Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya.
PLoS Negl Trop Dis. 2018 Oct 17;12(10):e0006852. doi: 10.1371/journal.pntd.0006852. eCollection 2018 Oct.
The recommended strategy for control of schistosomiasis is preventive chemotherapy with praziquantel (PZQ). Pre-school children (PSC) are excluded from population treatment programs. In high endemic areas, these children are also at risk, and require treatment with PZQ. The Government of Kenya initiated the National School-Based Deworming Programme (NSBDP) where PSC in Early Childhood Development Education (ECDE) Centers are only eligible for treatment with albendazole (ABZ) but not with PZQ.
METHODOLOGY/PRINCIPAL FINDINGS: 400 PSC were enrolled, from 10 randomly selected ECDE Centers in Kwale County, Kenya where children were treated with crushed PZQ tablets mixed with orange juice, at a single dose of 40 mg/kg. Adverse events were assessed 24 hours post-treatment through questionnaires administered to the parents or guardians. Acceptability was determined by observing if the child spat and/ or vomited all or part of the PZQ dose immediately after treatment. Efficacy was assessed by examining urine samples for Schistosoma haematobium eggs in the 5 weeks post-treatment follow-up. Children testing negative for S. haematobium during the follow-up were considered cured. Egg reduction rate (ERR) was calculated as the decrement in the infection intensity (group's geometric mean egg counts per 10 ml of urine) following treatment expressed as a proportion of the pre-treatment infection intensity. Before treatment, 80 out of the 400 children enrolled in the study tested positive for S. haematobium (20.0% (95% confidence interval (CI) 16.4-24.2%). Of these, 41 had infections of heavy intensity (51.3%) while the rest (48.7%) were of light intensity. Five weeks post-treatment, 10 children who had heavy intensity infection were diagnosed with S. haematobium (prevalence: 2.5% (95% CI 1.5-4.9%). Infection intensities decreased significantly from 45.9 (95% CI: 31.0-68.0) eggs/ 10 ml urine to1.4 (95% CI: 1.1-1.7) eggs/ 10 ml urine during pre-and post-treatment respectively. The ERR was 96.9%. There were no severe adverse events during follow up 24 hours post treatment. Treatment tolerability among the 400 children was high as none of the children spat and/ or vomited as observed in this study.
CONCLUSION/SIGNIFICANCE: The study revealed that crushed PZQ is safe and effective in the treatment of urogenital schistosomiasis in this age group. It is therefore recommended that PZQ should be administered to the PSC in Kwale County.
控制血吸虫病的推荐策略是用吡喹酮（PZQ）进行预防性化疗。学前儿童（PSC）被排除在人群治疗方案之外。在高流行地区，这些儿童也有感染风险，需要用 PZQ 进行治疗。肯尼亚政府启动了国家学校驱虫方案（NSBDP），其中在幼儿发展教育（ECDE）中心的 PSC 仅符合用阿苯达唑（ABZ）治疗的条件，而不符合用 PZQ 治疗的条件。
方法/主要发现：在肯尼亚夸莱县的 10 个随机选择的 ECDE 中心，招募了 400 名 PSC，他们接受了 PZQ 压碎片与橙汁混合的单一剂量 40mg/kg 的治疗。通过向父母或监护人发放问卷，在治疗后 24 小时评估不良事件。可接受性通过观察孩子是否在治疗后立即吐出或吐出全部或部分 PZQ 剂量来确定。通过在治疗后 5 周的随访中检查尿液样本中是否存在血吸虫卵来评估疗效。在随访期间检测到 S. haematobium 阴性的儿童被认为是治愈的。卵减少率（ERR）是通过治疗后感染强度（每组尿液中每 10 毫升的几何平均卵数）的减少来计算的，以治疗前感染强度的比例表示。在治疗前，400 名入组研究的儿童中有 80 名检测出 S. haematobium 阳性（20.0%（95%置信区间（CI）16.4-24.2%）。其中，41 人感染强度较重（51.3%），其余（48.7%）感染强度较轻。治疗后 5 周，10 名患有重度感染的儿童被诊断为 S. haematobium（患病率：2.5%（95%CI 1.5-4.9%）。感染强度从治疗前的 45.9（95%CI：31.0-68.0）个/10ml 尿液显著下降到治疗后的 1.4（95%CI：1.1-1.7）个/10ml 尿液。ERR 为 96.9%。在治疗后 24 小时的随访中没有严重的不良事件。在这项研究中，400 名儿童中没有一人出现呕吐或吐出 PZQ，表明治疗的耐受性很高。
结论/意义：研究表明，粉碎的 PZQ 是安全有效的，可用于治疗该年龄段的泌尿生殖道血吸虫病。因此，建议在夸莱县为 PSC 提供 PZQ。
