title: Efficacy and safety of two closely spaced doses of praziquantel against Schistosoma haematobium and S. mansoni and re-infection patterns in school-aged children in Niger.
abstract: The aim of this study was to assess the efficacy and safety of two closely spaced doses of praziquantel (PZQ) against Schistosoma haematobium and S. mansoni infection in school-aged children, and to characterise re-infection patterns over a 12-month period. The study was carried out in five villages in western Niger: Falmado, Seberi and Libore (single S. haematobium infection foci), and Diambala and Namarigoungou (mixed S. haematobium-S. mansoni infection foci). Parasitological examinations consisted of triplicate urine filtrations and triplicate Kato-Katz thick smears at each visit. Two 40mg/kg oral doses of PZQ were administered 3 weeks apart. Adverse events were monitored within 4h after dosing by the survey team and 24h after treatment using a questionnaire. Our final study cohort comprised 877 children who were infected with either S. haematobium, or S. mansoni, or both species concurrently and received both doses of PZQ. Follow-up visits were conducted 6 weeks, 6 months and 12 months after the first dose of PZQ. At baseline, the geometric mean (GM) infection intensity of S. haematobium ranged from 3.6 (Diambala) to 30.3eggs/10ml of urine (Falmado). The GM infection intensity of S. mansoni ranged from 86.7 (Diambala) to 151.4eggs/g of stool (Namarigoungou). Adverse events were reported by 33.0% and 1.5% of the children after the first and second doses of PZQ, respectively. We found cure rates (CRs) in S. haematobium-infected children 3 weeks after the second dose of PZQ ranging between 49.2% (Falmado) and 98.4% (Namarigoungou) and moderate-to-high egg reduction rates (ERRs) (71.4-100%). Regarding S. mansoni, only moderate CRs and ERRs were found (51.7-58.8% in Diambala, 55.2-60.2% in Namarigoungou). Twelve months post-treatment, prevalence rates approached pre-treatment levels, but infection intensities remained low. In conclusion, PZQ, given in two closely spaced doses, is efficacious against S. haematobium, but the low ERR observed against S. mansoni raises concern about mounting PZQ tolerance.
authors.affiliation: Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), 1448, Bd de l'Indépendance, B.P. 13724, Niamey, Niger; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland. Electronic address: garbamadou@yahoo.fr.
authors.forename: Amadou
authors.initials: A
authors.lastname: Garba
authors.forename: Mariama S
authors.initials: MS
authors.lastname: Lamine
authors.forename: Nouhou
authors.initials: N
authors.lastname: Barkiré
authors.forename: Ali
authors.initials: A
authors.lastname: Djibo
authors.forename: Boubacar
authors.initials: B
authors.lastname: Sofo
authors.forename: Anouk N
authors.initials: AN
authors.lastname: Gouvras
authors.forename: Rabiou
authors.initials: R
authors.lastname: Labbo
authors.forename: Hannatou
authors.initials: H
authors.lastname: Sebangou
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Webster
authors.forename: Alan
authors.initials: A
authors.lastname: Fenwick
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
mesh_terms: D000293:Adolescent; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D009548:Niger / Q000453:epidemiology; D011223:Praziquantel / Q000008:administration & dosage / Q000009:adverse effects*; D015995:Prevalence; D012008:Recurrence; D012548:Schistosoma haematobium / Q000302:isolation & purification*; D012550:Schistosoma mansoni / Q000302:isolation & purification*; D012553:Schistosomiasis haematobia / Q000188:drug therapy* / Q000453:epidemiology; D012555:Schistosomiasis mansoni / Q000188:drug therapy* / Q000453:epidemiology; D013334:Students; D016896:Treatment Outcome
chemical_list: D000871:Anthelmintics; D011223:Praziquantel