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What is the impact of acquired immunity on the transmission of schistosomiasis and the efficacy of current and planned mass drug administration programmes?
- Source :
- PLoS Neglected Tropical Diseases, PLoS Neglected Tropical Diseases, Vol 15, Iss 12, p e0009946 (2021)
- Publication Year :
- 2021
- Publisher :
- Public Library of Science, 2021.
-
Abstract
- Schistosomiasis causes severe morbidity in many countries with endemic infection with the schistosome digenean parasites in Africa and Asia. To control and eliminate the disease resulting from infection, regular mass drug administration (MDA) is used, with a focus on school-aged children (SAC; 5–14 years of age). In some high transmission settings, the World Health Organization (WHO) also recommends the inclusion of at-risk adults in MDA treatment programmes. The question of whether ecology (age-dependant exposure) or immunity (resistance to reinfection), or some combination of both, determines the form of observed convex age-intensity profile is still unresolved, but there is a growing body of evidence that the human hosts acquire some partial level of immunity after a long period of repeated exposure to infection. In the majority of past research modelling schistosome transmission and the impact of MDA programmes, the effect of acquired immunity has not been taken into account. Past work has been based on the assumption that age-related contact rates generate convex horizontal age-intensity profiles. In this paper, we use an individual based stochastic model of transmission and MDA impact to explore the effect of acquired immunity in defined MDA programmes. Compared with scenarios with no immunity, we find that acquired immunity makes the MDA programme less effective with a slower decrease in the prevalence of infection. Therefore, the time to achieve morbidity control and elimination as a public health problem is longer than predicted by models with just age-related exposure and no build-up of immunity. The level of impact depends on the baseline prevalence prior to treatment (the magnitude of the basic reproductive number R0) and the treatment frequency, among other factors. We find that immunity has a larger impact within moderate to high transmission settings such that it is very unlikely to achieve morbidity and transmission control employing current MDA programmes.<br />Author summary The question of ‘ecology or immunology’ as determinants of the shape of age intensity profiles of infection is still not resolved, but a degree of immunity is believed to slowly build up over long periods of exposure. In this study we show that acquired immunity dependent on the integral of past exposure to infection has a strong effect on the potential impact of MDA programmes to control morbidity induced by schistosome infection. We employ an individual based stochastic model of parasite transmission and control to demonstrate the effects of acquired immunity. In particular, we show that MDA programmes are less effective if human hosts acquire some level of immunity in proportion to the sum of an individual’s past exposure to infection. If acquired immunity is acting with strength, in some moderate to high transmission settings, we show that the current treatment guidelines are unlikely to achieve morbidity control and elimination as a public health problem. This suggests that programme adaptations to increase the frequency of treatment where at all possible are required. This study aims to provide health workers with quantitative tools to assess what treatment strategies are best applied in given epidemiological settings.
- Subjects :
- Male
Epidemiology
RC955-962
Disease
Adaptive Immunity
law.invention
Medical Conditions
law
Arctic medicine. Tropical medicine
Medicine and Health Sciences
Prevalence
Schistosomiasis
Public and Occupational Health
Child
11 Medical and Health Sciences
Anthelmintics
Age Factors
Eukaryota
Acquired immune system
Transmission (mechanics)
Infectious Diseases
Helminth Infections
Child, Preschool
Schistosoma
Mass Drug Administration
Female
Public aspects of medicine
RA1-1270
Research Article
Neglected Tropical Diseases
medicine.medical_specialty
Adolescent
Immunology
Infectious Disease Epidemiology
Young Adult
Immunity
Environmental health
Tropical Medicine
Helminths
medicine
Parasitic Diseases
Animals
Humans
Mass drug administration
Treatment Guidelines
Health Care Policy
business.industry
Public health
Public Health, Environmental and Occupational Health
Organisms
Biology and Life Sciences
06 Biological Sciences
Models, Theoretical
medicine.disease
Tropical Diseases
Invertebrates
Schistosoma Haematobium
Health Care
Health Statistics
Morbidity
business
Basic reproduction number
Zoology
Subjects
Details
- Language :
- English
- ISSN :
- 19352735 and 19352727
- Volume :
- 15
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- PLoS Neglected Tropical Diseases
- Accession number :
- edsair.doi.dedup.....5bbf4177d2ccd3403dcddc19a14aa6c9