title: Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children.
abstract: Where very young children come into contact with water containing schistosome cercariae, infections occur and schistosomiasis can be found. In high transmission environments, where mothers daily bathe their children with environmentally drawn water, many infants and preschool-aged children have schistosomiasis. This 'new' burden, inclusive of co-infections with Schistosoma haematobium and Schistosoma mansoni, is being formally explored as infected children are not presently targeted to receive praziquantel (PZQ) within current preventive chemotherapy campaigns. Thus an important PZQ treatment gap exists whereby infected children might wait up to 4-5 years before receiving first treatment in school. International treatment guidelines, set within national treatment platforms, are presently being modified to provide earlier access to medication(s). Although detailed pharmacokinetic studies are needed, to facilitate pragmatic dosing in the field, an extended 'dose pole' has been devised and epidemiological monitoring has shown that administration of PZQ (40 mg/kg), in either crushed tablet or liquid suspension, is both safe and effective in this younger age-class; drug efficacy, however, against S. mansoni appears to diminish after repeated rounds of treatment. Thus use of PZQ should be combined with appropriate health education/water hygiene improvements for both child and mother to bring forth a more enduring solution.
authors.affiliation: Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, London, SW7 5BD, UK. jrstoth@liv.ac.uk
authors.forename: J Russell
authors.initials: JR
authors.lastname: Stothard
authors.forename: José C
authors.initials: JC
authors.lastname: Sousa-Figueiredo
authors.forename: Martha
authors.initials: M
authors.lastname: Betson
authors.forename: Helen K
authors.initials: HK
authors.lastname: Green
authors.forename: Edmund Y W
authors.initials: EY
authors.lastname: Seto
authors.forename: Amadou
authors.initials: A
authors.lastname: Garba
authors.forename: Moussa
authors.initials: M
authors.lastname: Sacko
authors.forename: Francisca
authors.initials: F
authors.lastname: Mutapi
authors.forename: Susana
authors.initials: S
authors.lastname: Vaz Nery
authors.forename: Mutamad A
authors.initials: MA
authors.lastname: Amin
authors.forename: Margaret
authors.initials: M
authors.lastname: Mutumba-Nakalembe
authors.forename: Annalan
authors.initials: A
authors.lastname: Navaratnam
authors.forename: Alan
authors.initials: A
authors.lastname: Fenwick
authors.forename: Narcis B
authors.initials: NB
authors.lastname: Kabatereine
authors.forename: Albis F
authors.initials: AF
authors.lastname: Gabrielli
authors.forename: Antonio
authors.initials: A
authors.lastname: Montresor
mesh_terms: D000349:Africa / Q000453:epidemiology; D000367:Age Factors; D000740:Anemia / Q000453:epidemiology; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D060085:Coinfection; D005243:Feces / Q000469:parasitology; D005260:Female; D006529:Hepatomegaly; D006801:Humans; D007223:Infant; D011223:Praziquantel / Q000008:administration & dosage* / Q000627:therapeutic use; D015995:Prevalence; D012553:Schistosomiasis haematobia / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D012555:Schistosomiasis mansoni / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D013163:Splenomegaly; D014867:Water / Q000469:parasitology / Q000592:standards
chemical_list: D000871:Anthelmintics; D014867:Water; D011223:Praziquantel