Putting the treatment of paediatric schistosomiasis into context

Abstract

Despite increased international efforts to control schistosomiasis using preventive chemotherapy, several challenges still exist in reaching the target populations. Until recently, preschool-aged children had been excluded from the recommended target population for mass drug administration, i.e. primary school children aged 6–15 years. Our studies and those of others provided the evidence base for the need to treat preschool-aged children that led to recommendations by the World Health Organization to include preschool-aged children in treatment programmes in 2010. The major challenge now lies in the unavailability of a child-size formulation of the appropriate anthelmintic drug, praziquantel.The currently available formulation of praziquantel presents several problems. First, it is a large tablet, making it difficult for young children and infants to swallow it and thus requires its breaking/crushing to allow for safe uptake. Second, it is bitter so it is often mixed with a sweetener to make it palatable for young children. Third, the current formulation of 600 mg does not allow for flexible dose adjustments for this age group. Thus, there is a need to formulate a child-appropriate praziquantel tablet.This paper discusses the target product profile for paediatric praziquantel, as well as knowledge gaps pertinent to the successful control of schistosome infection and disease in preschool-aged children.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0300-8) contains supplementary material, which is available to authorized users.

Reinfection of urogenital schistosomiasis in pre-school children in a highly endemic district in Northern Zimbabwe: a 12 months compliance study

“…In the Expanded Programme on Immunisation (EPI) in sub-Saharan Africa these children are accessed successfully through primary health care (PHC) programmes. In this current study in Zimbabwe, these young children were also accessed through the PHC [ 29 ]. Given that monitoring of reinfections is dependent on the religious participation to follow up programmes, there is a need to ascertain to what extent do PSAC comply to successive participation and if the PHC system is effective regards the accessibility of PSAC for participation in schistosomiasis control programmes.…”

Intestinal schistosomiasis of Ijinga Island, north-western Tanzania: Prevalence, intensity of infection, hepatosplenic morbidities and their associated factors

“…Studies have reported an association between the enlargement of the left liver lobe and S. mansoni infection and its intensity [11,31,32]. The main concern here, is the development of S. mansoni related hepatosplenic morbidities at such young age and the fact that, to date this age group is not considered for MDA with praziquantel [35,39,41]. At the time when these children will be attending primary school, they are at risk of having already developed advanced stages of hepatosplenic disease.…”

“…In our present study, almost 41% of the pre-school children were missed by KK technique. Taking into account that the peadiatric formulation of praziquantel will be available in the near future [35,39], which will allow including of PSAC into the MDA program, it is important to include a more sensitive diagnostic test for case detection in this age group and for monitoring of drug efficacy [35].…”

Fine-scale heterogeneity in Schistosoma mansoni force of infection measured through antibody response

“…Global control programs currently exclude preschool age children due in part to lack of evidence for efficacy and safety in this group, but clinical trials are in progress to develop safe delivery methods for praziquantel for children under 6 years old. 26,27 Complementary strategies that focus on environmental interventions should be promoted in tandem with MDA to help reduce transmission among this vulnerable age group. 28 for use under a CC0 license.…”