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Proceedings of the National Academy of... Jan 2024Schistosomiasis is a neglected tropical disease affecting over 150 million people. Hotspots of transmission-communities where infection prevalence does not decline...
Schistosomiasis is a neglected tropical disease affecting over 150 million people. Hotspots of transmission-communities where infection prevalence does not decline adequately with mass drug administration-present a key challenge in eliminating schistosomiasis. Current approaches to identify hotspots require evaluation 2-5 y after a baseline survey and subsequent mass drug administration. Here, we develop statistical models to predict hotspots at baseline prior to treatment comparing three common hotspot definitions, using epidemiologic, survey-based, and remote sensing data. In a reanalysis of randomized trials in 589 communities in five endemic countries, a regression model predicts whether infection prevalence will exceed the WHO threshold of 10% in year 5 ("prevalence hotspot") with 86% sensitivity, 74% specificity, and 93% negative predictive value (NPV; assuming 30% hotspot prevalence), and a regression model for achieves 90% sensitivity, 90% specificity, and 96% NPV. A random forest model predicts whether moderate and heavy infection prevalence will exceed a public health goal of 1% in year 5 ("intensity hotspot") with 92% sensitivity, 79% specificity, and 96% NPV, and a boosted trees model for achieves 77% sensitivity, 95% specificity, and 91% NPV. Baseline prevalence is a top predictor in all models. Prediction is less accurate in countries not represented in training data and for a third hotspot definition based on relative prevalence reduction over time ("persistent hotspot"). These models may be a tool to prioritize high-risk communities for more frequent surveillance or intervention against schistosomiasis, but prediction of hotspots remains a challenge.
Topics: Humans; Animals; Mass Drug Administration; Schistosomiasis; Schistosomiasis mansoni; Schistosoma haematobium; Models, Statistical
PubMed: 38181058
DOI: 10.1073/pnas.2315463120 -
Nature Medicine Jan 2024Schistosomiasis treatment entirely relies on a single drug, praziquantel, prompting research into alternative therapeutics. Here we evaluated the efficacy and safety of... (Randomized Controlled Trial)
Randomized Controlled Trial
Schistosomiasis treatment entirely relies on a single drug, praziquantel, prompting research into alternative therapeutics. Here we evaluated the efficacy and safety of the antimalarial combination artesunate-mefloquine for the treatment of schistosomiasis in a proof-of-concept, pragmatic, open-label, randomized controlled trial in primary schools of six villages endemic for schistosomiasis in northern Senegal. Children (6-14 years) were eligible if Schistosoma eggs were detected by microscopy in urine and/or stool. In total, 726 children were randomized 1:1 to praziquantel (standard care: 40 mg kg single dose; n = 364) or to artesunate-mefloquine (antimalarial dosage: artesunate 4 mg kg and mefloquine 8 mg kg daily for three consecutive days; n = 362). Eight children not meeting the inclusion criteria were excluded from efficacy analysis. Median age of the remaining 718 participants was 9 years; 399 (55.6%) were male, and 319 (44.4%) female; 99.3% were infected with Schistosoma haematobium and 15.2% with S. mansoni. Primary outcomes were cure rate, assessed by microscopy, and frequency of drug-related adverse effects of artesunate-mefloquine versus praziquantel at 4 weeks after treatment. Cure rate was 59.6% (208/349) in the artesunate-mefloquine arm versus 62.1% (211/340) in the praziquantel arm. The difference of -2.5% (95% confidence interval (CI) -9.8 to 4.8) met the predefined criteria of noninferiority (margin set at 10%). All drug-related adverse events were mild or moderate, and reported in 28/361 children receiving artesunate-mefloquine (7.8%; 95% CI 5.4 to 11.0) versus 8/363 (2.2%; 95% CI 1.1 to 4.3) receiving praziquantel (P < 0.001). Artesunate-mefloquine at antimalarial dosage was moderately safe and noninferior to standard-care praziquantel for the treatment of schistosomiasis, predominantly due to S. haematobium. Multicentric trials in different populations and epidemiological settings are needed to confirm these findings. ClinicalTrials.gov identifier: NCT03893097 .
Topics: Child; Female; Humans; Male; Antimalarials; Artesunate; Mefloquine; Praziquantel; Schistosomiasis; Treatment Outcome; Adolescent
PubMed: 38177851
DOI: 10.1038/s41591-023-02719-4 -
Medycyna Pracy Dec 2023The work presents the intentional use of harmful biological agents based on National Register of Biological Agents (Krajowego Rejestru Czynników Biologicznych - KRCB)...
BACKGROUND
The work presents the intentional use of harmful biological agents based on National Register of Biological Agents (Krajowego Rejestru Czynników Biologicznych - KRCB) collected by June 2023.
MATERIAL AND METHODS
The KRCB is a central database gathering notifications of the intentional use of biological agents in risk groups 2-4 in the workplace in accordance with the regulation of the Minister of Health of December 11, 2020 amending the regulation regarding biological agents.
RESULTS
with the regulation of the Minister of Health of December 11, 2020 amending the regulation regarding biological agents. Results: Notifications were sent by 712 enterprises for: diagnostic - 62%, research - 31% and industrial purposes - 7%. Notifications were most often sent by hospital and non-hospital clinical and diagnostic laboratories (33% each group) and higher education and research units - 16%. In total, 7352 workers (88% women, 12% men) were exposed to biological agents intentionally used at work. Biological agents from 2 and 3 group risk were used by 98% and 16% enterprises, respectively. The most frequently were used bacteria (with the exception of non-pathogenic strains) - 5972 (81%) exposed workers, - respectively 5760 (78%) and - 5155 (70%). Among the total workers, nearly 25% were exposed to at least 1 biological agent carcinogenic to humans, including viruses (hepatitis B virus [HBV] - 1800 workers, 24%; hepatitis C virus [HCV] - respectively, 1767, 24%; human immunodeficiency virus-1 [HIV-1] - 1557, 21%; human gammaherpesvirus type 4 (Epstein-Barr virus) - 199, 3%; - 52, <1%; human gammaherpesvirus type 8 [HHV-8] - 16, <1%; human T-lymphotropic virus type 1 [HTLV- 1] - 38, <1%; bacteria - 299, 4%; parasites - 9, <1%).
CONCLUSIONS
Intentionally used biological agents most often pose a threat to workers of hospital and non-hospital clinical and diagnostic laboratories, but a higher health risk concerns workers of and higher education and research units. Med Pr Work Health Saf. 2023;74(6):501-11.
Topics: Male; Humans; Female; Poland; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Biological Factors; Hepatitis C
PubMed: 38160423
DOI: 10.13075/mp.5893.01458 -
Heliyon Dec 2023Rapid diagnosis of urogenital schistosomiasis caused by requires an accurate and timely assay, especially for low-intensity infection cases and in non-endemic areas....
Rapid diagnosis of urogenital schistosomiasis caused by requires an accurate and timely assay, especially for low-intensity infection cases and in non-endemic areas. The mitochondrial cytochrome oxidase 1 (cox1) gene fragment of was selected as detection target as this short fragment, which can be rapidly sequenced and yet possess good diagnostic resolution. A pair of primers and a fluorescent probe were designed according to the principle of recombinase-aided amplification (RAA), which was subsequently optimized and applied as an -specific RAA assay. Its diagnostic performance was validated for sensitivity and specificity in comparison to microscopy-based egg counting after urine filtration. The RAA assay could detect as little as 10 copies/μL of recombinant plasmid, and no cross-reactions were observed with , , , or . This test can be conducted at 39 °C and the whole RAA reaction can be completed within 20 min. The validation of the RAA assay showed that it had 100 % consistency with urine-egg microscopy, as it does not require an elaborate reading tool, is simple to use, and should be useful for field diagnostics and point-of-care applications.
PubMed: 38144328
DOI: 10.1016/j.heliyon.2023.e23031 -
Travel Medicine and Infectious Disease 2024We aimed to evaluate the performance of a novel multiplex serological assay, able to simultaneously detect IgG of six infections, as a screening tool for imported...
BACKGROUND
We aimed to evaluate the performance of a novel multiplex serological assay, able to simultaneously detect IgG of six infections, as a screening tool for imported diseases in migrants.
METHODS
Six panels of 40 (n = 240) anonymized serum samples with confirmed infections were used as positive controls to assess the multiplex assay's sensitivity. One panel of 40 sera from non-infected subjects was used to estimate the seropositivity cutoffs, and 32 non-infected sera were used as negative controls to estimate each serology's sensitivity and specificity. The multi-infection screening test was validated in a prospective cohort of 48 migrants from endemic areas. The sensitivity of the Luminex assay was calculated as the proportion of positive results over all positive samples identified by reference tests. The specificity was calculated using 32 negative samples. Uncertainty was quantified with 95 % confidence intervals using receiver operating characteristic analyses.
RESULTS
The sensitivity/specificity were 100 %/100 % for HIV (gp41 antigen), 97.5 %/100 % for Hepatitis B virus (HBV-core antigen), 100 %/100 % for Hepatitis C virus (HCV-core antigen), 92.5 %/90.6 % for strongyloidiasis [31-kDa recombinant antigen (NIE)], 97.5 %/100 % for schistosomiasis (combined serpin Schistosoma mansoni and S.haematobium antigens) and 95 %/90.6 % for Chagas disease [combined Trypanosoma cruzi kinetoplastid membrane protein-11 (KMP11) and paraflagellar rod proteins 2 (PFR2) antigens]. In the migrant cohort, antibody response to the combination of the T.cruzi antigens correctly identified 100 % individuals, whereas HBV-core antigen correctly identified 91.7 % and Strongyloides-NIE antigen 86.4 %.
CONCLUSIONS
We developed a new, robust and accurate 8-plex Luminex assay that could facilitate the implementation of screening programmes targeting migrant populations.
Topics: Animals; Humans; Transients and Migrants; Prospective Studies; Schistosomiasis; Immunoassay; Schistosoma mansoni; Hepatitis C; Hepacivirus
PubMed: 38141899
DOI: 10.1016/j.tmaid.2023.102681 -
Life (Basel, Switzerland) Dec 2023Schistosomiasis and soil-transmitted helminthiasis remain a public health concern in Tanzania. This study investigated the prevalence and intensities of , , and...
Schistosomiasis and soil-transmitted helminthiasis remain a public health concern in Tanzania. This study investigated the prevalence and intensities of , , and soil-transmitted helminths and associated factors in Itilima district, north-western Tanzania. A cross-sectional survey was conducted between August and September 2020 among 3779 primary schoolchildren in 62 primary schools and 1122 adults in 19 villages. Urine samples were obtained from each participant and examined visually for the presence of macrohaematuria, microhaematuria, and eggs using a urine dipstick and urine filtration test. A single stool sample was obtained from each participant and screened for and soil-transmitted helminths using the Kato Katz and formalin-ether concentration techniques. A questionnaire was administered to schoolchildren to elucidate the risk factors for schistosomiasis. The overall prevalence of in adults was 8.1% (95% confidence interval (CI), 6.6-9.8%). In total, 3779 schoolchildren had complete results from urine testing, and the overall prevalence of S. was 10.1% (95% CI, 9.1-11.1%). The prevalence of S. and soil-transmitted helminths was relatively low among both children and adults compared to S. . Factors associated with infection among schoolchildren were the mother's occupation, children aged 11-15 years, and water contact behaviour. The odds of having schistosomiasis infection among children aged 11-15 are 40% higher than those aged 5-10 (95% confidence interval (CI), 10-80%, = 0.04). Children of parents who are livestock keepers have 12.3 times higher odds of having infection compared to those who have small-scale businesses (95% CI, 1.0-5.4, = 0.03). Children who are in contact with infested water more than three times a week have 2.1 times higher odds of having an infection compared to those who do not (95% CI, 2.1; 1.6-2.8, < 0.001). The findings provide updated geographical information on prevalence, yielding insights into the planning and implementation of mass drug administration in rural Tanzania.
PubMed: 38137933
DOI: 10.3390/life13122333 -
Tropical Medicine and Infectious Disease Dec 2023Migratory flows and international travel are triggering an increase in imported cases of schistosomiasis in non-endemic countries. The present study aims to evaluate the...
Migratory flows and international travel are triggering an increase in imported cases of schistosomiasis in non-endemic countries. The present study aims to evaluate the effectiveness of the LAMP technique on patients' urine samples for the diagnosis of imported schistosomiasis in a non-endemic area in comparison to a commercial immunochromatographic test and microscopic examination of feces and urine. A prospective observational study was conducted in sub-Saharan migrants attending the Tropical Medicine Unit, Almería, Spain. For schistosomiasis diagnosis, serum samples were tested using an immunochromatographic test (Schistosoma ICT IgG-IgM). Stool and urine samples were examined by microcopy. Urine samples were evaluated by combining three LAMP assays for the specific detection of , , and for the genus . To evaluate the diagnostic accuracy, a latent class analysis (LCA) was performed. In total, 115 patients were included (92.2% male; median age: 28.3 years). Of these, 21 patients (18.3%) were diagnosed with schistosomiasis confirmed by microscopy, with being the most frequent species identified (18/115; 15.7%). The Schistosoma ICT IgG-IgM test result was 100% positive and Schistosoma-LAMP was 61.9% positive, reaching as high as 72.2% for . The sensitivity and specificity estimated by LCA, respectively, were: 92% and 76% for Schistosoma ICT IgG-IgM, 68% and 44% for Schistosoma-LAMP, and 46% and 97% for microscopy. In conclusion, the Schistosoma-LAMP technique presented a higher sensitivity than microscopy for the diagnosis of imported urinary schistosomiasis, which could improve the diagnosis of active infection, both in referral centers and in centers with limited experience or scarce resources and infrastructure.
PubMed: 38133450
DOI: 10.3390/tropicalmed8120518 -
Parasites & Vectors Dec 2023
PubMed: 38102664
DOI: 10.1186/s13071-023-06061-z -
PLOS Global Public Health 2023Assessment of the burden of disease and techniques for clinical diagnosis could ultimately help in schistosomiasis control. This study assessed the impact of exercises...
Toward schistosomiasis control: Assessment of infection-associated voiding symptoms, quality of life and the impact of exercise coupled with water intake on egg recovery in an endemic community in Ghana.
Assessment of the burden of disease and techniques for clinical diagnosis could ultimately help in schistosomiasis control. This study assessed the impact of exercises and water intake on ova recovery during laboratory diagnosis and schistosomiasis-associated urinary symptoms and quality of life (QOL) among inhabitants of Dendo, an endemic community in Ghana. The clinical findings and responses of 400 randomly selected participants were used for the study. The International Prostate Symptoms Score (I-PSS) was used to collect information on participants' self-reported urinary symptoms and QOL. Finally, urine samples were collected on two consecutive days, initially without exercise and water intake and then after exercise and water intake, and about 10 ml of it were microscopically examined for the presence and quantification of ova. The data collected from the study were analyzed using IBM SPSS. Schistosoma haematobium egg recovery increased significantly (p < 0.001) from 206 (51.5%) to 220 (55.0%) after exercise and water intake with the highest increase being observed among participants less than 20 years (53.3% to 57.1% after exercise and water intake). As high as 90.3% and 56.8% of Schistosoma-positive participants reported IPSS>7 (symptomatic voiding disorders) and QOL≥4 (mostly dissatisfied or unhappy QOL) respectively. The commonest voiding symptoms reported were nocturia (98.9%) and incomplete emptying (79.6%). Positive correlations between egg count, IPSS score, and QOL were observed. This study provides important evidence for the inclusion of exercise and water intake in the microscopic diagnosis of Schistosoma haematobium and reveals that schistosomiasis significantly impacts the affected individuals' urinary health and overall quality of life.
PubMed: 37983234
DOI: 10.1371/journal.pgph.0002514 -
PLoS Neglected Tropical Diseases Nov 2023Schistosomiasis is one of the most important neglected tropical diseases, with a great impact on public health and more than 200,000 deaths annually. Schistosoma...
BACKGROUND
Schistosomiasis is one of the most important neglected tropical diseases, with a great impact on public health and more than 200,000 deaths annually. Schistosoma haematobium causes urinary tract (UT) morbidity. Since schistosomiasis morbidity control programs focus on children older than 5 years, pre-school age children (PSAC) morbidity is not well known.
METHODS
We conducted a cross-sectional study in Cubal (Angola) among 245 PSAC with the objective of evaluating the prevalence of S. haematobium infection, the intensity of infection, and associated morbidity. For this purpose, urine filtration test followed by microscopic visualization and ultrasound examinations were performed.
RESULTS
The estimated overall prevalence of urogenital schistosomiasis was 30.2% (CI 95%; 24.5-35.9), with 20.3% (CI 95%; 15.3-25.3) of the samples analysed showing a high intensity of infection. A total of 54.5% (CI 95%; 47.6-61.8) of infected children presented UT lesions, showing a significant association between schistosomiasis infection and UT morbidity (p-value < 0.001). Bladder wall thickening was the most common lesion, being present in 100% of abnormal ultrasounds. We found that anaemia and severe malnutrition were not significantly associated with the development of UT lesions.
CONCLUSIONS
S. haematobium infection in PSAC causes great UT detectable morbidities. Therefore, there is an evident need of including them in mass drug administration (MDA) campaigns and consequently the development of an adapted praziquantel treatment dosage for children under 2 years of age.
Topics: Animals; Humans; Child; Child, Preschool; Infant; Schistosomiasis haematobia; Prevalence; Angola; Cross-Sectional Studies; Morbidity; Schistosoma haematobium
PubMed: 37939154
DOI: 10.1371/journal.pntd.0011751