Achieving Elimination as a Public Health Problem for Schistosoma mansoni and S. haematobium: When Is Community-Wide Treatment Required?

Jaspreet Toor,T Déirdre Hollingsworth,Graham F Medley,Anouk Gouvras,David Rollinson,Hugo C Turner,Charles H King,Roy M Anderson

doi:10.1093/infdis/jiz609

Abstract

The World Health Organization (WHO) has set elimination as a public health problem (EPHP) as a goal for schistosomiasis. As the WHO treatment guidelines for schistosomiasis are currently under revision, we investigate whether school-based or community-wide treatment strategies are required for achieving the EPHP goal. In low- to moderate-transmission settings with good school enrolment, we find that school-based treatment is sufficient for achieving EPHP. However, community-wide treatment is projected to be necessary in certain high-transmission settings as well as settings with low school enrolment. Hence, the optimal treatment strategy depends on setting-specific factors such as the species present, prevalence prior to treatment, and the age profile of infection.

Highlights

There is a limited supply and availability, in Africa, of the treatment drug, praziquantel, used to treat infected individuals
In low to moderate baseline prevalence settings (SAC prevalence
In moderate-prevalence settings for S. haematobium, analyses suggest that EPHP can be achieved by treating 75% SAC only in 1 round of treatment

Summary

Introduction

There is a limited supply and availability, in Africa, of the treatment drug, praziquantel, used to treat infected individuals. Merck KGaA is currently the sole donor of praziquantel with 250 million tablets available annually, primarily for SAC [9]. Praziquantel is typically used in school-based (targeting SAC only) or community-wide (targeting both SAC and adults) mass drug administration (MDA) programs in which a proportion of the population is treated without diagnosis of infection. Given the limited supply of praziquantel, it is vital that the appropriate treatment strategy is used to prevent unnecessary treatment and to enable the efficient use of this valuable resource, allowing redeployment to those needing treatment. Additional praziquantel over that available in donations can be purchased but comes at a further cost for treatment programs. Through analysis of mathematical models on schistosomiasis transmission dynamics and EPHP Strategies for Schistosomiasis jid 2019:XX (XX XXXX) S1

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