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• W2079380554 abstract "Preventive chemotherapy with 40 mg/kg of praziquantel has been endorsed and advocated by WHO for the global control of schistosomiasis, yet the drug does not prevent reinfection. In this Viewpoint, we discuss issues related to this control strategy, which is now implemented in many countries where schistosomiasis is endemic. Since its inception in 1979, much optimism has surrounded mass drug administration for the control of schistosomiasis globally, for which praziquantel has served as the cornerstone drug. Numerous studies have claimed that preventive chemotherapy (ie, 40 mg/kg of praziquantel), given once or twice a year, can signifi cantly reduce the prevalence and intensity of infection and control morbidity in the long term. In the past decade, close to US$1 billion dollars have been raised for campaigns against neglected tropical diseases, largely from international donors (eg, Merck, World Bank, Unites States Agency for International Development, British Department for International Development, Geneva Global, and the Bill & Melinda Gates Foundation). Donations have been delivered vertically to local endemic communities through national health care services, largely using volunteers. To date, 28 million children have been treated for schistosomiasis through the Merck Praziquantel Donation Program. Since 2007, Merck has been providing WHO with up to 25 million tablets per year, free of charge. In the next fi ve years, the company will increase that number to 250 million tablets per year. The donation commitment for the entire continent of Africa amounts to €17·2 million. Despite the commitment to mass drug administration programmes, it is becoming increasingly clear that the sustainable control of schistosomiasis will require an integrated and intersectorial approach that goes beyond deworming. While the global use of praziquantel is being scaled up, concerns are also growing about inadequate drug coverage, low cure rates, poor drug compliance, and the potential for development of drug resistance. Additional concern surrounds the paucity of baseline information before starting mass drug administration programmes and their inadequate monitoring and evaluation, once started. Praziquantel is eff ective against all species of schistosome that infect humans, and it is the drug of choice to treat infection. However, parasitological cure depends on the treatment dose. A systematic review and meta-analysis of 52 clinical trials showed that, compared with placebo, a dose of 30–60 mg/kg praziquantel cures around 76% (range 67–83%) of cases of schistosomiasis. No signifi cant diff erences in cure rates were recorded between patients infected with Schistoma haematobium, Schistoma japonicum or Schistoma mansoni. A dose of 40 mg/kg, which is the current dose recommended by the WHO, cures 52% of infections (range 49–55%) compared with 91% (from 88–92%) when doses were increased to 60, 80, and 100 mg/kg, divided into two or more doses. In the early 1980s and again in 2011, the WHO, in an attempt to optimise praziquantel use for the treatment of schistosomiasis, launched a series of international clinical trials comparing the effi cacy and safety of 40 mg/kg and 60 mg/kg in patients infected with schistosome in Asia, Africa, and the Americas. In these trials, the 40 mg/kg dose was eff ective (92% cure rate) and better tolerated than the 60 mg/kg dose. However, because of the small sample size in each country (around 200 people per site), the generalisability of these fi ndings is questionable. An “audacious goal” has been to eliminate several neglected tropical diseases in Africa by 2020. Unfortunately, the strategy advocated for schistosomiasis will not work for several reasons. First, so-called preventive chemotherapy does not prevent reinfection or alter the life cycle of the parasites. Patients are typically weak, malnourished, immunosuppressed, and living in a rudimentary home with no running water or sanitation. Thus, they are highly susceptible to immediate reinfection after treatment. Moreover, they inevitably come into contact with water contaminated with schistosome cercariae when bathing, washing clothes, and fi shing. Second, the drugs are not getting to the people who need them the most. Many countries have reported less than 50% drug coverage among the highest risk groups. Drugs are typically delivered to remote villages that have fragmented or non-existing health services by volunteers on foot or by boat. The same unpaid staff are expected to educate and treat local inhabitants and to return months or years later for monitoring and evaluation. Third, drug compliance is very low, with many countries reporting less than 50% compliance. Patients are often asked to take empirical treatment for a disease they know very little about, even if they are not infected or show no symptoms. Up to 80% of those who ultimately take the drug have transient side-eff ects such as dizziness, syncope, vomiting, and diarrhoea. Once observed and reported by others in the community, compliance quickly drops. In sum, preventive chemotherapy is not the silver bullet for schistosomiasis control that it is purported to be. Because of the fragile state of the global economy, donor funding is uncertain. Many of the current programmes are ill-conceived, are run in parallel with national health services, and have no exit strategy. Lancet 2015; 385: 2220–21" @default.
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• W2079380554 date "2015-05-01" @default.
• W2079380554 modified "2023-10-18" @default.
• W2079380554 title "An audacious goal: the elimination of schistosomiasis in our lifetime through mass drug administration" @default.
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