title: Impact of Schistosoma mansoni on malaria transmission in Sub-Saharan Africa.
abstract: BACKGROUND
  Sub-Saharan Africa harbors the majority of the global burden of malaria and schistosomiasis infections. The co-endemicity of these two tropical diseases has prompted investigation into the mechanisms of coinfection, particularly the competing immunological responses associated with each disease. Epidemiological studies have shown that infection with Schistosoma mansoni is associated with a greater malaria incidence among school-age children.
  
  
  METHODS
  We developed a co-epidemic model of malaria and S. mansoni transmission dynamics which takes into account key epidemiological interaction between the two diseases in terms of elevated malaria incidence among individuals with S. mansoni high egg output. The model was parameterized for S. mansoni high-risk endemic communities, using epidemiological and clinical data of the interaction between S. mansoni and malaria among children in sub-Saharan Africa. We evaluated the potential impact of the S. mansoni-malaria interaction and mass treatment of schistosomiasis on malaria prevalence in co-endemic communities.
  
  
  RESULTS
  Our results suggest that in the absence of mass drug administration of praziquantel, the interaction between S. mansoni and malaria may reduce the effectiveness of malaria treatment for curtailing malaria transmission, in S. mansoni high-risk endemic communities. However, when malaria treatment is used in combination with praziquantel, mass praziquantel administration may increase the effectiveness of malaria control intervention strategy for reducing malaria prevalence in malaria- S. mansoni co-endemic communities.
  
  
  CONCLUSIONS
  Schistosomiasis treatment and control programmes in regions where S. mansoni and malaria are highly prevalent may have indirect benefits on reducing malaria transmission as a result of disease interactions. In particular, mass praziquantel administration may not only have the direct benefit of reducing schistosomiasis infection, it may also reduce malaria transmission and disease burden.
authors.affiliation: School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Martial L
authors.initials: ML
authors.lastname: Ndeffo Mbah
authors.affiliation: School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Skrip
authors.affiliation: School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Scott
authors.initials: S
authors.lastname: Greenhalgh
authors.affiliation: National School of Tropical Medicine, and Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Hotez
authors.affiliation: School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology*; D006801:Humans; D007159:Immunologic Tests; D015994:Incidence; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000635:transmission; D008297:Male; D008962:Models, Theoretical; D011223:Praziquantel / Q000627:therapeutic use*; D015995:Prevalence; D012111:Residence Characteristics; D012548:Schistosoma haematobium / Q000276:immunology; D012550:Schistosoma mansoni / Q000276:immunology; D012552:Schistosomiasis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000635:transmission
chemical_list: D000871:Anthelmintics; D011223:Praziquantel