title: No apparent reduction in schistosome burden or genetic diversity following four years of school-based mass drug administration in mwea, central kenya, a heavy transmission area.
abstract: BACKGROUND
  Schistosomiasis is a debilitating neglected tropical disease that infects over 200 million people worldwide. To combat this disease, in 2012, the World Health Organization announced a goal of reducing and eliminating transmission of schistosomes. Current control focuses primarily on mass drug administration (MDA). Therefore, we monitored transmission of Schistosoma mansoni via fecal egg counts and genetic markers in a typical school based MDA setting to ascertain the actual impacts of MDA on the targeted schistosome population.
  
  
  METHODS
  For 4 years, we followed 67 children enrolled in a MDA program in Kenya. Infection status and egg counts were measured each year prior to treatment. For 15 of these children, for which there was no evidence of acquired resistance, meaning they became re-infected following each treatment, we collected microsatellite genotype data from schistosomes passed in fecal samples as a representation of the force of transmission between drug treatments. We genotyped a total of 4938 parasites from these children, with an average of 329.2 parasites per child for the entire study, and an average of 82.3 parasites per child per annual examination. We compared prevalence, egg counts, and genetic measures including allelic richness, gene diversity (expected heterozygosity), adult worm burdens and effective number of breeders among time points to search for evidence for a change in transmission or schistosome populations during the MDA program.
  
  
  RESULTS
  We found no evidence of reduced transmission or schistosome population decline over the course of the program. Although prevalence declined in the 67 children as it did in the overall program, reinfection rates were high, and for the 15 children studied in detail, schistosome egg counts and estimated adult worm burdens did not decline between years 1 and 4, and genetic diversity increased over the course of drug treatment.
  
  
  CONCLUSIONS
  School based control programs undoubtedly improve the health of individuals; however, our data show that in an endemic area, such a program has had no obvious effect on reducing transmission or of significantly impacting the schistosome population as sampled by the children we studied in depth. Results like these, in combination with other sources of information, suggest more integrated approaches for interrupting transmission and significantly diminishing schistosome populations will be required to achieve sustainable control.
authors.affiliation: Centre for Biotechnology Research and Development, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Agola E
authors.initials: AE
authors.lastname: Lelo
authors.affiliation: Kenyatta University, Department of Biochemistry, Nairobi, Kenya.
authors.forename: David N
authors.initials: DN
authors.lastname: Mburu
authors.affiliation: Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya.
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Magoma
authors.affiliation: Centre for Biotechnology Research and Development, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Ben N
authors.initials: BN
authors.lastname: Mungai
authors.affiliation: Centre for Biotechnology Research and Development, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Jimmy H
authors.initials: JH
authors.lastname: Kihara
authors.affiliation: Centre for Biotechnology Research and Development, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Ibrahim N
authors.initials: IN
authors.lastname: Mwangi
authors.affiliation: Centre for Biotechnology Research and Development, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Maina
authors.affiliation: Centre for Biotechnology Research and Development, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Kinuthia
authors.affiliation: Centre for Biotechnology Research and Development, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Mutuku
authors.affiliation: Department of Biology, University of New Mexico, Albuquerque, New Mexico, United States of America.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Loker
authors.affiliation: Centre for Biotechnology Research and Development, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Mkoji
authors.affiliation: Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific Northwest, Western University of Health Sciences, Lebanon, Oregon, United States of America.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Steinauer
mesh_terms: D000328:Adult; D000818:Animals; D002648:Child; D017281:Cost of Illness; D005243:Feces / Q000469:parasitology; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012550:Schistosoma mansoni / Q000235:genetics; D012555:Schistosomiasis mansoni / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D012574:Schools