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3. Review of 2022 WHO guidelines on the control and elimination of schistosomiasis

Author

Lo, Nathan C, Bezerra, Fernando Schemelzer Moraes, Colley, Daniel G, Fleming, Fiona M, Homeida, Mamoun, Kabatereine, Narcis, Kabole, Fatma M, King, Charles H, Mafe, Margaret A, Midzi, Nicholas, Mutapi, Francisca, Mwanga, Joseph R, Ramzy, Reda M R, Satrija, Fadjar, Stothard, J Russell, Traoré, Mamadou Souncalo, Webster, Joanne P, Utzinger, Jürg, Zhou, Xiao-Nong, Danso-Appiah, Anthony, Eusebi, Paolo, Loker, Eric S, Obonyo, Charles O, Quansah, Reginald, Liang, Song, Vaillant, Michel, Murad, M Hassan, Hagan, Paul, and Garba, Amadou

Published
2022
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9. Review of 2022 World Health Organization guidelines on the control and elimination of schistosomiasis

Author

Lo, Nathan C., Moraes Bezerra, Fernando Schemelzer, Colley, Daniel G., Fleming, Fiona M., Homeida, Mamoun, Kabatereine, Narcis, Kabole, Fatma M., King, Charles H., Mafe, Margaret A., Midzi, Nicholas, Mutapi, Francisca, Mwanga, Joseph, Ramzy, Reda M.R., Satrija, Fadjar, Stothard, Russell, Traoré, Mamadou Souncalo, Webster, Joanne P., Utzinger, Jürg, Zhou, Xia-Nong, Danso-Appiah, Anthony, Eusebi, Paolo, Loker, Eric S., Obonyo, Charles O., Quansah, Reginald, Song, Liang, Vaillant, Michel, Murad, M. Hassan, Hagan, Paul, and Garba, Amadou

Subjects
wc_810, wc_765, wa_530
Abstract

Schistosomiasis is a helminthiasis infecting approximately 250 million people worldwide. In 2001, the World Health Assembly (WHA) 54.19 resolution defined a new global strategy for control of schistosomiasis through preventive chemotherapy programmes. This resolution culminated in the 2006 WHO guidelines that recommended empirical treatment by mass drug administration with praziquantel, predominately to school-aged children in endemic settings at regular intervals. Since then, school-based and community-based preventive chemotherapy programmes have been scaled-up, reducing schistosomiasis-associated morbidity. Over the past 15 years, new scientific evidence—combined with a more ambitious goal of eliminating schistosomiasis and an increase in the global donated supply of praziquantel—has highlighted the need to update public health guidance worldwide. In February, 2022, WHO published new guidelines with six recommendations to update the global public health strategy against schistosomiasis, including expansion of preventive chemotherapy eligibility from the predominant group of school-aged children to all age groups (2 years and older), lowering the prevalence threshold for annual preventive chemotherapy, and increasing the frequency of treatment. This Review, written by the 2018–2022 Schistosomiasis Guidelines Development Group and its international partners, presents a summary of the new WHO guideline recommendations for schistosomiasis along with their historical context, supporting evidence, implications for public health implementation, and future research needs.

Published
2022

10. Efficacy and safety of praziquantel plus artemisinin-based combinations versus praziquantel in the treatment of Kenyan children with Schistosoma mansoni infection: open-label, randomized, head-to-head, non-inferiority trial.

Author

Obonyo CO, Were VO, Wamae P, and Muok EMO

Subjects
Humans, Child, Female, Male, Adolescent, Kenya, Animals, Anthelmintics therapeutic use, Anthelmintics adverse effects, Pyrimethamine therapeutic use, Pyrimethamine adverse effects, Amodiaquine therapeutic use, Amodiaquine adverse effects, Mefloquine therapeutic use, Mefloquine adverse effects, Artesunate therapeutic use, Treatment Outcome, Piperazines, Quinolines, Praziquantel therapeutic use, Praziquantel adverse effects, Artemisinins therapeutic use, Artemisinins adverse effects, Schistosomiasis mansoni drug therapy, Drug Therapy, Combination, Drug Combinations, Schistosoma mansoni drug effects
Abstract

Praziquantel alone is insufficient for the control of schistosomiasis due to poor efficacy against juvenile worms and increasing concerns about the risk of drug resistance. We compared the efficacy and safety of praziquantel combined with four different artemisinin-based combinations to praziquantel alone in treating Schistosoma mansoni infection in Kenyan children. In this randomized, open-label, five-arm, head-to-head, non-inferiority trial, children (aged 9-15 years) with S. mansoni infection according to duplicate Kato Katz thick smears from a stool sample in the Mwea irrigation scheme of central Kenya, were enrolled. Participants were randomly assigned (1:1:1:1:1) via a computer-generated block randomization procedure to receive a single oral dose of praziquantel (PZQ) (40 mg/kg/day) alone or in combination with a 3-day course (4 mg/kg of artesunate) of artesunate plus sulfalene-pyrimethamine (As + SP), artesunate plus amodiaquine (As + AQ), artesunate plus mefloquine (As + MQ) or dihydroartemisinin-piperaquine (DHAP). Laboratory technicians were masked to treatment allocation, but participants, clinicians, and study nurses were not. The primary outcomes were the cure rate and frequency of adverse events, which were assessed 6 weeks after treatment in the available case population using a per-protocol analysis. The non-inferiority margin was set at -10% for the risk difference in cure rates between combination therapy and PZQ alone. Between 12 September 2018 and 11 January 2019, 540 participants were assigned to receive PZQ alone ( n = 108), PZQ plus As + SP ( n = 108), PZQ plus As + AQ ( n = 108), PZQ plus As + MQ ( n = 108), or PZQ plus DHAP ( n = 108). Primary outcome data were available for 523 (96.9%) participants. The cure rate was 82.5% (85/103) in PZQ alone, 81.7% (85/104) in PZQ plus As + SP, 76.2% (80/105) in PZQ plus As + AQ, 88.7% (94/106) in PZQ plus As + MQ, and 85.7% (90/105) in PZQ plus DHAP arm. Non-inferiority was declared for PZQ plus As + MQ (difference 6.2 [95% confidence interval: -3.3 to 15.6]) and PZQ plus DHAP (3.2 [-6.7 to 13.1]) but not for PZQ plus As + SP (-0.8 [-11.2 to 9.6]) or PZQ plus As + AQ (-6.3 [-17.3 to 4.6]). Adverse events were reported by 26% (138/540) of participants, including abdominal pain, headache, and vomiting. There were no serious adverse events. Alternatives to praziquantel should include praziquantel plus artesunate-mefloquine or praziquantel plus dihydroartemisinin-piperaquine. However, further multicentre trials are needed in different epidemiological settings and population groups to confirm these findings.CLINICAL TRIALSThis study is registered with the Pan-African Clinical Trials Registry under PACTR202001919442161., Competing Interests: The authors declare no conflict of interest.

Published
2025
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