Changing policy and practice in the control of pediatric schistosomiasis.

Abstract

Schistosomiasis is a chronic disease that affects ∼200 million people. The extended health impact of the disease has been estimated to exceed that of malaria or tuberculosis and to be nearer to that of HIV/AIDS. Within endemic areas, children carry the heaviest burden of infection. Infection/disease is controlled by the treatment of infected subjects with the anthelminthic drug praziquantel. Global initiatives from Partners of Parasite Control, including the World Health Organization (WHO), advocate regular school-based deworming strategies to reduce the development of severe morbidity, promote school-child health and development, and improve the cognitive potential of children. Until recently, preschool-aged children were excluded from schistosome treatment, creating a health inequity in affected populations. In 2010, the WHO updated their recommendations for the treatment of schistosomiasis in preschool-aged children (ie, children aged ≤5 years). This change was the culmination of several decades of research on schistosome epidemiology, immunology, and pathology in this age group. The recent development of a pediatric formulation of praziquantel (soon to enter clinical trials) should advance control efforts in preschool-aged children, with the goal of including these children in preventative chemotherapy (as currently occurs for soil-transmitted helminths). This review discusses the research work supporting the WHO revision of recommendations for treating preschool-aged children, as well as current barriers and knowledge gaps in pediatric schistosomiasis control.