Kabatende Joseph, Ntirenganya Lazare, Mugisha Michael, Barry Abbie, Ruberanziza Eugene, Bienvenu Emile, Bergman Ulf, Aklillu Eleni
Department of Global Public Health, Karolinska Institutet, Karolinska University Hospital, Widerströmska Huset, 171 77 Stockholm, Sweden.
Rwanda Food and Drugs Authority, Nyarutarama Plaza, KG 9 Avenue, Kigali P.O. Box 1948, Rwanda.
Pathogens. 2023 Sep 17;12(9):1170. doi: 10.3390/pathogens12091170.
Preventive chemotherapy with single-dose praziquantel is the WHO-recommended intervention strategy to eliminate schistosomiasis as a public health problem in endemic countries. Surveillance of drugs used in mass drug administration (MDA) programs is recommended to evaluate its effectiveness in reducing transmissions. After a decade-long implementation of a school-based MDA program in Rwanda, we conducted efficacy surveillance of single-dose praziquantel MDA against infection. Two weeks before MDA, stool examinations were performed to screen MDA-eligible school children (n = 4998) for infection using the Kato-Katz technique, and 265 (6.5%) children tested positive for the infection. All children received praziquantel and albendazole as preventive chemotherapy through the MDA campaign. Infected children were enrolled and followed for efficacy monitoring, and stool examination was repeated after three weeks post-MDA (n = 188). Before treatment, 173 (92%) had a light infection, and 15 (8%) had a moderate infection intensity. The primary and secondary outcomes were parasitological cure and egg reduction rates at three weeks post-treatment. The overall cure and egg reduction rates for infection were 97.9% (95% CI = 94.6-99.4) and 97.02%, respectively. Among the 173 children with light infection intensity, 170 (98.3%, 95% CI = 95.0-99.6) were cured, and among the 15 children who had moderate infection intensity, 14 (93.3%) were cured. No significant association between cure rate and pre-treatment infection intensity was observed. We conclude that single-dose praziquantel is efficacious against light-to-moderate infection. Preventive chemotherapy with praziquantel effectively reduces schistosome reservoirs and transmission among school-age children.
采用单剂量吡喹酮进行预防性化疗是世界卫生组织推荐的干预策略，目的是在血吸虫病流行国家消除作为公共卫生问题的血吸虫病。建议对大规模药物管理（MDA）项目中使用的药物进行监测，以评估其在减少传播方面的有效性。在卢旺达实施了长达十年的基于学校的MDA项目后，我们对单剂量吡喹酮MDA预防感染的效果进行了监测。在MDA前两周，采用加藤厚涂片法对符合MDA条件的在校儿童（n = 4998）进行粪便检查，以筛查感染情况，265名（6.5%）儿童检测出感染呈阳性。所有儿童通过MDA活动接受吡喹酮和阿苯达唑作为预防性化疗。对感染儿童进行登记并跟踪以监测疗效，在MDA后三周重复进行粪便检查（n = 188）。治疗前，173名（92%）为轻度感染，15名（8%）为中度感染强度。主要和次要结局分别为治疗后三周的寄生虫学治愈和虫卵减少率。感染的总体治愈率和虫卵减少率分别为97.9%（95%CI = 94.6 - 99.4）和97.02%。在173名轻度感染强度的儿童中，170名（98.3%，95%CI = 95.0 - 99.6）治愈，在15名中度感染强度的儿童中，14名（93.3%）治愈。未观察到治愈率与治疗前感染强度之间存在显著关联。我们得出结论，单剂量吡喹酮对轻度至中度感染有效。吡喹酮预防性化疗有效地减少了学龄儿童中的血吸虫宿主和传播。
