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Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children

  • J. RUSSELL STOTHARD (a1), JOSÉ C. SOUSA-FIGUEIREDO (a1) (a2), MARTHA BETSON (a1), HELEN K. GREEN (a1), EDMUND Y. W. SETO (a3), AMADOU GARBA (a4), MOUSSA SACKO (a5), FRANCISCA MUTAPI (a6), SUSANA VAZ NERY (a7), MUTAMAD A. AMIN (a8), MARGARET MUTUMBA-NAKALEMBE (a9), ANNALAN NAVARATNAM (a9), ALAN FENWICK (a9), NARCIS B. KABATEREINE (a10), ALBIS F. GABRIELLI (a11) and ANTONIO MONTRESOR (a11)
  • DOI: http://dx.doi.org/10.1017/S0031182011001235
  • Published online: 24 August 2011
Abstract
SUMMARY

Where very young children come into contact with water containing schistosome cercariae, infections occur and schistosomiasis can be found. In high transmission environments, where mothers daily bathe their children with environmentally drawn water, many infants and preschool-aged children have schistosomiasis. This ‘new’ burden, inclusive of co-infections with Schistosoma haematobium and Schistosoma mansoni, is being formally explored as infected children are not presently targeted to receive praziquantel (PZQ) within current preventive chemotherapy campaigns. Thus an important PZQ treatment gap exists whereby infected children might wait up to 4–5 years before receiving first treatment in school. International treatment guidelines, set within national treatment platforms, are presently being modified to provide earlier access to medication(s). Although detailed pharmacokinetic studies are needed, to facilitate pragmatic dosing in the field, an extended ‘dose pole’ has been devised and epidemiological monitoring has shown that administration of PZQ (40 mg/kg), in either crushed tablet or liquid suspension, is both safe and effective in this younger age-class; drug efficacy, however, against S. mansoni appears to diminish after repeated rounds of treatment. Thus use of PZQ should be combined with appropriate health education/water hygiene improvements for both child and mother to bring forth a more enduring solution.

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The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <http://creativecommons.org/licenses/by-nc-sa/2.5/>. The written permission of Cambridge University Press must be obtained for commercial re-use.
Corresponding author
*Corresponding author: J. Russell Stothard, Centre for Tropical and Infectious Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. Tel.: +44 0151 7053724; E-mail: jrstoth@liv.ac.uk
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