Young Adults in Endemic Areas: An Untreated Group in Need of School-Based Preventive Chemotherapy for Schistosomiasis Control and Elimination

Abstract

Parasitologic surveys of young adults in college and university settings are not commonly done, even in areas known to be endemic for schistosomiasis and soil-transmitted helminths. We have done a survey of 291 students and staff at the Kisumu National Polytechnic in Kisumu, Kenya, using the stool microscopy Kato-Katz (KK) method and the urine point-of-care circulating cathodic antigen (POC-CCA) test. Based on three stools/two KK slides each, in the 208 participants for whom three consecutive stools were obtained, Schistosoma mansoni prevalence was 17.8%. When all 291 individuals were analyzed based on the first stool, as done by the national neglected tropical disease (NTD) program, and one urine POC-CCA assay (n = 276), the prevalence was 13.7% by KK and 23.2% by POC-CCA. Based on three stools, 2.5% of 208 participants had heavy S. mansoni infections (≥400 eggs/gram feces), with heavy S. mansoni infections making up 13.5% of the S. mansoni cases. The prevalence of the soil-transmitted helminths (STH: Ascaris lumbricoides, Trichuris trichiura and hookworm) by three stools was 1.4%, 3.1%, and 4.1%, respectively, and by the first stool was 1.4%, 2.4% and 1.4%, respectively. This prevalence and intensity of infection with S. mansoni in a college setting warrants mass drug administration with praziquantel. This population of young adults is ‘in school’ and is both approachable and worthy of inclusion in national schistosomiasis control and elimination programs.

Residence Time, Water Contact, and Age-driven Schistosoma mansoni Infection in Hotspot Communities in Uganda

“…Most MDA has focused on SAC because of their vulnerability and the ease of access for treatments. However, in hotspot communities, young adults, in particular, have low praziquantel MDA compliance rates, 25,49 high disease rates, practice open defecation, and could have an important role in the rapid infection and reinfection rates of SAC and PSAC. 33 Although other scholars have observed this high burden, 41,50 PSAC are not targeted by the control program, and there is no approved pediatric formulation for this group.…”

<p>Impact of annual preventive mass chemotherapy for soil-transmitted helminths among primary school children in an endemic area of Gurage zone: a prospective cross-sectional study</p>

“…However, even after mass chemotherapy, some children still had residual STH and/or S. mansoni infections. This may reflect the maintenance of transmission among untreated populations23,24 or a failure to clear infections after chemotherapy25 in a proportion of children.…”

Schistosomiasis Control: Leave No Age Group Behind

“…Numerous opportunities exist to improve access of MDA to adults [82], and local data documenting the most significant barriers may be useful in designing the most effective strategies for improvement in specific communities or regions. Some interventions likely to be successful in many sites include optimizing selection and training for community drug distributors [83], providing health education about schistosomiasis [84] focusing on adults who have lived in villages for prolonged periods [85], and targeting young adults in college or other youth settings [51,86]. Repeated MDA campaigns can lead to treatment fatigue [85], and low compliance may be low due to nonspecific symptoms.…”