title: Mapping of Schistosoma mansoni in the Nile Delta, Egypt: Assessment of the prevalence by the circulating cathodic antigen urine assay.
abstract: In line with WHO recommendations on elimination of schistosomiasis, accurate identification of all areas of residual transmission is a key step to design and implement measures aimed at interrupting transmission in low-endemic settings. To this purpose, we assessed the prevalence of active S. mansoni infection in five pilot governorates in the Nile Delta of Egypt by examining schoolchildren (6-15 years) using the Urine-Circulating Cathodic Antigen (Urine-CCA) cassette test; we also carried out the standard Kato-Katz (KK) thick smear, the monitoring and evaluation tool employed by Egypt's national schistosomiasis control programme. Prevalence rates determined by the Urine-CCA test for all governorates were higher than those determined by KK (p<0.01). Of 35 districts surveyed in the five governorates, S. mansoni infection was detected in 19 districts (54.3%) using KK, and in 31 districts (88.6%) by Urine-CCA (χ2=9.94; P=0.0016). S. mansoni infections were detected by Urine-CCA, but not by KK in 12 districts (34.3%), and infection was not detected by either of the two diagnostic methods in four districts in Qalyubia governorate. Males and higher age-groups have significantly higher Urine-CCA prevalence rates. Based on the findings of the current S. mansoni mapping exercise, authorities of the Ministry of Health and Population (MoHP) adopted a new elimination strategy by readjusting thresholds for mass treatment with praziquantel and targeting all transmission areas. MoHP is now planning to remap in all other endemic governorates using Urine-CCA with the aim of identifying all areas of transmission where the elimination strategy should be applied.
authors.affiliation: Ministry of Health and Population, Cairo, Egypt. Electronic address: ayatef@yahoo.com.
authors.forename: Ayat A
authors.initials: AA
authors.lastname: Haggag
authors.affiliation: Ministry of Health and Population, Cairo, Egypt. Electronic address: amalrabiee1@gmail.com.
authors.forename: Amal
authors.initials: A
authors.lastname: Rabiee
authors.affiliation: Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Egypt. Electronic address: khaledabdu@yahoo.com.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Abd Elaziz
authors.affiliation: Regional Advisor for Neglected Tropical Diseases, Department of Communicable Disease Prevention and Control, WHO/EMRO, Cairo, Egypt. Electronic address: GabrielliA@who.int.
authors.forename: Albis F
authors.initials: AF
authors.lastname: Gabrielli
authors.affiliation: Department of Public Health, Faculty of Medicine, Cairo University, Egypt. Electronic address: rehababelhai@kasralainy.edu.eg.
authors.forename: Rehab
authors.initials: R
authors.lastname: Abdel Hay
authors.affiliation: National Nutrition Institute, General Organisation for Teaching Hospitals and Institutes, Cairo, Egypt. Electronic address: reda.mr.ramzy@gmail.com.
authors.forename: Reda M R
authors.initials: RMR
authors.lastname: Ramzy
mesh_terms: D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D000947:Antigens, Helminth / Q000652:urine*; D002648:Child; D004534:Egypt / Q000453:epidemiology; D005260:Female; D062305:Geographic Mapping; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011223:Praziquantel / Q000627:therapeutic use; D015995:Prevalence; D012550:Schistosoma mansoni / Q000276:immunology*; D012555:Schistosomiasis mansoni / Q000188:drug therapy / Q000453:epidemiology* / Q000652:urine; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
chemical_list: D000871:Anthelmintics; D000947:Antigens, Helminth; D011223:Praziquantel
keywords: Egypt; Elimination; Kato-Katz; Mapping; S. mansoni; Urine-CCA