Human fascioliasis is becoming a serious public health problem with a number of endemic areas identified in different countries. The viability of humans as definitive hosts has been experimentally demonstrated, and there is now a need to control the human infection along with the veterinary infection. In 1998, following reports on high prevalence among children in the Nile Delta, the Egyptian Ministry of Health and Population launched the first public health, school-based intervention to control human fascioliasis. An innovative selective treatment approach, with chemotherapy targeted to specific high risk age groups and villages, was adopted. First, high prevalence districts were identified by a regional baseline survey, then screening and selective treatment of all schoolchildren took place in high prevalence villages within those districts. From 1998 to 2002 the programme screened almost 36000 schoolchildren, in six districts, treating 1280 cases of human fascioliasis. Prevalence in the endemic area was reduced from 5.6 to 1.2%. The control intervention is described in detail, including data on cost. The targeted, selective chemotherapy approach was appropriate in addressing low prevalence infection, effective in reducing prevalence rates and transmission of the disease, and in the present situation, more cost-effective than mass distribution.
Praziquantel is still very effective for the treatment of schistosomiasis, but there are rising concerns on the potential risk of developing resistances because of the extensive use of this drug. Triclabendazole, a systemic anthelmintic, is very effective against other trematodes such as Paragonimus spp. and Fasciola spp. It has been reported to be effective in vitro and in experimental animals against Schistosoma mansoni. However, its antischistosomal efficacy in humans has not yet been evaluated. The objective of the study was to evaluate the efficacy of triclabendazole at the dosage currently used for the treatment of human fascioliasis (10mg/kg body weight) in subjects co-infected with S. mansoni and Fasciola spp. The study was carried out in Behera, a highly endemic area for both parasites, by personnel of the Egyptian Ministry of Health and Population. Ten subjects (m = 4, f = 6; age, 8-58years), who were infected at the same time by Fasciola spp. and S. mansoni, were enrolled. Six weeks after therapy, seven subjects were still excreting ova of S. mansoni, whereas none was excreting Fasciola spp. ova. At the given dosage, triclabendazole appeared not to be sufficiently effective in the treatment of S. mansoni.
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