The World Health Organization (WHO) is urging countries to implement WHO recommendations on treating all peoples affected by schistosomiasis (bilharzia), beyond the traditional target of treating only school-age children.
Dr Amadou Garba, Scientist, Schistosomiasis Control Programme, WHO Department of Control of Neglected Tropical Diseases.
Scaled up interventions have significantly improved global coverage of treatment among school-children and other at-risk groups. In 2014, a global coverage of more than 20% of all people requiring treatment for the disease was achieved. Coverage among school-age children exceeded 49 million, representing 34.6% global coverage in this age group. Furthermore, 61.6 million people were treated, based on data reported from 30 out of 52 countries. In WHO’s African Region, 18 million more people were treated in 2014 than in 2013.
“We’ve seen an increase of more than 53% in treatments in the African Region alone”... “And this despite the fact that a few countries could not implement control programmes due to the recent Ebola virus disease outbreak.””.
Dr Gautam Biswas, Coordinator, Preventive Chemotherapy and Transmission Control unit, WHO Department of Control of Neglected Tropical Diseases.
The WHO-recommended strategy to eliminate schistosomiasis involves large-scale treatment of affected populations through periodic, targeted treatment of school-children with praziquantel.1 Implementation is supported by WHO technical guidelines and tools and in collaboration with partners, research institutions, the private sector, nongovernmental organizations, international development agencies and other United Nations organizations.
Donated praziquantel: the key to achieving elimination
The increase in the number of treatments is attributable to many factors, including improved availability of donated praziquantel, essentially from Merck; new countries starting to implement large-scale schistosomiasis control programmes; geographical scale-up of treatment within countries; and improved reporting to WHO.
But to maintain the trend, WHO urges increased access to quality-assured praziquantel.
“We have the strategy, but we need the support to be able to deliver”...“Increased donations of praziquantel will not meet the need to treat all affected populations. More should be done to provide the medicine at an affordable price to encourage implementation in all countries.”
Dr Dirk Engels, Director, Department of Control of Neglected Tropical Diseases.
Furthermore, additional funding is required to expand distribution of praziquantel in countries where the disease is most endemic.
The disease
Schistosomiasis is a chronic, parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma. Transmission has been documented in 78 countries; however, those requiring mass treatment directed to high-risk population groups live in 52 countries.
Intestinal schistosomiasis can result in abdominal pain, diarrhoea and blood in the stool, while the classic sign of urogenital schistosomiasis is haematuria (blood in the urine). Fibrosis of the bladder and ureters, and kidney and liver damage are diagnosed in advanced cases.
Experience from China and Egypt demonstrates that preventive chemotherapy (that is, large scale treatment without individual diagnosis) with high coverage can significantly impact indices of infection and reduce transmission.
The global target set by WHO in the Roadmap on neglected tropical diseases is to attain at least 75% coverage of preventive chemotherapy in pre-school and school-age children by 2020.
In 2012, the World Health Assembly (WHO’s decision-making body) adopted resolution WHA65.21 on the elimination of schistosomiasis, calling on all countries endemic for schistosomiasis to analyse and develop applicable plans with progressive targets, to intensify control interventions and to ensure the provision of essential medicines.
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1Cipla Ltd (India) is currently the only WHO prequalified generic praziquantel manufacturer