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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

Percentage of symptoms reported after treatment (left column) and percentage of symptoms ameliorated (right column).A side-effect is defined as a symptom absent before treatment and experienced after treatment; amelioration of a symptom is defined as a symptom that was experienced before treatment and no longer present 24 hours afterwards. A–B: children (N = 781) v. mothers (N = 539); C–D: baseline (N = 781) v. follow-ups (children only, N = 171 and 167, respectively for 6 and 12 month follow-ups); E–F: PZQ+ALB integrated chemotherapy (N = 529) v. ALB monotherapy (N = 370, children only).
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pntd-0001864-g002: Percentage of symptoms reported after treatment (left column) and percentage of symptoms ameliorated (right column).A side-effect is defined as a symptom absent before treatment and experienced after treatment; amelioration of a symptom is defined as a symptom that was experienced before treatment and no longer present 24 hours afterwards. A–B: children (N = 781) v. mothers (N = 539); C–D: baseline (N = 781) v. follow-ups (children only, N = 171 and 167, respectively for 6 and 12 month follow-ups); E–F: PZQ+ALB integrated chemotherapy (N = 529) v. ALB monotherapy (N = 370, children only).

Mentions: Side-effect data were available for 781 children and 539 mothers from SIMI's baseline survey (raw data are available in Supplementary Tables S1 and S2). Prevalence levels of egg-patent S. mansoni infection in these study participants were 32·4% (CI95 29·1–35·8%) and 48·6% (CI95 44·3–52·9%), respectively for children and mothers. Mothers reported a higher prevalence of new symptoms post-treatment than their children for all listed symptoms with the exception of bloody stools. On the other hand, mothers reported a lower percentage of improvement of existing symptoms after treatment than their children for all listed symptoms with the exception of vomiting and bloody stools (Fig. 2 A–B).


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)

Percentage of symptoms reported after treatment (left column) and percentage of symptoms ameliorated (right column).A side-effect is defined as a symptom absent before treatment and experienced after treatment; amelioration of a symptom is defined as a symptom that was experienced before treatment and no longer present 24 hours afterwards. A–B: children (N = 781) v. mothers (N = 539); C–D: baseline (N = 781) v. follow-ups (children only, N = 171 and 167, respectively for 6 and 12 month follow-ups); E–F: PZQ+ALB integrated chemotherapy (N = 529) v. ALB monotherapy (N = 370, children only).
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0001864-g002: Percentage of symptoms reported after treatment (left column) and percentage of symptoms ameliorated (right column).A side-effect is defined as a symptom absent before treatment and experienced after treatment; amelioration of a symptom is defined as a symptom that was experienced before treatment and no longer present 24 hours afterwards. A–B: children (N = 781) v. mothers (N = 539); C–D: baseline (N = 781) v. follow-ups (children only, N = 171 and 167, respectively for 6 and 12 month follow-ups); E–F: PZQ+ALB integrated chemotherapy (N = 529) v. ALB monotherapy (N = 370, children only).
Mentions: Side-effect data were available for 781 children and 539 mothers from SIMI's baseline survey (raw data are available in Supplementary Tables S1 and S2). Prevalence levels of egg-patent S. mansoni infection in these study participants were 32·4% (CI95 29·1–35·8%) and 48·6% (CI95 44·3–52·9%), respectively for children and mothers. Mothers reported a higher prevalence of new symptoms post-treatment than their children for all listed symptoms with the exception of bloody stools. On the other hand, mothers reported a lower percentage of improvement of existing symptoms after treatment than their children for all listed symptoms with the exception of vomiting and bloody stools (Fig. 2 A–B).

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