FioSchisto’s expert perspective on implementing WHO guidelines for schistosomiasis control and transmission elimination in Brazil

Abstract

The World Health Organization (WHO) recognizes schistosomiasis as one of the Neglected Tropical Diseases targeted for global elimination in the 2030 Agenda of the Sustainable Development Goals. In Brazil, schistosomiasis mansoni is considered a public health problem, particularly prevalent among vulnerable populations living in areas with poor environmental and sanitary conditions. In 2022, the WHO published a Guideline encompassing recommendations to assist national programs in endemic countries in achieving morbidity control, eliminating schistosomiasis as a public health problem, and advancing towards interrupting transmission. The perspectives presented here, collectively prepared by members of the Oswaldo Cruz Foundation’s (Fiocruz) Schistosomiasis Translational Program (FioSchisto), along with invited experts, examine the feasibility of the WHO recommendations for the Brazilian settings, providing appropriate recommendations for public health policies applicable to the epidemiological reality of Brazil, and suggests future research to address relevant issues. In Brazil, the provision of safe water and sanitation should be the key action to achieve schistosomiasis elimination goals. The agencies involved in measures implementation should act together with the Primary Care teams for planning, executing, monitoring, and evaluating actions in priority municipalities based on their epidemiological indicators. Host snails control should prioritize judicious ecological interventions at breeding sites. The Information, Education, and Communication (IEC) strategy should be associated with water and sanitation and other control actions, actively involving school community. To identify infected carriers, FioSchisto recommends a two-stage approach of immunological and molecular tests to verify transmission interruption during the intervention and beyond. Praziquantel administration should be done under medical supervision at the Primary Care level. MDA should be considered in exceptional settings, as a measure of initial attack strategy in locations presenting high endemicity, always integrated with water and sanitation, IEC, and snail control. To assist decision-making, as well as the monitoring and evaluation of strategic actions, there is a need for an Information System. FioSchisto considers this systematization essential to make investments in strategic research to support the improvement of schistosomiasis control actions. Efforts toward schistosomiasis elimination in Brazil will succeed with a paradigm shift from the vertical prescriptive framework to a community-centered approach involving intersectoral and interdisciplinary collaboration.

Investigating Immunotoxicity in Black Carp (Mylopharyngodon piceus) Fingerlings Exposed to Niclosamide

“…Through an examination of the changes in biochemical parameters and gene expression profiles in the liver of M. piceus following 28 days of exposure, valuable insights into the molecular and biological responses of this fish to the toxicant, as well as potential detoxification pathways, were gained. As efforts to control molluscicides continue to prioritize minimizing impacts on native, non-target species, it is imperative to incorporate a thorough understanding of the potential adverse effects and pathways of elimination of molluscicides in order to develop more informed and targeted strategies for managing aquatic snails Pomacea canaliculate [22,23]. Consistent with prior findings, niclosamide (NIC) infiltrates the fish organism and predominantly accumulates in the liver [10,24].…”

Climate and urbanization drive changes in the habitat suitability of Schistosoma mansoni competent snails in Brazil

“…Brazil aims for schistosomiasis elimination by 2030 and indeed has reduced transmission substantially since the inception of their national surveillance system in the 1950s 16 . However, total elimination remains elusive.…”

“…Globally, schistosomiasis control has been orchestrated through preventative and reactive medical treatment via administration of the drug praziquantel 2 , WASH interventions (access to safe water, sanitation, and hygiene) 2 , and environmental interventions (e.g., water engineering and snail control) 18 , 19 . In Brazil, public health professionals have found that mass drug administration has temporary effects 16 . Therefore, current recommendations for risk reduction include integration of water sanitation, community-education, and removal of snail breeding sites through non-molluscicide based environmental interventions, such as aquatic vegetation removal, draining flooded areas, and modification of watercourses.…”

“…Therefore, current recommendations for risk reduction include integration of water sanitation, community-education, and removal of snail breeding sites through non-molluscicide based environmental interventions, such as aquatic vegetation removal, draining flooded areas, and modification of watercourses. Mass drug administration is only suggested under exceptional circumstances 16 . Elucidating how environmental variables have influenced past changes in snail occurrence can help to anticipate which areas may benefit from increased surveillance for disease emergence and facilitate more precise allocation of resources.…”