Abstract
Schistosomiasis affects over 200 million people worldwide, most of whom are children. Research and control strategies directed at preschool-aged children (PSAC), i.e., ≤5 years old, have lagged behind those in older children and adults. With the recent WHO revision of the schistosomiasis treatment guidelines to include PSAC, and the recognition of gaps in our current knowledge on the disease and its treatment in this age group, there is now a concerted effort to address these shortcomings. Global and national schistosome control strategies are yet to include PSAC in treatment schedules. Maximum impact of schistosome treatment programmes will be realised through effective treatment of PSAC. In this review, we (i) discuss the current knowledge on the dynamics and consequences of paediatric schistosomiasis and (ii) identify knowledge and policy gaps relevant to these areas and to the successful control of schistosome infection and disease in this age group. Herein, we highlight risk factors, immune mechanisms, pathology, and optimal timing for screening, diagnosis, and treatment of paediatric schistosomiasis. We also discuss the tools required for treating schistosomiasis in PSAC and strategies for accessing them for treatment.
Highlights
Several factors influence the risk for schistosome infection in preschool-aged children (PSAC), including those already identified in other age groups [Fig 1]
The immune responses occurring in the early stages of infection are poorly documented in humans, and these events in PSAC would be very informative on the nature and development of both pathological and parasite-protective immunity
In a recent study in Zimbabwean PSAC, we showed an increase in anti-parasite IgM and IgE titres, six weeks after treatment with PZQ, and this was associated with resistance to reinfection [42]
Summary
Operational difficulties, including obtaining parasitology samples for diagnosis, failure to detect light infections, and inadequate knowledge about risk factors in PSAC, have biased studies towards school-aged children (SAC), i.e., !6 years old and adults. There is a need for inclusion of PSAC in large-scale projects that map the distribution of schistosomiasis, to inform planning for drug procurement and operational strategies for including these children in national control programmes.
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