Call for Experts  ̶  WHO Guideline Development Group on treatment of patients with cystic echinococcosis

WHO Guideline on treatment of patients with cystic echinococcosis

The World Health Organization (WHO) is seeking experts to serve as members of the Guideline Development Group (GDG) that will contribute to the development of a ‘WHO guideline on treatment of patients with cystic echinococcosis’.

This Call for experts provides information about the WHO guideline that will be developed, the role of GDG at WHO, the profiles of experts currently being sought, and the application and selection processes.

Background

Human echinococcosis is a zoonotic disease that is caused by parasites of the genus Echinococcus. The two most important forms, which are of medical and public health relevance in humans, are cystic echinococcosis (CE), caused by infection with a species complex centred on Echinococcus granulosus and alveolar echinococcosis (AE), caused by infection with E. multilocularis. This call for experts relates to CE.

Human infection with E. granulosus leads to the development of one or more hydatid cysts located most often in the liver and lungs, and less frequently in the bones, kidneys, spleen, muscles, central nervous system and other locations.  The impact of the disease varies with the number, location and size of the cysts and manifests commonly with pain and compromised organ function, worsening as the cysts enlarge. Infection is debilitating and fatal in some patients. It is a significant public health problem in large pastoral areas (the disease cycle of the parasite involves dogs and mainly sheep) in South America, North Africa, Eastern Europe, the Middle East, Central Asia, Russia and China.

Treatment: CE is often expensive and complicated to treat, sometimes requiring extensive surgery and/or prolonged drug therapy. There are several options for the treatment of cystic echinococcosis: 1) anti-parasitic drug treatment, 2) percutaneous treatment of the hydatid cysts with the PAIR (Puncture, Aspiration, Injection, Re-aspiration) technique, standard catheterization, or the modified catheterization technique, 3) surgery, and 4) “watch and wait”.

The choice is primarily based on the imaging characteristics of the cyst, following a stage-specific approach, and on the health care infrastructure and human resources available. The approach is primarily guided by an assessment of the emergency signs and symptoms of the patient at presentation.

Ensuring that patients are not over-treated or submitted to unnecessary treatments, and that the most appropriate treatment and procedures are used, is critical for the benefit and well-being of the patient.

Objectives and desired impact of the WHO guideline

Due to (i) the complexity of CE, (ii) the range of disease manifestations and (iii) the infrastructural, technical and skills’ requirements for the various treatment options (availability and safety), it is important for the patient’s wellbeing to stratify treatment recommendations by health services setting.

It is important not to overtreat patients, who might for example, undergo unnecessary surgeries. It is expected that clear and appropriate guidance will reduce and avoid over and maltreatment of patients.

This Guideline will be able to make recommendations to enable clinicians in their respective health care environments to treat CE patients appropriately and at the highest standards of care possible by providing recommendations on the indications of the four main treatment modalities: (1) anti-parasitic drug treatment, (2) percutaneous methods, (3) surgery, (4) “watch & wait” depending on the classification and location of the cysts.

Role of the Guideline Development Groups in WHO

As part of the WHO guideline development process, the Guideline Development¹, the Guideline Development Group will support WHO in:

• Providing input into the scope of the guideline and in the development of key questions in PICO (Population, Intervention or Exposure, Comparison, Outcome) format;
• Choosing and ranking priority outcomes;
• Examining the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profiles or other assessments of the quality of the evidence used to inform the recommendations and provide input;
• Formulating recommendations, including direction and strength;
• Reviewing the preliminary version of the recommendations in the guideline document before submission for WHO executive clearance process for publication and further dissemination.

The GDG will meet to reach a consensus on the direction and strength of each of the draft recommendations, explicitly taking into consideration factors of human rights and sociocultural adaptability, societal implications, equality and non-discrimination, economic considerations, feasibility and health system considerations, certainty (or quality) of the evidence and balance of benefit and harms^2,3. They will also consider issues on guideline implementation, monitoring and evaluation, and knowledge gaps.

There will be several virtual meetings of the GDG:

• Explanation of the process and review of the draft PICO questions:  Expected February 2022
• Development of Recommendations based on the findings of the evidence profiles:  Several virtual meetings expected between November 2022 and January 2023.

The working language of the meetings will be English.

Eligibility criteria for potential Guideline Development Group members

The GDG will be multidisciplinary, with members who have a range of technical knowledge, skills and experience. WHO welcomes expressions of interest from:

1. Relevant technical experts in the treatment of patients with cystic echinococcosis:

• Medical experts in the different treatments used for echinococcosis:
  1. anti-parasitic drug treatment,
  2. percutaneous methods,
  3. surgery,
  4. “watch & wait” 
• Surgery (especially liver and lung surgery)
• Parasitology
• Imaging

2. End-users who will adopt, adapt and implement the guideline, including:

• Health professionals, including providers at the primary care setting
• Health program managers
• Healthcare system managers

3. Representatives of agencies involved in the treatment of cystic echinococcosis, including:

• Non-government organizations
• Professional societies

4. Representatives of groups most affected by this guideline, including:

5. Relevant technical experts in the treatment of patients with cystic echinococcosis:

• Pastoralist communities

6. Other technical experts, such as:

• Experts on ethics, equity, human rights and gender in public health
• Health economist
• Epidemiologist.

GDG members should have no significant conflict of interest that would impair their neutrality, independence or objectivity in the guideline development process. To this end, applicants are required to complete the WHO Declaration of Interest for WHO Experts and the shortlisting by WHO of any individual for selection as a member of a GDG is dependent on WHO determining that there is no conflict of interest or that those conflicts that were identified can be appropriately managed (i.e., in addition to WHO’s evaluation of such individual’s experience, expertise and motivation and other criteria).

Submitting your application

To register your interest in being considered for above-mentioned Guideline Development Group, please submit your application by Friday 16 January 2021 by email, to kavalieroud@who.int cc botek@who.int  with the subject “GDG CE”.

You will need to submit the following documents:

• A cover letter, indicating your motivation to apply.
• Your curriculum vitae (including education background, relevant work experience, and relevant peer-reviewed publications).
• A completed Declaration of Interest form for WHO Experts, which can be downloaded here.
• A Confidentiality Undertaking form, which can be downloaded here (optional at this time).

After you have submitted your interest, your application will be reviewed by WHO. Due to an expected high volume of interest, only shortlisted individuals will be informed.

Important information about the selection processes

Each curriculum vitae will be reviewed to assess whether the applicant meets the qualifications and has relevant expertise in the subject matter areas listed above. Declaration of Interest forms will be reviewed. Any potential or perceived conflicts of interest disclosed in the Declaration of Interests form will be considered in the selection process. Representatives of commercial organizations may not serve as experts.

The selection of members of the GDGs will be based on the following criteria: technical expertise, experience in international and country policy work, communication skills, and ability to work constructively with people from different cultural backgrounds and orientations. The selection of GDG members will also take account of the need for diverse perspectives from different regions, especially from low and middle-income countries, and for gender diversity.

WHO will publish the names and a short biography of the shortlisted individuals on the WHO internet ahead of the first meeting of the GDG.

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