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Insufficiency of annual praziquantel treatment to control Schistosoma mansoni infections in adult women: A longitudinal cohort study in rural Tanzania

BACKGROUND: Current World Health Organization (WHO) guidelines recommend annual mass drug administration using praziquantel in areas with high schistosome endemicity. Yet little is known about incidence and reinfection rates after treatment in women with frequent exposure to schistosomes. We sought...

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Autores principales: Mishra, Pallavi, Colombe, Soledad, Paul, Ndalloh, Mlingi, Jane, Tosiri, Inobena, Aristide, Christine, Gao, Joanna, Kashangaki, Philibert, Nagai, Honest, Kalluvya, Samuel E., de Dood, Claudia J., Corstjens, Paul L., Mngara, Julius, van Dam, Govert J., Downs, Jennifer A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894890/
https://www.ncbi.nlm.nih.gov/pubmed/31751333
http://dx.doi.org/10.1371/journal.pntd.0007844
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author Mishra, Pallavi
Colombe, Soledad
Paul, Ndalloh
Mlingi, Jane
Tosiri, Inobena
Aristide, Christine
Gao, Joanna
Kashangaki, Philibert
Nagai, Honest
Kalluvya, Samuel E.
de Dood, Claudia J.
Corstjens, Paul L.
Mngara, Julius
van Dam, Govert J.
Downs, Jennifer A.
author_facet Mishra, Pallavi
Colombe, Soledad
Paul, Ndalloh
Mlingi, Jane
Tosiri, Inobena
Aristide, Christine
Gao, Joanna
Kashangaki, Philibert
Nagai, Honest
Kalluvya, Samuel E.
de Dood, Claudia J.
Corstjens, Paul L.
Mngara, Julius
van Dam, Govert J.
Downs, Jennifer A.
author_sort Mishra, Pallavi
collection PubMed
description BACKGROUND: Current World Health Organization (WHO) guidelines recommend annual mass drug administration using praziquantel in areas with high schistosome endemicity. Yet little is known about incidence and reinfection rates after treatment in women with frequent exposure to schistosomes. We sought to quantify response to anti-schistosome treatment and incident S. mansoni infections in a cohort of rural women living in a schistosome-endemic area of northwest Tanzania. METHODS AND PRINCIPAL FINDINGS: We enrolled women with and without S. mansoni infection into a 12-month longitudinal cohort. Every 3 months, women were tested for schistosome infection using microscopic examinations for ova on filtered urine, Kato Katz slides, and serum Circulating Anodic Antigen (CAA). Those with schistosome infection received treatment with praziquantel 40 mg/kg according to the standard of care. We studied 35 women who were S. mansoni positive by stool microscopy and 46 women without schistosome infection who returned for at least one follow-up. Of the women who were initially infected, 14 (40%) were schistosome-positive at a follow-up visit. Four women developed incident infections, for a cumulative incidence of 8.7% and incidence rate of 0.99 per 100 person-months throughout the year among initially uninfected women. Only 3 women were egg-positive at any follow-up. Women with persistent, recurrent, or incident infection during the study period were significantly younger (p = 0.032) and had fewer children than women who remained uninfected or those who cleared the infection and did not experience recurrence (p = 0.003). Having fewer children remained significant after controlling for age (p = 0.023). There was no difference in initial intensity of infection by CAA or stool egg count, HIV status, or socioeconomic status. Although most water contact behaviors were comparable between the two groups, women with recurrent or incident schistosome infections were significantly more likely to have recently swum in the lake (p = 0.023). CONCLUSIONS: Our data suggests that annual praziquantel treatment reduces intensity of schistosome infections but is insufficient in providing stable parasite eradication in over a third of women in endemic communities. Furthermore, microscopy lacks adequate sensitivity to evaluate efficacy of treatment in this population. Our work demonstrates that further investigation into treatment efficacy and reinfection rates is warranted and suggests that increased frequency of praziquantel treatment is needed to improve cure rates in high-risk populations.
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spelling pubmed-68948902019-12-13 Insufficiency of annual praziquantel treatment to control Schistosoma mansoni infections in adult women: A longitudinal cohort study in rural Tanzania Mishra, Pallavi Colombe, Soledad Paul, Ndalloh Mlingi, Jane Tosiri, Inobena Aristide, Christine Gao, Joanna Kashangaki, Philibert Nagai, Honest Kalluvya, Samuel E. de Dood, Claudia J. Corstjens, Paul L. Mngara, Julius van Dam, Govert J. Downs, Jennifer A. PLoS Negl Trop Dis Research Article BACKGROUND: Current World Health Organization (WHO) guidelines recommend annual mass drug administration using praziquantel in areas with high schistosome endemicity. Yet little is known about incidence and reinfection rates after treatment in women with frequent exposure to schistosomes. We sought to quantify response to anti-schistosome treatment and incident S. mansoni infections in a cohort of rural women living in a schistosome-endemic area of northwest Tanzania. METHODS AND PRINCIPAL FINDINGS: We enrolled women with and without S. mansoni infection into a 12-month longitudinal cohort. Every 3 months, women were tested for schistosome infection using microscopic examinations for ova on filtered urine, Kato Katz slides, and serum Circulating Anodic Antigen (CAA). Those with schistosome infection received treatment with praziquantel 40 mg/kg according to the standard of care. We studied 35 women who were S. mansoni positive by stool microscopy and 46 women without schistosome infection who returned for at least one follow-up. Of the women who were initially infected, 14 (40%) were schistosome-positive at a follow-up visit. Four women developed incident infections, for a cumulative incidence of 8.7% and incidence rate of 0.99 per 100 person-months throughout the year among initially uninfected women. Only 3 women were egg-positive at any follow-up. Women with persistent, recurrent, or incident infection during the study period were significantly younger (p = 0.032) and had fewer children than women who remained uninfected or those who cleared the infection and did not experience recurrence (p = 0.003). Having fewer children remained significant after controlling for age (p = 0.023). There was no difference in initial intensity of infection by CAA or stool egg count, HIV status, or socioeconomic status. Although most water contact behaviors were comparable between the two groups, women with recurrent or incident schistosome infections were significantly more likely to have recently swum in the lake (p = 0.023). CONCLUSIONS: Our data suggests that annual praziquantel treatment reduces intensity of schistosome infections but is insufficient in providing stable parasite eradication in over a third of women in endemic communities. Furthermore, microscopy lacks adequate sensitivity to evaluate efficacy of treatment in this population. Our work demonstrates that further investigation into treatment efficacy and reinfection rates is warranted and suggests that increased frequency of praziquantel treatment is needed to improve cure rates in high-risk populations. Public Library of Science 2019-11-21 /pmc/articles/PMC6894890/ /pubmed/31751333 http://dx.doi.org/10.1371/journal.pntd.0007844 Text en © 2019 Mishra et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Mishra, Pallavi
Colombe, Soledad
Paul, Ndalloh
Mlingi, Jane
Tosiri, Inobena
Aristide, Christine
Gao, Joanna
Kashangaki, Philibert
Nagai, Honest
Kalluvya, Samuel E.
de Dood, Claudia J.
Corstjens, Paul L.
Mngara, Julius
van Dam, Govert J.
Downs, Jennifer A.
Insufficiency of annual praziquantel treatment to control Schistosoma mansoni infections in adult women: A longitudinal cohort study in rural Tanzania
title Insufficiency of annual praziquantel treatment to control Schistosoma mansoni infections in adult women: A longitudinal cohort study in rural Tanzania
title_full Insufficiency of annual praziquantel treatment to control Schistosoma mansoni infections in adult women: A longitudinal cohort study in rural Tanzania
title_fullStr Insufficiency of annual praziquantel treatment to control Schistosoma mansoni infections in adult women: A longitudinal cohort study in rural Tanzania
title_full_unstemmed Insufficiency of annual praziquantel treatment to control Schistosoma mansoni infections in adult women: A longitudinal cohort study in rural Tanzania
title_short Insufficiency of annual praziquantel treatment to control Schistosoma mansoni infections in adult women: A longitudinal cohort study in rural Tanzania
title_sort insufficiency of annual praziquantel treatment to control schistosoma mansoni infections in adult women: a longitudinal cohort study in rural tanzania
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894890/
https://www.ncbi.nlm.nih.gov/pubmed/31751333
http://dx.doi.org/10.1371/journal.pntd.0007844
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