An achievable goal: control and elimination of schistosomiasis

Abstract

We were saddened to read the negative view of Allen Ross and colleagues (May 30, p 2220)1Ross AG Olveda RM Li Y An audacious goal: the elimination of schistosomiasis in our lifetime through mass drug administration.Lancet. 2015; 385: 2220-2221Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar about worldwide elimination of schistosomiasis. The authors judge that efforts to eliminate schistosomiasis from Africa are “audacious” and “will not work”. They suggest that funding should not be spent on distribution of praziquantel because this approach is “inherently flawed” because it “does not prevent reinfection” and might cause side-effects.2Muhumuza S Olsen A Katahiore A Nuwaha F Uptake of preventive treatment for intestinal schistosomiasis among school children in Jinja district Uganda: a cross sectional study.PLoS One. 2013; 8: e63438Crossref PubMed Scopus (40) Google Scholar They ignore the fact that praziquantel has been used for more than 30 years to treat hundreds of millions of people with little or no side-effects.3Danso-Appiah A Olliaro PL Donegan S Sinclair D Utzinger J Drugs for treating Schistosoma mansoni infection.Cochrane Database Syst Rev. 2013; 28 (CD000528.)Google Scholar, 4Kramer CV Zhang F Sinclair D Olliaro PL Drugs for treating urinary schistosomiasis.Cochrane Database Syst Rev. 2014; 8 (CD000053.)Google Scholar Preventive chemotherapy with praziquantel is a crucial component for disease control that immediately reduces morbidity and ill health caused by schistosomiasis. This treatment is not deemed a “stand alone approach” for elimination as they suggest. Indeed, the 2012 World Health Assembly resolution 65.21 on elimination of schistosomiasis, which they did not reference, is closely aligned with what Ross and colleagues suggest: “An integrated and intersectorial approach that goes beyond deworming.” In our view, the perception put forward by Ross and colleagues is biased and has a real danger of triggering scaling down of praziquantel treatment in endemic communities at a time when countries and donors are in the process of scaling up use of this drug within a comprehensive package to control and eliminate neglected tropical diseases. The authors mention only China's success in controlling schistosomiasis, but forget that praziquantel was essential for such progress.5Chen MG Use of praziquantel for clinical treatment and morbidity control of Schistosomiasis japonica in China: a review of 30 years' experience.Acta Trop. 2005; 96: 168-176Crossref PubMed Scopus (110) Google Scholar In fact, success has been reported in elimination of urogenital and intestinal schistosomiasis in parts of the Americas, Asia, and the Middle East, and huge progress has been made in morbidity control in other countries, such as Burkina Faso, Uganda, and Sudan.6Toure S Zhang Y Bosqué-Oliva et al.Two year impact of single praziquantel treatment on infection in the national control programme on schistosomiasis in Burkina Faso.Bull World Health Organ. 2008; 86: 780-787Crossref PubMed Scopus (82) Google Scholar, 7Rollinson D Knopp S Levitz S et al.Time to set the agenda for schistosomiasis elimination.Acta Tropica. 2013; 128: 423-440Crossref PubMed Scopus (386) Google Scholar Ross and colleagues forget to mention the ecological complexity of Schistosoma japonicum compared with African schistosomes, offering a simple opportunity to reduce transmission, as recognised in an agreement between China, Zanzibar, and WHO to eliminate urogenital schistosomiasis. The authors acknowledge the Merck Praziquantel Donation Program, but do not appreciate its importance for Africa. By 2016, this investment will provide 100 million treatments a year and could be game changing in expanding the much needed control and elimination programmes supported by organisations such as the Department for International Development and US Agency for International Development. We are hopeful that the international community and endemic countries will extend integrated control and elimination programmes. Integrated programmes will focus on preventive chemotherapy and include other interventions, such as behavioural changes and snail control to reduce reinfection. Some of the fastest growing economies are in Africa; we expect these countries to invest in control and elimination of schistosomiasis and other neglected tropical diseases, which are associated with poverty. As Nelson Mandela said, “it always seems impossible until it's done”. Schistosomiasis elimination is possible and preventive chemotherapy is the start of the road towards a world free of this scourge on humanity. We declare no competing interests. We thank David Molyneux, Amadou Garba, and Lester Chitsulo for their comments and support. An audacious goal: the elimination of schistosomiasis in our lifetime through mass drug administrationPreventive chemotherapy with 40 mg/kg of praziquantel has been endorsed and advocated by WHO1 for the global control of schistosomiasis, yet the drug does not prevent reinfection. In this Viewpoint, we discuss issues related to this control strategy, which is now implemented in many countries where schistosomiasis is endemic. Full-Text PDF