title: Performance and safety of praziquantel for treatment of intestinal schistosomiasis in infants and preschool children.
abstract: BACKGROUND
  In 2012 the WHO formally recognised that infants and preschool children are at significant risk of schistosomiasis and qualify for treatment with praziquantel (PZQ). Targeted surveys determining both the performance and safety of this drug are now needed in endemic areas. We have formally assessed parasitological cure and putative side-effects in a prospective cohort of Schistosoma mansoni-infected children (aged 5 months-7 years old) in lakeshore settings of Uganda.
  
  
  RESULTS
  From a total of 369 children found to be egg-patent for intestinal schistosomiasis, 305 were followed-up three to four weeks after PZQ treatment and infection status re-assessed. Separately, a previously tested side-effect questionnaire was employed before and 24 hours after PZQ treatment to assess incidence and amelioration of symptoms in young children and their mothers. While the overall observed parasitological cure was 56.4%, a significant difference was found between a sub-set of children who had a history of multiple PZQ treatments (between one and four in an 18 month period), where cure rate was 41.7%, and those who had never received treatment (cure rate was 77·6%). PZQ proved to be safe, with only mild reported side effects which cleared within a month after treatment. Prevalence of reported symptoms was significantly lower in children than in mothers, and fewer side-effects were reported upon subsequent rounds of PZQ treatment.
  
  
  CONCLUSIONS
  Our findings show that PZQ treatment of young children resulted in satisfactory cure rates, and marked reduction in egg-output, with only mild and transient reported side-effects. However, the cure rate is clearly lower in younger children and those with history of previous treatment. Cure rate, but not egg reduction rate, was also lower in children with heavier pre-intervention infection intensity. With chemotherapy now recommended as a long-term strategy for disease control in young children, research into optimising the periodicity of targeted treatment strategies is now crucial.
authors.affiliation: Disease Control Strategy Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: José C
authors.initials: JC
authors.lastname: Sousa-Figueiredo
authors.forename: Martha
authors.initials: M
authors.lastname: Betson
authors.forename: Aaron
authors.initials: A
authors.lastname: Atuhaire
authors.forename: Moses
authors.initials: M
authors.lastname: Arinaitwe
authors.forename: Annalan M D
authors.initials: AM
authors.lastname: Navaratnam
authors.forename: Narcis B
authors.initials: NB
authors.lastname: Kabatereine
authors.forename: Quentin
authors.initials: Q
authors.lastname: Bickle
authors.forename: J Russell
authors.initials: JR
authors.lastname: Stothard
mesh_terms: D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010270:Parasite Egg Count; D011223:Praziquantel / Q000008:administration & dosage* / Q000009:adverse effects*; D012550:Schistosoma mansoni / Q000187:drug effects / Q000302:isolation & purification; D012555:Schistosomiasis mansoni / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014454:Uganda
chemical_list: D000871:Anthelmintics; D011223:Praziquantel