The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial

Sanya, Richard E.; Nkurunungi, Gyaviira; Spaans, Remy Hoek; Nampijja, Margaret; O’Hara, Geraldine; Kammerer, Robert; Oduru, Gloria; Nakawungu, Prossy Kabuubi; Niwagaba, Emmanuel; Abayo, Elson; Kabagenyi, Joyce; Zziwa, Christopher; Tumusiime, Josephine; Nakazibwe, Esther; Kaweesa, James; Kakooza, Fred Muwonge; Akello, Mirriam; Lubyayi, Lawrence; Verweij, Jaco J.; Nash, Stephen; Ree, Ronald van; Mpairwe, Harriet; Tukahebwa, Edridah M.; Webb, Emily L.; Elliott, Alison M; Team, LaVIISWA Trial

doi:10.1093/cid/ciy761

Cited by 27 publications

(50 citation statements)

References 34 publications

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“…Our rural and urban settings were atypical. Observations in the rural survey are against a backdrop of three years of well‐organized community‐level anthelminthic intervention that led to a decline in helminth intensity in both standard and intensive treatment arms, but had no effect on overall Sm prevalence . Before analysis of risk factors, we confirmed a lack of effect of the intensive (compared with standard) anthelminthic treatment on allergy‐related outcomes.…”

Section: Discussionsupporting

confidence: 83%

“…A baseline household survey preceded the trial intervention; helminth‐allergy associations at baseline have been reported . A household‐based allergy outcomes survey (the “rural survey”) was conducted between September 2015 and August 2016, following 3 years of anthelminthic intervention: there was no difference in the prevalence of allergy outcomes between the two trial arms . Sampling for the survey involved random selection of 70 households from each village using a Stata program.…”

Section: Methodsmentioning

confidence: 99%

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Do helminth infections underpin urban‐rural differences in risk factors for allergy‐related outcomes?

Nkurunungi

Lubyayi

Versteeg

et al. 2019

Clin Experimental Allergy

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Summary Background It is proposed that helminth exposure protects against allergy‐related disease, by mechanisms that include disconnecting risk factors (such as atopy) from effector responses. Objective We aimed to assess how helminth exposure influences rural‐urban differences in risk factors for allergy‐related outcomes in tropical low‐ and middle‐income countries. Methods In cross‐sectional surveys in Ugandan rural Schistosoma mansoni (Sm)‐endemic islands, and in nearby mainland urban communities with lower helminth exposure, we assessed risk factors for atopy (allergen‐specific skin prick test [SPT] reactivity and IgE [asIgE] sensitization) and clinical allergy‐related outcomes (wheeze, urticaria, rhinitis and visible flexural dermatitis), and effect modification by Sm exposure. Results Dermatitis and SPT reactivity were more prevalent among urban participants, urticaria and asIgE sensitization among rural participants. Pairwise associations between clinical outcomes, and between atopy and clinical outcomes, were stronger in the urban survey. In the rural survey, SPT positivity was inversely associated with bathing in lakewater, Schistosoma‐specific IgG4 and Sm infection. In the urban survey, SPT positivity was positively associated with age, non‐Ugandan maternal tribe, being born in a city/town, BCG scar and light Sm infection. Setting (rural vs urban) was an effect modifier for risk factors including Sm‐ and Schistosoma‐specific IgG4. In both surveys, the dominant risk factors for asIgE sensitization were Schistosoma‐specific antibody levels and helminth infections. Handwashing and recent malaria treatment reduced odds of asIgE sensitization among rural but not urban participants. Risk factors for clinical outcomes also differed by setting. Despite suggestive trends, we did not find sufficient evidence to conclude that helminth (Sm) exposure explained rural‐urban differences in risk factors. Conclusions and clinical relevance Risk factors for allergy‐related outcomes differ between rural and urban communities in Uganda but helminth exposure is unlikely to be the sole mechanism of the observed effect modification between the two settings. Other environmental exposures may contribute significantly.

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Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Do helminth infections underpin urban‐rural differences in risk factors for allergy‐related outcomes?

Nkurunungi

Lubyayi

Versteeg

et al. 2019

Clin Experimental Allergy

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“…Between December 2017 and July 2018, we conducted a cross-sectional survey in fishing communities on the Koome Islands in Mukono District, Uganda, with an estimated population of 16,000. HIV prevalence in Koome was around 21% in adults aged 18+ in 2016 [19]. Based on data from a household survey conducted in 2013, as part of the LaVIISWA study [20], within the 15-25 year age group, reported alcohol misuse (defined as consuming at least five alcoholic drinks per day in the last 12 months on average), prevalence was 5%-6%.…”

Section: Study Setting Design and Proceduresmentioning

confidence: 99%

“…The target population was young people aged 15-24 years and the primary outcome was prevalence of alcohol misuse. The target sample size of 1204 young people was calculated to allow us a precision of 2.5% with which to estimate a prevalence of alcohol misuse of up to 15% [19,21], assuming a design effect of 1.5. If the design effect was higher, at 2, then this sample size would allow us precision of 2.5% with which to estimate a prevalence of up to 11%.…”

Section: Study Setting Design and Proceduresmentioning

confidence: 99%

“…Adolescence is a vulnerability window for initiation and continuation of polysubstance use and associated harms [3]. For instance, globally, the prevalence of current drinking increases from 26.5% among [15][16][17][18][19] year olds to 40.7% among [20][21][22][23][24] year olds, while the prevalence of heavy episodic drinking increases from 13.6% to 21.8% [1]. An estimated 14% of all deaths among [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] year olds are attributable to alcohol [4].…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology of Alcohol Misuse and Illicit Drug Use Among Young People Aged 15–24 Years in Fishing Communities in Uganda

Kuteesa

Weiss

Cook

et al. 2020

IJERPH

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Background: We determined the prevalence of and risk factors for alcohol misuse and illicit drug use among young Ugandans in fishing communities, a recognised “key population” for human immunodeficiency virus (HIV) infection. Methods: We conducted a cross-sectional survey among young people (15–24 years) in fishing communities in Koome, Uganda, in December 2017–July 2018. Using Audio-Assisted Self-Interviewing, we collected data on socio-demographic characteristics and alcohol use, including the Alcohol Use Disorders Identification Test (AUDIT) and timeline follow-back calendar (TLFB). Blood samples were analysed for HIV, herpes simplex virus 2 (HSV2), and Phosphatidyl ethanol (PEth 16:0/18:1). Urine samples were analysed for illicit drugs. Results: Among 1281 participants (52.7% male, mean age 20 years), 659 (51.4%) reported ever drinking alcohol, 248 (19.4%) had 12-month-AUDIT ≥ 8, and 261 (20.5%) had whole-blood PEth 16:0/18:1 concentration ≥ 20 ng/mL, indicating significant consumption. In multivariable analyses, PEth 16:0/18:1 ≥ 20ng/mL, AUDIT ≥ 8 and binge drinking (≥6 standard drinks per drinking occasion in the previous month from TLFB) were all strongly associated with older age, low education, smoking, and HSV2. Illicit drug use prevalence was 5.2% and was associated with older age, low education, being single, and smoking. Conclusion: Levels of alcohol misuse were high among young people in fishing communities and associated with HSV2, a proxy for risky sexual behaviour. Alcohol and illicit drug harm reduction services and HIV prevention programs in Uganda should prioritise young fisherfolk.

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Urban-rural differences in immune responses to mycobacterial and tetanus vaccine antigens in a tropical setting: A role for helminths?

Kabagenyi

Natukunda

Nassuuna

et al. 2020

Parasitology International

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Several vaccines elicit lower efficacy or impaired immune responses in rural compared to urban settings, and in tropical low-income countries compared to high-income countries. An unresolved hypothesis is that immunomodulation by parasitic infections such as helminths (prevalent in rural tropical settings) contributes to suppression of vaccine responses. Among 1–17-year-old Ugandan residents of rural Schistosoma mansoni ( Sm )-endemic islands and proximate urban communities with lower helminth exposure, we assessed plasma antibody and whole blood assay cytokine responses to tetanus toxoid (TT) and purified protein derivative of Mycobacterium tuberculosis (PPD). These were taken to represent recall responses to tetanus and BCG vaccination in infancy. PPD-specific responses are additionally induced by tuberculous and non-tuberculous mycobacterial exposure. Urban-rural comparisons showed that PPD-specific IFN-γ and IL-13 and TT-specific IL-13 and IgG concentrations were lower in the rural setting, but that PPD-specific IgE concentrations were higher. Among rural participants, Sm infection was inversely associated with PPD-specific IFN-γ, while nematode infection was positively associated with PPD-specific IgG. Among urban participants, Sm infection was positively associated with PPD-specific responses but inversely associated with TT-specific responses, while nematode infection was inversely associated with TT-specific IgG and IgG4, but no associations were observed with PPD-specific responses. Despite these associations, for the urban-rural comparisons there were no notable changes in test statistics after adjusting for current helminth infections, suggesting that helminths were not the sole explanation for the urban-rural differences observed. Helminths likely work in concert with other environmental exposures and operational factors to influence vaccine response.

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The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial

Cited by 27 publications

References 34 publications

Do helminth infections underpin urban‐rural differences in risk factors for allergy‐related outcomes?

Do helminth infections underpin urban‐rural differences in risk factors for allergy‐related outcomes?

Epidemiology of Alcohol Misuse and Illicit Drug Use Among Young People Aged 15–24 Years in Fishing Communities in Uganda

Urban-rural differences in immune responses to mycobacterial and tetanus vaccine antigens in a tropical setting: A role for helminths?

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