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Performance and safety of praziquantel for treatment of intestinal schistosomiasis in infants and preschool children.

Sousa-Figueiredo JC, Betson M, Atuhaire A, Arinaitwe M, Navaratnam AM, Kabatereine NB, Bickle Q, Stothard JR - PLoS Negl Trop Dis (2012)

Bottom Line: PZQ proved to be safe, with only mild reported side effects which cleared within a month after treatment.Prevalence of reported symptoms was significantly lower in children than in mothers, and fewer side-effects were reported upon subsequent rounds of PZQ treatment.Our findings show that PZQ treatment of young children resulted in satisfactory cure rates, and marked reduction in egg-output, with only mild and transient reported side-effects.

View Article: PubMed Central - PubMed

Affiliation: Disease Control Strategy Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

ABSTRACT

Background: In 2012 the WHO formally recognised that infants and preschool children are at significant risk of schistosomiasis and qualify for treatment with praziquantel (PZQ). Targeted surveys determining both the performance and safety of this drug are now needed in endemic areas. We have formally assessed parasitological cure and putative side-effects in a prospective cohort of Schistosoma mansoni-infected children (aged 5 months-7 years old) in lakeshore settings of Uganda.

Methodology/principal findings: From a total of 369 children found to be egg-patent for intestinal schistosomiasis, 305 were followed-up three to four weeks after PZQ treatment and infection status re-assessed. Separately, a previously tested side-effect questionnaire was employed before and 24 hours after PZQ treatment to assess incidence and amelioration of symptoms in young children and their mothers. While the overall observed parasitological cure was 56.4%, a significant difference was found between a sub-set of children who had a history of multiple PZQ treatments (between one and four in an 18 month period), where cure rate was 41.7%, and those who had never received treatment (cure rate was 77·6%). PZQ proved to be safe, with only mild reported side effects which cleared within a month after treatment. Prevalence of reported symptoms was significantly lower in children than in mothers, and fewer side-effects were reported upon subsequent rounds of PZQ treatment.

Conclusion/significance: Our findings show that PZQ treatment of young children resulted in satisfactory cure rates, and marked reduction in egg-output, with only mild and transient reported side-effects. However, the cure rate is clearly lower in younger children and those with history of previous treatment. Cure rate, but not egg reduction rate, was also lower in children with heavier pre-intervention infection intensity. With chemotherapy now recommended as a long-term strategy for disease control in young children, research into optimising the periodicity of targeted treatment strategies is now crucial.

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Related in: MedlinePlus

Number of volunteers upon enrolment and sample submission compliance pre- and post-intervention surveys.No. of children upon follow-up by age: 2 children aged 5–12 months, 23 children aged 13–24 months, 39 children aged 25–36 months, 45 children aged 37–48 months, 83 children aged 49–60 months, 66 children aged 61–72 months and 35 children aged 73–84 months (missing age information for 12 children).
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Related In: Results  -  Collection


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pntd-0001864-g001: Number of volunteers upon enrolment and sample submission compliance pre- and post-intervention surveys.No. of children upon follow-up by age: 2 children aged 5–12 months, 23 children aged 13–24 months, 39 children aged 25–36 months, 45 children aged 37–48 months, 83 children aged 49–60 months, 66 children aged 61–72 months and 35 children aged 73–84 months (missing age information for 12 children).

Mentions: The study involved a comparison of PZQ efficacy in (i) a random sample of 507 children (mean age 4.3, range, range 5 months–7 years old) from the SIMI cohort who had been found to be egg positive at the closing stages of the project or had received at least one PZQ dose in the past 18 months (“previously treated”), and (ii) a random sample of 472 children (mean age 3.7, range 5 months–7 years old) who had not been previously treated (“treatment-naïve”). In total, 369 were found to be egg-patent for intestinal schistosomiasis. Of these, 305 were followed up 21–28 days later and infection status re-assessed according to WHO guidelines. Of these 125 were “treatment-naïve” and 180 children were “previously treated”. For more details, see Fig. 1.


Performance and safety of praziquantel for treatment of intestinal schistosomiasis in infants and preschool children.

Sousa-Figueiredo JC, Betson M, Atuhaire A, Arinaitwe M, Navaratnam AM, Kabatereine NB, Bickle Q, Stothard JR - PLoS Negl Trop Dis (2012)

Number of volunteers upon enrolment and sample submission compliance pre- and post-intervention surveys.No. of children upon follow-up by age: 2 children aged 5–12 months, 23 children aged 13–24 months, 39 children aged 25–36 months, 45 children aged 37–48 months, 83 children aged 49–60 months, 66 children aged 61–72 months and 35 children aged 73–84 months (missing age information for 12 children).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3475660&req=5

pntd-0001864-g001: Number of volunteers upon enrolment and sample submission compliance pre- and post-intervention surveys.No. of children upon follow-up by age: 2 children aged 5–12 months, 23 children aged 13–24 months, 39 children aged 25–36 months, 45 children aged 37–48 months, 83 children aged 49–60 months, 66 children aged 61–72 months and 35 children aged 73–84 months (missing age information for 12 children).
Mentions: The study involved a comparison of PZQ efficacy in (i) a random sample of 507 children (mean age 4.3, range, range 5 months–7 years old) from the SIMI cohort who had been found to be egg positive at the closing stages of the project or had received at least one PZQ dose in the past 18 months (“previously treated”), and (ii) a random sample of 472 children (mean age 3.7, range 5 months–7 years old) who had not been previously treated (“treatment-naïve”). In total, 369 were found to be egg-patent for intestinal schistosomiasis. Of these, 305 were followed up 21–28 days later and infection status re-assessed according to WHO guidelines. Of these 125 were “treatment-naïve” and 180 children were “previously treated”. For more details, see Fig. 1.

Bottom Line: PZQ proved to be safe, with only mild reported side effects which cleared within a month after treatment.Prevalence of reported symptoms was significantly lower in children than in mothers, and fewer side-effects were reported upon subsequent rounds of PZQ treatment.Our findings show that PZQ treatment of young children resulted in satisfactory cure rates, and marked reduction in egg-output, with only mild and transient reported side-effects.

View Article: PubMed Central - PubMed

Affiliation: Disease Control Strategy Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

ABSTRACT

Background: In 2012 the WHO formally recognised that infants and preschool children are at significant risk of schistosomiasis and qualify for treatment with praziquantel (PZQ). Targeted surveys determining both the performance and safety of this drug are now needed in endemic areas. We have formally assessed parasitological cure and putative side-effects in a prospective cohort of Schistosoma mansoni-infected children (aged 5 months-7 years old) in lakeshore settings of Uganda.

Methodology/principal findings: From a total of 369 children found to be egg-patent for intestinal schistosomiasis, 305 were followed-up three to four weeks after PZQ treatment and infection status re-assessed. Separately, a previously tested side-effect questionnaire was employed before and 24 hours after PZQ treatment to assess incidence and amelioration of symptoms in young children and their mothers. While the overall observed parasitological cure was 56.4%, a significant difference was found between a sub-set of children who had a history of multiple PZQ treatments (between one and four in an 18 month period), where cure rate was 41.7%, and those who had never received treatment (cure rate was 77·6%). PZQ proved to be safe, with only mild reported side effects which cleared within a month after treatment. Prevalence of reported symptoms was significantly lower in children than in mothers, and fewer side-effects were reported upon subsequent rounds of PZQ treatment.

Conclusion/significance: Our findings show that PZQ treatment of young children resulted in satisfactory cure rates, and marked reduction in egg-output, with only mild and transient reported side-effects. However, the cure rate is clearly lower in younger children and those with history of previous treatment. Cure rate, but not egg reduction rate, was also lower in children with heavier pre-intervention infection intensity. With chemotherapy now recommended as a long-term strategy for disease control in young children, research into optimising the periodicity of targeted treatment strategies is now crucial.

Show MeSH
Related in: MedlinePlus