Abstract
BackgroundSoil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity. To mitigate their disease burden, at-risk groups in endemic regions receive periodic mass drug administration using anthelmintics, most commonly albendazole and mebendazole. Assessing the efficacy of anthelmintic drugs is important for confirming that these regimens are working effectively and that drug resistance has not emerged. In this study we aimed to characterise the therapeutic efficacy of albendazole against Ascaris spp. and N. americanus in Timor-Leste, using a quantitative polymerase chain reaction (qPCR) method for parasite detection and quantification.ResultsA total of 314 participants from 8 communities in Timor-Leste provided stool samples before and 10–14 days after the administration of a single 400 mg dose of albendazole. Helminth infection status and infection intensity (measured in Ct-values and relative fluorescence units) were determined using qPCR. Efficacy was determined by examining the cure rates and infection intensity reduction rates. Albendazole was found to be highly efficacious against Ascaris spp., with a cure rate of 91.4% (95% CI: 85.9–95.2%) and infection intensity reduction rate of 95.6% (95% CI: 88.3–100%). The drug was less efficacious against N. americanus with a cure rate of 58.3% (95% CI: 51.4–64.9%) and infection intensity reduction rate of 88.9% (95% CI: 84.0–97.0%).ConclusionsThe observed cure rates and infection intensity reduction rates obtained for Ascaris spp. and to a lower extent N. americanus, demonstrate the continued efficacy of albendazole against these species and its utility as a mass chemotherapy agent in Timor-Leste. Furthermore, this study demonstrates the usefulness of qPCR as a method to measure the efficacy of anthelminthic drugs. Additional research is necessary to translate Ct-values into eggs per gram in a systematic way.Trial registrationAustralian and New Zealand Clinical Trials Registry 12614000680662 (registered 27 June 2014).
Highlights
Soil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity
The aim of this study was to determine the efficacy of a single dose of albendazole against soil-transmitted helminths (STHs) infections using quantitative polymerase chain reaction for the detection and quantification of Ascaris spp., N. americanus, Ancylostoma spp. and T. trichiura, in the context of the implementation of the WASH for WORMS study, a cluster randomised controlled trial (RCT) in rural communities in Timor-Leste [17, 22]
The most prevalent species was N. americanus at 69. 4%, followed by Ascaris spp. at 51. 6%
Summary
Soil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity. To mitigate their disease burden, at-risk groups in endemic regions receive periodic mass drug administration using anthelmintics, most commonly albendazole and mebendazole. The infective stages of these parasites thrive in the warm moist soils of tropical regions, and are transmitted through oral ingestion or skin penetration [2]. These modes of transmission mean that the most affected individuals are from poor communities that lack the adequate water, hygiene and sanitation necessary to prevent transmission and reinfection. Studies have indicated the significant adverse impact of STH infection on school attendance and performance and future economic productivity, the health impact of STH infection is being debated [4,5,6]
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