Anderson, Roy M., Turner, Hugo C., Truscott, James E., Hollingsworth, T. Déirdre and Brooker, Simon J. (2015) Should the goal for the treatment of soil transmitted Helminth (STH) infections be changed from morbidity control in children to community-wide transmission elimination? PLoS Neglected Tropical Diseases, 9 (8). e0003897. doi:10.1371/journal.pntd.0003897 ISSN 1935-2727.

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Abstract

Morbidity induced by infection with the major soil transmitted infections (STH—Ascaris lumbricoides, Trichuris trichiura, and hookworms) results in an estimated 5.19 million disability-adjusted life years (DALYs) [1]. The World Health Organization’s (WHO) policy for control centres on three groups, preschool aged children (pre-SAC), school-aged children (SAC), and women of child bearing age, on the basis that heavy infection in these groups will have a detrimental impact on anaemia, child growth, and development. The current WHO guidelines focus on school-aged children, both for monitoring infection and as a target for treatment, although treatment of pre-SAC and women of childbearing age is also recommended where sustainable delivery mechanisms exist, especially in areas of intense transmission [2,3]. The guidelines recommend treating SAC annually where any STH prevalence falls between 20% and 50% and twice a year where it exceeds 50% [3].

The London Declaration on Neglected Tropical Diseases in 2012 endorsed WHO goals to scale up mass drug administration (MDA) for STH, so that by 2020, 75% of the pre-SAC and SAC in need will be treated regularly [4]. Building on an existing roadmap, WHO announced an intention to meet the target [2,5,6]. Progress has been good in some areas, but less so in others. In 2012, global coverage of those in need was 37% for SAC and 29% for pre-SAC [5]. Data for the more recent years is as yet to be published by WHO [5], but a huge gain in coverage is not expected, despite increased drug donations from the pharmaceutical companies who manufacture the main anthelmintics. This is due in part to the logistical challenges in getting even donated drugs to these populations, who are often beyond “the end of the road.” At present, many countries with endemic STH infections are not availing themselves of the freely donated drugs to treat children.

We are still a long way from the 2020 target of 75%. Even if this target is reached, will it be enough to eliminate transmission and the disease arising from heavy infections with STH? If not, how should the guidelines be changed to push towards morbidity control, and ideally, the eventual elimination of transmission?

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RJ Pediatrics
Divisions:	Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- ) Faculty of Science, Engineering and Medicine > Science > Mathematics
Library of Congress Subject Headings (LCSH):	Helminthiasis -- Treatment, Helminthiasis in children
Journal or Publication Title:	PLoS Neglected Tropical Diseases
Publisher:	Public Library of Science
ISSN:	1935-2727
Official Date:	20 August 2015
Dates:	Date Event 20 August 2015 Published 23 June 2015 Accepted
Volume:	9
Number:	8
Page Range:	e0003897
DOI:	10.1371/journal.pntd.0003897
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	30 December 2015
Date of first compliant Open Access:	30 December 2015
Funder:	Bill & Melinda Gates Foundation, Wellcome Trust (London, England)
Grant number:	OPP1033751 (Bill & Melinda Gates Foundation), 098045 (Wellcome Trust )
Is Part Of:	RMA and SJB receive funding from the Bill and Melinda Gates Foundation (OPP1033751). SJB is supported by the Wellcome Trust through a Senior Fellowship in Basic Biomedical Science (098045). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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