Objective:To assess efficacy of albendazole against Ascaris(A.)lumbricoides among school-children at three sites of Rajahmundry,Sundergarh and Wayanad.Methods:Sites were selected based on soil-transmitted helminths pr...Objective:To assess efficacy of albendazole against Ascaris(A.)lumbricoides among school-children at three sites of Rajahmundry,Sundergarh and Wayanad.Methods:Sites were selected based on soil-transmitted helminths prevalence,different sociocultural-geographical characteristics and operational feasibility.9-12 Years old children from 14 schools were included.The study was conducted in two rounds:baseline&follow up survey.All eligible children found positive for A.lumbricoides at baseline were administered supervised single tablet albendazole 400 mg under the National Deworming Day Initiative.During post-treatment follow-up survey,eligible children who provided second stool sample were included in the final analysis.Stool samples were examined using WHO recommended Kato-Katz technique.Efficacy was estimated based on cure rate(CR)and Fecal Egg Count Reduction Rate(FECRR)among children found positive in baseline and follow-up surveys.Results:328 Out of 625(52.5%)were found positive for A.lumbricoides in the baseline survey and 85 out of 178 samples(47.8%)during post-treatment follow-up survey.Overall,the estimated CR was 52.2%.FECRR(95%CI)for albendazole was 72.6%(79.2%-66.0%).The FECRR was highest in East Godaveri[89.7%(96.8%-82.6%)],followed by Sundergarh[86.4%(95.3%-77.5%)]and Wayanad[69%(81.7%-56.4%)].Conclusions:Our study confirmed overall reduction in FEC although with varying albendazole efficacy for A.lumbricoides infection at three different locations in India.However,these finding may be assessed in context of ongoing MDA under Filaria control program and further studies by in vivo as well as in vitro methods are required to reach to a conclusion on possible resistance if any.展开更多
Background:The Kato-Katz technique is recommended for the diagnosis of helminth infections in epidemiological surveys,drug efficacy studies and monitoring of control interventions.We assessed the comparability of the ...Background:The Kato-Katz technique is recommended for the diagnosis of helminth infections in epidemiological surveys,drug efficacy studies and monitoring of control interventions.We assessed the comparability of the average amount of faeces generated by three Kato-Katz templates included in test kits from two different providers.Methods:Nine hundred Kato-Katz thick smear preparations were done;300 per kit.Empty slides,slides plus Kato-Katz template filled with stool and slides plus stool after careful removal of the template were weighed to the nearest 0.1 mg.The average amount of stool that was generated on the slide was calculated for each template,stratified by standard categories of stool consistency(i.e.mushy,soft,sausage-shaped,hard and clumpy).Results:The average amount of stool generated on slides was 40.7 mg(95%confidence interval(CI):40.0–41.4 mg),40.3 mg(95%CI:39.7–40.9 mg)and 42.8 mg(95%CI:42.2–43.3 mg)for the standard Vestergaard Frandsen template,and two different templates from the Chinese Center for Disease Control and Prevention(China CDC),respectively.Mushy stool resulted in considerably lower average weights when the Vestergaard Frandsen(37.0 mg;95%CI:34.9–39.0 mg)or new China CDC templates(37.4 mg;95%CI:35.9–38.9 mg)were used,compared to the old China CDC template(42.2 mg;95%CI:40.7–43.7 mg)and compared to other stool consistency categories.Conclusion:The average amount of stool generated by three specific Kato-Katz templates was similar(40.3–42.8 mg).Since the multiplication factor is somewhat arbitrary and small changes only have little effect on infection intensity categories,it is suggested that the standard multiplication factor of 24 should be kept for the calculation of eggs per gram of faeces for all investigated templates.展开更多
Background:Implementation of control programmes for Strongyloides stercoralis infection is among the targets of the World Health Organization Roadmap to 2030.Aim ofthis work was to evaluate the possible impact in term...Background:Implementation of control programmes for Strongyloides stercoralis infection is among the targets of the World Health Organization Roadmap to 2030.Aim ofthis work was to evaluate the possible impact in terms of economic resources and health status of two different strategies of preventive chemotherapy(PC)compared to the current situation(strategy A,no PC):administration of ivermectin to school-age children(SAC)and adults(strategy B)versus ivermectin to SAC only(strategy C).Methods:The study was conducted at the IRCCS Sacro Cuore Don Calabria hospital,Negrar di Valpolicella,Verona,Italy,at the University of Florence,Italy,and at the WHO,Geneva,Switzerland,from May 2020 to April 2021.Data for the model were extracted from literature.A mathematical model was developed in Microsoft Excel to assess the impact of strategies B and C in a standard population of 1 million subjects living in a strongyloidiasis endemic area.In a case base seenario,15%prevalence of strongyloidiasis was considered;the 3 strategies were then evaluated at different thresholds of prevalenee,ranging from 5 to 20%.The results were reported as number of infected subjects,deaths,costs,and Incremental-Effectiveness Ratio(ICER).A 1-year and a 10-year horizons were considered.Results:In the case base seenario,cases of infections would reduce dramatically in the first year of implementation of PC with both strategy B and C:from 172500 cases to 77040 following strategy B and 146700 following strategy C.The additional cost per recovered person was United States Dollar(USD)2.83 and USD 1.13 in strategy B and C,respectively,compared to no treatment in the first year.For both strategies,there was a downtrend in costs per recovered person with increasing prevalenee.The number of adverted deaths was larger for strategy B than C,but cost to advert one death was lower for strategy C than B.Conclusions:This analysis permits to estimate the impact of two PC strategies for the control of strongyloidiasis in terms of costs and adverted infections/deaths.This could represent a basis on which each endemic country can evaluate which strategy can be implemented,based on available funds and national health priorities.展开更多
Background:The goal of soil-transmitted helminthiases(STH)control programmes is to eliminate STH-associated morbidity in the target population by reducing the prevalence of moderate-and heavy-intensity infections and ...Background:The goal of soil-transmitted helminthiases(STH)control programmes is to eliminate STH-associated morbidity in the target population by reducing the prevalence of moderate-and heavy-intensity infections and the overall STH infection prevalence mainly through preventive chemotherapy(PC)with either albendazole or mebendazole.Endemic countries should measure the success of their control programmes through regular epidemiological assessments.We evaluated changes in STH prevalence in countries that conducted effective PC coverage for STH to guide changes in the frequency of PC rounds and the number of tablets needed.Methods:We selected countries from World Health Organization(WHO)^Preventive Chemotherapy and Transmission control(PCT)databank that conducted≥5 years of PC with effective coverage for school-age children(SAC)and extracted STH baseline and impact assessment data using the WHO Epidemiological Data Reporting Form,Ministry of Health reports and/or peer-reviewed publications.We used pooled and weighted means to plot the prevalence of infection with any STH and with each STH species at baseline and after≥5 years of PC with effective coverage.Finally,using the WHO STH decision tree,we estimated the reduction in the number of tablets needed.Results:Fifteen countries in four WHO regions conducted annual or semi-annual rounds of PC for STH for 5 years or more and collected data before and after interventions.At baseline,the pooled prevalence was 48.9%(33.1-64.7%)for any STH,23.2%(13.7-32.7%)for Ascoris lumbricoides,21.01%(9.7-32.3%)for Trichuris trichiuro and 18.2%(10.9-25.5%)for hookworm infections,while after>5 years of PC for STH,the prevalence was 14.3%(7.3-21.3%)for any STH,6.9%(1.3-12.5%)for A.lumbricoides,5.3%(1.06-9.6%)for T.trichiura and 8.1%(4.0-12.2%)for hookworm infections.Conclusions:Countries endemic for STH have made tremendous progress in reducing STH-associated morbidity,but very few countries have data to demonstrate that progress.In this study,the data show that nine countries should adapt their PC strategies and the frequency of PC rounds to yield a 36%reduction in drug needs.The study also highlights the importance of impact assessment surveys to adapt control strategies according to STH prevalence.展开更多
Background:Soil-transmitted helminthiases(STH)are part of the group of neglected tropical diseases traditionally treated with preventive chemotherapy interventions.In recent years,drug donations have been essential to...Background:Soil-transmitted helminthiases(STH)are part of the group of neglected tropical diseases traditionally treated with preventive chemotherapy interventions.In recent years,drug donations have been essential to expanding preventive chemotherapy and achieving progressive control of morbidity from STH.This study aims to evaluate the need for anthelminthic medicines during 2020–2030.Methods:To estimate the need for anthelminthic medicines,we considered three different scenarios:(1)the control programmes continues to expand coverage and maintains the frequency of drug administration established at baseline;(2)the programmes continues to expand coverage but adapts the frequency of drug administration when the STH prevalence is reduced and(3)the STH programme becomes self-sustainable in some endemic countries.Results:We estimate that the number of anthelmintic medicines needed to treat school-aged children will increase by 40%by 2025 and by 52%by 2030 if countries do not change the frequency of preventive chemotherapy(scenario 1);that the number of tablets needed will reduce by 32.4%by 2025 and by 49.1%in 2030 if endemic countries reduce the frequency of preventive chemotherapy(scenario 2);and drug donations could be reduced by 54.4%by 2025 and 74.4%by 2030 if some endemic countries could become independent in drug procurement(scenario 3).Conclusions:The number of anthelmintic medicines needed to achieve elimination of morbidity due to STH in school-aged children will decline during 2020–2030.The decline will be substantial if a number of“upper-middle income”countries in which STH are endemic procure,as expected,anthelminthic medicines independently.展开更多
文摘Objective:To assess efficacy of albendazole against Ascaris(A.)lumbricoides among school-children at three sites of Rajahmundry,Sundergarh and Wayanad.Methods:Sites were selected based on soil-transmitted helminths prevalence,different sociocultural-geographical characteristics and operational feasibility.9-12 Years old children from 14 schools were included.The study was conducted in two rounds:baseline&follow up survey.All eligible children found positive for A.lumbricoides at baseline were administered supervised single tablet albendazole 400 mg under the National Deworming Day Initiative.During post-treatment follow-up survey,eligible children who provided second stool sample were included in the final analysis.Stool samples were examined using WHO recommended Kato-Katz technique.Efficacy was estimated based on cure rate(CR)and Fecal Egg Count Reduction Rate(FECRR)among children found positive in baseline and follow-up surveys.Results:328 Out of 625(52.5%)were found positive for A.lumbricoides in the baseline survey and 85 out of 178 samples(47.8%)during post-treatment follow-up survey.Overall,the estimated CR was 52.2%.FECRR(95%CI)for albendazole was 72.6%(79.2%-66.0%).The FECRR was highest in East Godaveri[89.7%(96.8%-82.6%)],followed by Sundergarh[86.4%(95.3%-77.5%)]and Wayanad[69%(81.7%-56.4%)].Conclusions:Our study confirmed overall reduction in FEC although with varying albendazole efficacy for A.lumbricoides infection at three different locations in India.However,these finding may be assessed in context of ongoing MDA under Filaria control program and further studies by in vivo as well as in vitro methods are required to reach to a conclusion on possible resistance if any.
文摘Background:The Kato-Katz technique is recommended for the diagnosis of helminth infections in epidemiological surveys,drug efficacy studies and monitoring of control interventions.We assessed the comparability of the average amount of faeces generated by three Kato-Katz templates included in test kits from two different providers.Methods:Nine hundred Kato-Katz thick smear preparations were done;300 per kit.Empty slides,slides plus Kato-Katz template filled with stool and slides plus stool after careful removal of the template were weighed to the nearest 0.1 mg.The average amount of stool that was generated on the slide was calculated for each template,stratified by standard categories of stool consistency(i.e.mushy,soft,sausage-shaped,hard and clumpy).Results:The average amount of stool generated on slides was 40.7 mg(95%confidence interval(CI):40.0–41.4 mg),40.3 mg(95%CI:39.7–40.9 mg)and 42.8 mg(95%CI:42.2–43.3 mg)for the standard Vestergaard Frandsen template,and two different templates from the Chinese Center for Disease Control and Prevention(China CDC),respectively.Mushy stool resulted in considerably lower average weights when the Vestergaard Frandsen(37.0 mg;95%CI:34.9–39.0 mg)or new China CDC templates(37.4 mg;95%CI:35.9–38.9 mg)were used,compared to the old China CDC template(42.2 mg;95%CI:40.7–43.7 mg)and compared to other stool consistency categories.Conclusion:The average amount of stool generated by three specific Kato-Katz templates was similar(40.3–42.8 mg).Since the multiplication factor is somewhat arbitrary and small changes only have little effect on infection intensity categories,it is suggested that the standard multiplication factor of 24 should be kept for the calculation of eggs per gram of faeces for all investigated templates.
基金funded by the Italian Ministry of Health"Fondi Ricerca Corrente-L2P2"to IRCCS Sacro Cuore Don Calabria Hospital,Negrar,Verona,Italy and by funds of"Ministry of Education,University and Research(Italy)Excellence Departments 2018-2022"Project for the Department of Experimental and Clinical Medicine,University of Florenee,Florenee,Italy.
文摘Background:Implementation of control programmes for Strongyloides stercoralis infection is among the targets of the World Health Organization Roadmap to 2030.Aim ofthis work was to evaluate the possible impact in terms of economic resources and health status of two different strategies of preventive chemotherapy(PC)compared to the current situation(strategy A,no PC):administration of ivermectin to school-age children(SAC)and adults(strategy B)versus ivermectin to SAC only(strategy C).Methods:The study was conducted at the IRCCS Sacro Cuore Don Calabria hospital,Negrar di Valpolicella,Verona,Italy,at the University of Florence,Italy,and at the WHO,Geneva,Switzerland,from May 2020 to April 2021.Data for the model were extracted from literature.A mathematical model was developed in Microsoft Excel to assess the impact of strategies B and C in a standard population of 1 million subjects living in a strongyloidiasis endemic area.In a case base seenario,15%prevalence of strongyloidiasis was considered;the 3 strategies were then evaluated at different thresholds of prevalenee,ranging from 5 to 20%.The results were reported as number of infected subjects,deaths,costs,and Incremental-Effectiveness Ratio(ICER).A 1-year and a 10-year horizons were considered.Results:In the case base seenario,cases of infections would reduce dramatically in the first year of implementation of PC with both strategy B and C:from 172500 cases to 77040 following strategy B and 146700 following strategy C.The additional cost per recovered person was United States Dollar(USD)2.83 and USD 1.13 in strategy B and C,respectively,compared to no treatment in the first year.For both strategies,there was a downtrend in costs per recovered person with increasing prevalenee.The number of adverted deaths was larger for strategy B than C,but cost to advert one death was lower for strategy C than B.Conclusions:This analysis permits to estimate the impact of two PC strategies for the control of strongyloidiasis in terms of costs and adverted infections/deaths.This could represent a basis on which each endemic country can evaluate which strategy can be implemented,based on available funds and national health priorities.
文摘Background:The goal of soil-transmitted helminthiases(STH)control programmes is to eliminate STH-associated morbidity in the target population by reducing the prevalence of moderate-and heavy-intensity infections and the overall STH infection prevalence mainly through preventive chemotherapy(PC)with either albendazole or mebendazole.Endemic countries should measure the success of their control programmes through regular epidemiological assessments.We evaluated changes in STH prevalence in countries that conducted effective PC coverage for STH to guide changes in the frequency of PC rounds and the number of tablets needed.Methods:We selected countries from World Health Organization(WHO)^Preventive Chemotherapy and Transmission control(PCT)databank that conducted≥5 years of PC with effective coverage for school-age children(SAC)and extracted STH baseline and impact assessment data using the WHO Epidemiological Data Reporting Form,Ministry of Health reports and/or peer-reviewed publications.We used pooled and weighted means to plot the prevalence of infection with any STH and with each STH species at baseline and after≥5 years of PC with effective coverage.Finally,using the WHO STH decision tree,we estimated the reduction in the number of tablets needed.Results:Fifteen countries in four WHO regions conducted annual or semi-annual rounds of PC for STH for 5 years or more and collected data before and after interventions.At baseline,the pooled prevalence was 48.9%(33.1-64.7%)for any STH,23.2%(13.7-32.7%)for Ascoris lumbricoides,21.01%(9.7-32.3%)for Trichuris trichiuro and 18.2%(10.9-25.5%)for hookworm infections,while after>5 years of PC for STH,the prevalence was 14.3%(7.3-21.3%)for any STH,6.9%(1.3-12.5%)for A.lumbricoides,5.3%(1.06-9.6%)for T.trichiura and 8.1%(4.0-12.2%)for hookworm infections.Conclusions:Countries endemic for STH have made tremendous progress in reducing STH-associated morbidity,but very few countries have data to demonstrate that progress.In this study,the data show that nine countries should adapt their PC strategies and the frequency of PC rounds to yield a 36%reduction in drug needs.The study also highlights the importance of impact assessment surveys to adapt control strategies according to STH prevalence.
文摘Background:Soil-transmitted helminthiases(STH)are part of the group of neglected tropical diseases traditionally treated with preventive chemotherapy interventions.In recent years,drug donations have been essential to expanding preventive chemotherapy and achieving progressive control of morbidity from STH.This study aims to evaluate the need for anthelminthic medicines during 2020–2030.Methods:To estimate the need for anthelminthic medicines,we considered three different scenarios:(1)the control programmes continues to expand coverage and maintains the frequency of drug administration established at baseline;(2)the programmes continues to expand coverage but adapts the frequency of drug administration when the STH prevalence is reduced and(3)the STH programme becomes self-sustainable in some endemic countries.Results:We estimate that the number of anthelmintic medicines needed to treat school-aged children will increase by 40%by 2025 and by 52%by 2030 if countries do not change the frequency of preventive chemotherapy(scenario 1);that the number of tablets needed will reduce by 32.4%by 2025 and by 49.1%in 2030 if endemic countries reduce the frequency of preventive chemotherapy(scenario 2);and drug donations could be reduced by 54.4%by 2025 and 74.4%by 2030 if some endemic countries could become independent in drug procurement(scenario 3).Conclusions:The number of anthelmintic medicines needed to achieve elimination of morbidity due to STH in school-aged children will decline during 2020–2030.The decline will be substantial if a number of“upper-middle income”countries in which STH are endemic procure,as expected,anthelminthic medicines independently.
