemotherapy at an interval of 18 mo. The 2 regimens involving health education were the least cost effective.

[Economical consequences of coccidia infection in calves]

The studies were carried out in two farms - ZZK Kołbacz and SK Bielin, on 60 calves, 30 animals in each farm. The calves ware divided for control and experimental groups -15 animals per group. Baycox was administered two times in 7 days interval in a dosis of 20 mglkg of body weight. The weight gain and the course of coccidia infection in calves before and after traetment with Baycox ware examined. In control animals during the time of studies the coccidia infection was very hight. After administration of Baycox the intensity of coccidia infection was very low and oocysts were found in same animals, only. In SK Bielin before Baycox was used clinical coccidiosis and mortality of 6.9% calves was observed. After Baycox administration 1.9 % animals died, only. The results ware analyst statistically.

The cost effectiveness of mass drug therapy for intestinal helminths

This article reviews the principles involved in establishing the cost effectiveness of mass drug therapy for the major intestinal nematodes and the intestinal form of schistosomiasis, as well as the extent to which the available studies have provided definitive answers. For governments or agencies that have decided to introduce a control programme, there is considerable evidence about the comparative cost effectiveness of different types of delivery strategies. For example, mass treatment is more cost effective than selective treatment (treatment after individual screening) in high prevalence areas and at observed prices. Mass treatment targeted at known high risk groups, such as schoolchildren, for the major intestinal helminths (apart from hookworm) can be more cost effective than population-based mass treatment. However, this raises the question whether any form of mass anthelmintic chemotherapy is an efficient use of scare health resources in view of the competing demands for scarce public funds, and for the scarce resources of other funders of healthcare including donors, nongovernmental organisations and missions. Some evidence that it is an efficient use of resources is available; this article concludes by outlining the type of information that is required to strengthen the argument for mass therapy.

Intestinal helminthiases in Ecuador: the relationship between prevalence, genetic, and socioeconomic factors

Prevalence of infection with the intestinal helminths, Ascaris lumbricoides, Trichuris trichiura, Ancylostoma duodenale and Strongyloides stercoralis was examined in 632 residents of communities in Esmeraldas Province of Ecuador. These communities were divided into two groups according to area of habitation which reflected different socioeconomic circumstances. Attempts were made to correlate infection status with race and ABO blood group phenotype. The racial groups included blacks, Chachi amerindians, and mixed-race mestizos. Greater prevalences of infection were seen in the area of lower socioeconomic status. No racial or blood group associations with helminth infection were seen controlling for socioeconomic status.

Economic benefits of controlling internal and external parasites in South American camelids

A trial was carried out in alpacas (Lama pacos) and llamas (Lama glama) to determine the economic benefits of controlling both external and internal parasites by the use of ivermectin ("Ivomec," Merck Sharp & Dohme). After four months the treated male alpacas gained on average 3.1 kg more than the untreated males, and their fleece weighed 0.36 kg more. The treated female alpacas gained 1.9 kg more than the controls, but their fleece weighed 0.03 kg less. This treatment gave a net financial benefit to the farmer of U.S. $3.54 for each of his male alpacas and U.S. $1.36 for each of his female alpacas. The results for the llamas were not significant because there was great variation in the weight gains (and losses). Because the value of llama fleece is less, the economic benefits were also less.

Effects of parasitic infestation on the productivity of alpacas (Lama pacos)

A trial was carried out in alpacas (Lama pacos) to determine the economic benefit of controlling both external and internal parasites using ivermectin (Ivomec, Merck, Sharpe and Dohme). After four months the treated male alpacas had gained on average 3.1 kg more than the untreated males and their fleece weighed 0.36 kg more. Treated females gained 1.9 kg more than the controls but their fleece weighed 0.03 kg less. This resulted in a net financial benefit to the farmer of US$3.54 for each male alpaca and US$1.36 for each female.

Economic and production repercussions of deworming by pulse release device and oral suspension in grazing double-muscled fattening cattle

In this field trial, the repercussions of 2 administration forms of oxfendazole, namely a single administration of a front-loaded device (group 1; n = 18) and a repeated administration of a 90.6 per cent oral suspension (group 2; n = 18), were compared in first season-grazing double-muscled fattening bulls. The comparison was based on the production performances, the mean worm egg counts and the product- and labour-costs. The daily body gains determined on the whole trial period, i.e. 1.312 +/- 0.055 kg and 1.270 +/- 0.056 kg for groups 1 and 2 respectively, and mean worm egg counts per gram (on days 0 and 130:200.0 +/- 44.3 and 94.4 +/- 27.4 for group 1; 366.7 +/- 98.4 and 100.0 +/- 33.6 for group 2) did not differ significantly between the two groups. However, the total costs were lower with a front-loaded device (1,021 Belgian Francs) than with oral suspension (1,248 Belgian Francs per bull).

Equine helminth infections: control by selective chemotherapy

A programme of selective anthelmintic therapy was used in a herd of 31 horses. Faecal egg counts were done during the months of September, November, January, March, May and the following September. Horses with greater than or equal to 100 eggs per gram (epg) were treated with ivermectin, and those with less than 100 epg were not treated. The criteria for adequate internal parasite control in the herd was a median herd faecal egg count of less than or equal to 100 epg. Effectiveness of selective therapy was assessed by faecal egg count after nine months of treatment and was determined to be adequate when a median herd egg count of 0 epg was obtained. However, on returning from pasture the following September, median herd egg count had risen to 325 epg. A statistically significant correlation was seen in the paired September faecal egg counts of the horses in that initial September faecal egg count was predictive for the following September. Initial September faecal egg count was related to the number of anthelmintic treatments required during the period of selective therapy, whereas age of horse was not. We propose that faecal egg counts be incorporated into strategic anthelmintic programmes as an economical tool for identifying and targeting herd members predisposed to shedding elevated numbers of helminth eggs.

Influence of gastro-intestinal nematodes on the productivity of dairy cattle in the wet highlands of Sri Lanka

To study the response and economics of nematode control in cattle, trials with anthelmintics were carried out in the wet season at New Zealand farm in the highlands of Sri Lanka. Three age groups were used: stall fed yearlings, grazing heifers and lactating cows. Groups were treated with ivermectin or febantel and monitored along with control groups for faecal egg counts, growth and milk production. Treatment reduced the trichostrongylid faecal egg counts in yearlings, heifers and cows for six to 10 weeks, for more than 10 weeks and for 140 days respectively. The growth rate of treated yearlings did not increase significantly while treated heifers did grow significantly faster. Treated cows produced an average of 115 kg more milk over 133 days (P less than 0.05). The economic gains in reducing the age at first service and in terms of milk yield far outweighed the cost of anthelmintics used.

[An evaluation of the economic loss from intestinal helminthiases in the Uzbek SSR]

Calculations of economic loss costs due to procedures for helminth detection and the out-patient treatment of recognized cases of enterobiasis, hymenolepiasis, taeniasis, ascariasis, trichocephaliasis in the Uzbek SSR in 1985 were made as were the costs of inpatient treatment in the specialized clinics in 1986 with account for the loss due to the related decrease in the national output and payments for disability. Their total turned to be about 1.8 million rubles.

Influence of regular tick and helminth control on productivity of small ruminants in the Lolgorien area, Narok district, Kenya

Forty-five indigenous goats (one to two years old) and 45 indigenous sheep (six to eight months old) were exposed to natural tick and gastro-intestinal parasite challenge. All animals were born and reared in a pastoral husbandry system. Throughout the study they were housed at night under improved hygienic conditions and grazed during daytime with the flock from which they originated. Improvement of hygienic conditions reduced mortality. Control of intestinal parasites increased liveweight gain (LWG) in both species and reduced mortality most noticeably in sheep. Regular tick control had a negative influence on LWG in goats over one year old but a positive influence on LWG on young sheep. This, however, was of marginal economic benefit compared to a substantial benefit of helminth control.

Economics of deworming beef cattle

From the practitioner level and for the producer, there is far too much confusion concerning internal parasites in cattle and the justification of control measures. By coordinating research efforts between parasitologists and other scientists, awareness of internal parasites will be raised and the total impact of parasitism can better be evaluated.

Parasitic infections in asymptomatic homosexual men: cost-effective screening

The purpose of this study was to develop a cost-effective strategy for screening for enteric protozoan infections in homosexual men without gastrointestinal symptoms suggesting infection. One hundred and one homosexual men in Portland, Oregon, each submitted at least one unpurged stool sample; 91% submitted three samples each. Of these, 27% had Entamoeba histolytica, 61% had nonpathogenic protozoa with or without E. histolytica, 36% had a nonpathogen alone, and 3% had Giardia lamblia. Protozoan infection was highly associated with the practice of anilingus (p less than 0.005). Infection with E. histolytica correlated significantly with the presence of nonpathogenic protozoa (p less than 0.005). The following screening strategy was judged to be the most cost-effective: examine one sample first; if E. histolytica is found or if the sample is negative, no further investigation is required; if a nonpathogen is found, one additional sample should be obtained. This strategy had a sensitivity for E. histolytica of 85% and a cost of $136 per case detected.

Parasite screening and treatment among Indochinese refugees. Cost-benefit/utility and the General Health Policy Model

The General Health Policy Model and the Quality of Well-being scale are used to describe a "cost-benefit/utility" evaluation of a screening and treatment program for intestinal parasites among indochinese refugees in the United States. Cost-benefit/utility analysis subsumes conventional cost-effectiveness by explicitly adding social utility factors to the dollar dimension. Using actual data on parasite prevalence and program costs from one screening project and estimated figures for other factors, this article demonstrates calculation of the cost-benefit/utility outcome measure, dollars per well-year. Dollars per well-year for parasite screening are calculated for a number of examples. Further analysis and final conclusions on the worth of parasite screening and treatment programs await more reliable data for some terms of the developed model.

Parasitic disease in humans: the extent in Canada

Much is being said, often dramatically, about the potential hazards of parasitic diseases in Canada, but little or no attempt has been made to determine the true extent of the problem. Indigenous parasite pathogens are recognized in resident Canadians, and pathogens are acquired by travellers abroad or reported from immigrants. The role of each of these categories is important in the characterization of the problem of parasitic diseases in Canada. From data provided by provincial laboratories and hospitals it is estimated that 1 person in 1000 will spend 1 day per year in hospital because of intestinal parasites, and 1 in 100 each year will have a diagnosis of intestinal parasitic infection made from examination of a stool sample.