Journal of Infectious Diseases Advance Access published October 9, 2014
0 OCTOBER
Correspondence Mass Drug Administration (MDA) for Schistosomiasis
regimen of 60 mg/kg should be cautiously recommended. In addition, MDA has also been proved to be able to control the transmission of schistosomiasis effectively in sub-Saharan Africa. In Sierra Leone, a round of MDA reduced the prevalence of Schistosoma mansoni from 69% to 38.2% and the mean intensity from 170.8 to 47.3 EPG, and the percentage of children with moderate or severe S. mansoni infection fell from 35.6% pre-MDA to 9.9% postMDA [8], whereas 3 rounds of MDA resulted in a 67.2% reduction of prevalence and 85.9% reduction of mean intensity, respectively [9]. The success of MDA urges the expansion of this strategy to include school age children in regions with low endemicity in Sierra Leone, which is well on its way to eliminate schistosomiasis [9]. The suggestion of incorporating vaccination of bovines, which is unavailable and still at experimental stage, into a multifaceted integrated approach targeting the transmission pathways for schistosomiasis, seems a bit unrealistic. Complementation of the existing program with well-established and effective tools is, in our view, reasonable. China is currently transferring its expertise in schistosomiasis control to Africa, and the Philippines may also learn much from China’s experiences and lessons. However, the Philippines still needs to devise an optimal control strategy with adaptation to local circumstances to facilitate the progress towards the elimination of schistosomiasis. Notes Financial support. This work was supported by the Natural Science Foundation of Jiangsu Province (BK20141105), Jiangsu Provincial Special Fund for the Scientific Research of Clinical
CORRESPONDENCE
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JID
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Downloaded from http://jid.oxfordjournals.org/ at University of Nebraska-Lincoln Libraries on April 3, 2015
TO THE EDITOR—In a recent article published in the Journal of Infectious Diseases, Ross and colleagues [1] stated that “MDA on its own was insufficient to control the prevalence, intensity or morbidity of the disease.” The authors then say that “it is becoming increasingly clear that the sustainable control of schistosomiasis will require an integrated, inter-sectorial approach that goes beyond deworming.” Finally, they suggest that alternative control measures will be needed to complement the existing national mass drug administration (MDA) program. We agree that MDA alone is insufficient for the elimination of schistosomiasis, and that sustainable control of the disease requires an integrated strategy including praziquantel chemotherapy, snail control, health education, improved water supply and sanitation, and management of the sources of infection. However, MDA with praziquantel has been shown to be effective in reducing morbidity and the prevalence and intensity of schistosome infection. The introduction of praziquantel in the 1980s led to China’s national schistosomiasis control strategy shifting from transmission control to morbidity control (from mid-1980s to 2004), and praziquantel-based chemotherapy, as the cornerstone of the national control program, has been proven to enable the control of mortality, morbidity, and transmission of schistosomiasis japonica [2]. Since the initiation of the World Bank Loan Project for China’s Schistosomiasis Control in 1992, MDA with 40 mg/kg of praziquantel was implemented in all endemic regions with a human prevalence of >15%, selective chemotherapy in regions
with a prevalence from 3% to 15%, and extensive chemotherapy in areas with a prevalence of
0 OCTOBER
Correspondence Mass Drug Administration (MDA) for Schistosomiasis
regimen of 60 mg/kg should be cautiously recommended. In addition, MDA has also been proved to be able to control the transmission of schistosomiasis effectively in sub-Saharan Africa. In Sierra Leone, a round of MDA reduced the prevalence of Schistosoma mansoni from 69% to 38.2% and the mean intensity from 170.8 to 47.3 EPG, and the percentage of children with moderate or severe S. mansoni infection fell from 35.6% pre-MDA to 9.9% postMDA [8], whereas 3 rounds of MDA resulted in a 67.2% reduction of prevalence and 85.9% reduction of mean intensity, respectively [9]. The success of MDA urges the expansion of this strategy to include school age children in regions with low endemicity in Sierra Leone, which is well on its way to eliminate schistosomiasis [9]. The suggestion of incorporating vaccination of bovines, which is unavailable and still at experimental stage, into a multifaceted integrated approach targeting the transmission pathways for schistosomiasis, seems a bit unrealistic. Complementation of the existing program with well-established and effective tools is, in our view, reasonable. China is currently transferring its expertise in schistosomiasis control to Africa, and the Philippines may also learn much from China’s experiences and lessons. However, the Philippines still needs to devise an optimal control strategy with adaptation to local circumstances to facilitate the progress towards the elimination of schistosomiasis. Notes Financial support. This work was supported by the Natural Science Foundation of Jiangsu Province (BK20141105), Jiangsu Provincial Special Fund for the Scientific Research of Clinical
CORRESPONDENCE
•
JID
•
1
Downloaded from http://jid.oxfordjournals.org/ at University of Nebraska-Lincoln Libraries on April 3, 2015
TO THE EDITOR—In a recent article published in the Journal of Infectious Diseases, Ross and colleagues [1] stated that “MDA on its own was insufficient to control the prevalence, intensity or morbidity of the disease.” The authors then say that “it is becoming increasingly clear that the sustainable control of schistosomiasis will require an integrated, inter-sectorial approach that goes beyond deworming.” Finally, they suggest that alternative control measures will be needed to complement the existing national mass drug administration (MDA) program. We agree that MDA alone is insufficient for the elimination of schistosomiasis, and that sustainable control of the disease requires an integrated strategy including praziquantel chemotherapy, snail control, health education, improved water supply and sanitation, and management of the sources of infection. However, MDA with praziquantel has been shown to be effective in reducing morbidity and the prevalence and intensity of schistosome infection. The introduction of praziquantel in the 1980s led to China’s national schistosomiasis control strategy shifting from transmission control to morbidity control (from mid-1980s to 2004), and praziquantel-based chemotherapy, as the cornerstone of the national control program, has been proven to enable the control of mortality, morbidity, and transmission of schistosomiasis japonica [2]. Since the initiation of the World Bank Loan Project for China’s Schistosomiasis Control in 1992, MDA with 40 mg/kg of praziquantel was implemented in all endemic regions with a human prevalence of >15%, selective chemotherapy in regions
with a prevalence from 3% to 15%, and extensive chemotherapy in areas with a prevalence of
