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Review
. 2022 Sep;10(9):e1355-e1359.
doi: 10.1016/S2214-109X(22)00287-X.

Defining elimination as a public health problem for schistosomiasis control programmes: beyond prevalence of heavy-intensity infections

Affiliations
Review

Defining elimination as a public health problem for schistosomiasis control programmes: beyond prevalence of heavy-intensity infections

Ryan E Wiegand et al. Lancet Glob Health. 2022 Sep.

Abstract

WHO's 2021-30 road map for neglected tropical diseases (NTDs) outlines disease-specific and cross-cutting targets for the control, elimination, and eradication of NTDs in affected countries. For schistosomiasis, the criterion for elimination as a public health problem (EPHP) is defined as less than 1% prevalence of heavy-intensity infections (ie, ≥50 Schistosoma haematobium eggs per 10 mL of urine or ≥400 Schistosoma mansoni eggs per g of stool). However, we believe the evidence supporting this definition of EPHP is inadequate and the shifting distribution of schistosomiasis morbidity towards more subtle, rather than severe, morbidity in the face of large-scale control programmes requires guidelines to be adapted. In this Viewpoint, we outline the need for more accurate measures to develop a robust evidence-based monitoring and evaluation framework for schistosomiasis. Such a framework is crucial for achieving the goal of widespread EPHP of schistosomiasis and to meet the WHO road map targets. We encourage use of overall prevalence of schistosome infection (instead of the prevalence of heavy-intensity infections), development of species-dependent and age-dependent morbidity markers, and construction of a standardised monitoring and evaluation protocol.

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Conflict of interest statement

Declaration of interests CHK served on the Data Safety Monitoring Board, Praziquantel for Children Under Age Four Years Trial, National Institutes of Health; WHO Expert Advisory Panel on Parasitic Diseases (Schistosomiasis); WHO Guidelines Development Group on the implementation of control and elimination of schistosomiasis and the verification of elimination; WHO technical working group on protocols for remapping and impact assessment of schistosomiasis; and expert panel, praziquantel trial assessment, Pediatric Praziquantel Consortium. All other authors declare no competing interests.

References

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