scholarly journals Impact of mass drug administration of azithromycin for trachoma elimination on prevalence and azithromycin resistance of genital Mycoplasma genitalium infection

2019 ◽  
Vol 95 (7) ◽  
pp. 522-528 ◽  
Author(s):  
Mark Andrew Harrison ◽  
Emma Michele Harding-Esch ◽  
Michael Marks ◽  
Marcus James Pond ◽  
Robert Butcher ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Secondary Analysis ◽  
Mycoplasma Genitalium ◽  
Nucleic Acid Amplification ◽  
23S Rrna ◽  
Island Population ◽  
Cross Sectional ◽  
The Impact ◽  
Azithromycin Resistance

BackgroundMass drug administration (MDA) of 20 mg/kg (maximum 1 g in adults) azithromycin for ocular Chlamydia trachomatis (CT) infection is a key component of the WHO trachoma elimination strategy. However, this dose may be suboptimal in Mycoplasma genitalium infection and may encourage emergence of antimicrobial resistance (AMR) to azithromycin.ObjectivesTo determine the effect of MDA for trachoma elimination on M. genitalium prevalence, strain type and azithromycin resistance.MethodsA secondary analysis of CT-negative vulvovaginal swabs from three outpatient antenatal clinics (Honiara, Solomon Islands) from patients recruited either pre-MDA, or 10 months post-MDA in two cross-sectional surveys was carried out. Swabs were tested for M. genitalium infection using Fast Track Diagnostics Urethritis Plus nucleic acid amplification assay. M. genitalium-positive samples were subsequently tested for azithromycin resistance by sequencing domain V of the 23S rRNA DNA region of M. genitalium and underwent phylogenetic analysis by dual locus sequence typing.ResultsM. genitalium prevalence was 11.9% (28/236) in women pre-MDA and 10.9% (28/256) 10 months post-MDA (p=0.7467). Self-reported receipt of azithromycin as part of MDA was 49.2% in women recruited post-MDA and 17.9% (5/28) in those who tested M. genitalium positive. Of samples sequenced (21/28 pre-MDA, 22/28 post-MDA), all showed a macrolide susceptible genotype. Strain typing showed that sequence types diverged into two lineages, with a suggestion of strain replacement post-MDA.ConclusionA single round of azithromycin MDA in an island population with high baseline M. genitalium prevalence did not appear to impact on either prevalence or azithromycin resistance, in contrast to reported decreased genital CT prevalence in the same population. This may be due to limitations such as sample size, including CT-negative samples only, and low MDA coverage. Further investigation of the impact of multiple rounds of MDA on M. genitalium azithromycin AMR in antibiotic experienced and naïve populations is warranted.

scholarly journals Human population movement can impede the elimination of soil-transmitted helminth transmission in regions with heterogeneity in mass drug administration coverage and transmission potential between villages: a metapopulation analysis

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Carolin Vegvari ◽  
James E. Truscott ◽  
Klodeta Kura ◽  
Roy M. Anderson
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Human Population ◽  
Sub Saharan Africa ◽  
Population Movement ◽  
Mobility Patterns ◽  
Preventive Chemotherapy ◽  
Cross Sectional ◽  
The Impact ◽  
Human Population Movement

Abstract Background Soil-transmitted helminth (STH) infections affect predominantly socio-economically disadvantaged populations in sub-Saharan Africa, East Asia and the Americas. Previous mathematical modelling studies have evaluated optimal intervention strategies to break STH transmission in clusters of villages. These studies assumed that villages are closed independent units with no movement of people in or out of communities. Here we examine how human population movement, for example, of seasonal migrant labourers, affect the outcome of mass drug administration (MDA) programmes. Results We used a stochastic individual-based metapopulation model to analyse the impact of human population movement at varying rates on STH elimination efforts. Specifically, we looked at seasonal clumped movement events of infected individuals into a village. We showed that even if on average 75% of the entire resident population within a village are treated, an annual rate of 2–3% of the population arriving from an untreated source village can reduce the probability of STH elimination to less than 50% in high-prevalence settings. If a village is infection-free, an annual movement rate of 2–3% from an infected source village imposes a risk of re-introduction of STH of 75% or higher, unless the prevalence in the source village is less than 20%. Even a single arrival of 2–3% of the population can impose a risk of re-introducing STH of 50% or greater depending on the prevalence in the source village. The risk of re-introduction also depends on both the age group of moving individuals and STH species, since the pattern of cross-sectional age-prevalence and age-intensity profiles of infection in the human host are species-specific. Conclusions Planning for STH elimination programmes should account for human mobility patterns in defined regions. We recommend that individuals arriving from areas with ongoing STH transmission should receive preventive chemotherapy for STHs. This can most easily be implemented if migration is seasonal and overlaps with treatment rounds, e.g. seasonal migrant labour. Moreover, transmission hotspots in or near treatment clusters should be eliminated, for example, by implementing appropriate water, sanitation and hygiene (WASH) measures and targeting treatment to individuals living in hotspots.

scholarly journals Does mass drug administration for community-based scabies control works? The experience in Ethiopia

2020 ◽  
Vol 14 (06.1) ◽  
pp. 78S-85S
Author(s):  
Wendemagegn Enbiale ◽  
Ashenafi Ayalew ◽  
Teklehaymanot Gebrehiwot ◽  
Yared Mulu ◽  
Muluken Azage ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Cross Sectional Study ◽  
Political Commitment ◽  
Cure Rate ◽  
Community Based ◽  
Cross Sectional ◽  
The North ◽  
The Impact ◽  
North Gondar Zone

Introduction: After a scabies outbreak in Amhara Region, Ethiopia in 2015/2016, the Regional Health Bureau performed an extensive Mass Drug Administration (MDA). In May 2017, we collected data to assess the impact of the treatment on the scabies control. Methodology. We retrieved baseline data from the 2015/16 burden assessment: campaign organization and administration information. We did a community based cross-sectional study using a structured questionnaire on disease and treatment history plus the presence or absence of active scabies in three Zones. We selected households using stratified random sampling deployed 7581 questionnaires and performed key informant interviews. Results: 46.3% had a previous scabies diagnosis in the last 2 years of which 86.1% received treatment, and the cure rate was 90.6%. Fifteen months after intervention the scabies prevalence was 21.0 % (67.3% new cases and 32.7% recurrences). The highest burden of new cases (93.1%) was found in the North Gondar zone. The likelihood of treatment failure was higher for treatments offered in clinics (12.2%) as opposed to via the campaign (7.9%). Failure to follow the guidelines, shortage of medicine and lack of leadership prioritization were identified as reasons for resurgence of the disease. Conclusions: We demonstrated that community engagement is essential in the success of scabies MDA, alongside strong political commitment, and guideline adherence. Effectiveness and sustainability of the MDA was compromised by the failing of proper contact treatment, surveillance and case management.

scholarly journals Impact of Annual versus Semiannual Mass Drug Administration with Ivermectin and Albendazole on Helminth Infections in Southeastern Liberia

2021 ◽  
Author(s):  
Obiora A. Eneanya ◽  
Lincoln Gankpala ◽  
Charles W. Goss ◽  
Fatorma K. Bolay ◽  
Gary J. Weil ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Wuchereria Bancrofti ◽  
Infection Prevalence ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Helminth Infections ◽  
Helminthic Infections ◽  
Prevalence Estimates ◽  
The Impact

We compared the impact of three rounds of annual and five rounds of semiannual mass drug administration (MDA) with albendazole plus ivermectin on helminthic infections in Liberia. Repeated annual cross-sectional community surveys were conducted between 2013 and 2019 in individuals of 5 years and older. Primary outcome was the change of infection prevalence estimates from baseline to month 36 (12 months after the last treatment). After three rounds of annual MDA, Wuchereria bancrofti circulating filarial antigen (CFA) and microfilaria (Mf) prevalence estimates decreased from 19.7% to 4.3% and from 8.6% to 0%, respectively; after semiannual MDA, CFA and Mf prevalences decreased from 37.8% to 16.8% and 17.9% to 1%, respectively. Mixed effects logistic regression models indicated that the odds of having Mf decreased by 97% (P < 0.001) at month 36 (similar odds for annual and semiannual MDA zones). A parallel analysis showed that the odds of CFA were reduced by 83% and 69% at 36 months in the annual and semiannual treatment zones, respectively (P < 0.001). Onchocerca volvulus Mf prevalence decreased slightly after multiple MDA rounds in both treatment zones. Reductions in hookworm and Trichuris trichiura prevalences and intensities were slightly greater in the annual treatment zone. Ascaris lumbricoides prevalence rates were relatively unchanged, although infection intensities decreased sharply throughout. Results show that annual and semiannual MDA were equally effective for reducing LF and soil-transmitted helminth infection parameters over a 3-year period, and reductions recorded at month 36 were sustained by routine annual MDA through month 72.

scholarly journals Mass Drug Administration Interruption by COVID-19 reportedly increases lymphatic filarial attacks, pains, and perceived increased lymphatic filarial infection transmission in rural Ghana

2021 ◽  
Author(s):  
Alexander Kwarteng ◽  
Yarhands Dissou Arthur ◽  
Samuel Opoku Asiedu ◽  
John Kanyiri Yamba ◽  
Emmanuel Kobla Amewu ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Neglected Tropical Diseases ◽  
Cross Sectional Study ◽  
P Value ◽  
Chi Square ◽  
Statistical Tool ◽  
Cross Sectional ◽  
Rural Ghana ◽  
The Impact

Abstract BackgroundLike all other diseases, the advent of the COVID-19 pandemic has been implicated to impact the elimination schedule and control of neglected tropical diseases such as human lymphatic filarial (LF) infections in endemic countries. However, it is unclear the extent to which delays in mass drug administration has affected people living with chronic lymphatic filarial pathology in rural Ghana as a result of the COVID-19 pandemic, and thus remain to be investigated. MethodTo address this, a cross-sectional study where 133 LF participants from 8 LF-endemic communities in the Ahanta West District of Ghana were recruited to assess the impact of MDA interruptions as a result of COVID-19 among individuals presenting with the filarial pathology. Here, the chi-square test of independence was used as a statistical tool to assess the dependency: 1) between MDA interruption and filarial attacks 2) between MDA interruption and filarial-related pains 3) between MDA interruption and a perceived increase in LF transmission.ResultsStudy participants were asked whether the MDA interruption has affected them in any way. Here, 81% of the patients indicated yes, it had. In addition, we sought to investigate whether MDA interruption has resulted in increased filarial attacks and pains. At this, 68% of the study respondents reported an increase in filarial attacks. Similarly, 65% reported an increase in filarial-related pains. The study further reported that filarial attacks (B=14.997, df=1, p-value <0.001) and pains (a=11.773, df=1, p-value <0.001) are dependent on MDA interruption. Next, we further report that the perceived increase in LF transmission is dependent on MDA interruption (c=9.415, df=1, p-value=0.002). ConclusionIn this study, MDA interruption is reported to increase filarial attacks, filarial-related pains, and a perceived LF transmission increase in the study communities. This study's findings are important and urgent, suggesting that sustained MDA interruption in LF-endemic communities could further worsen LF patients' plight as filarial attacks, pains, and transmission could increase. Therefore, the need to immediately identify alternative modes of MDA distribution in LF-endemic areas where mass treatment has been halted in the wake of COVID-19 to prevent an unwarranted surge in LF attacks, pains, and transmission.

scholarly journals Impact of Mass Drug Administration on Prevalence of Schistosomiasis in Eight Riverine Communities in the Asuogyaman District of the Eastern Region, Ghana

2020 ◽  
pp. 18-32
Author(s):  
Quartey Abass ◽  
John Yao Bedzo ◽  
Stephen Manortey
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Geographical Area ◽  
Bivariate Analysis ◽  
Disease Rate ◽  
Significant Variable ◽  
Eastern Region ◽  
Cross Sectional ◽  
High Prevalence ◽  
The Impact

Background: The incidence of schistosomiasis in Ghana and more specifically in the Asuogyaman District had become a noticeable record following the creation of the Akosombo Dam in the early 1960s. This has inevitably since placed an enormous burden on the health service delivery systems in the geographical area. Mass Drug Administration (MDA) of Praziquantel has been used worldwide as a preventive and treatment intervention measure for the disease, and the study area is no exception. The study, therefore, aimed to assess the impact of MDA on the prevalence and associated risk factors of schistosomiasis in eight (8) selected riverine communities within the district. Methods: A descriptive retrospective cross-sectional study was conducted involving 896 respondents with ages ranging from 2 to 82 years and a mean age of 17±13.78 years. Data were obtained from the Volta River Authority (VRA) Public Health and Environmental Department. Pearson’s chi-square tests and logistic regression models were used to assess the association and predict the relationship between variables. Findings: Out of the 896 respondents, 93 (10.4 %) tested positive for Schistosoma haematobium. Proportionally, the Nyameben community had a high prevalence of 25.8% while Mami-Waterkope, and Mangoase both had a low prevalence of 3.2 %. The average uptake of Praziquantel was 41% across the study area. From the bivariate analysis, the respondents’ community of residence was noted as the only statistically significant variable contributing to infection. Respondents aged 13-39 were 1.68 times more likely to be infected compared to their younger counterparts after controlling for all other covariates in the predictive model. Conclusion: Mass Drug Administration had a tremendous effect on reducing the prevalence of urinary schistosomiasis to the present level of 10.4%. However, some “hotspots” like the Nyameben community will require special attention to reduce the high prevalence disease rate. Communities with low uptake of Praziquantel had a relatively high prevalence of schistosomiasis.

Non-compliance to Mass Drug Administration Associated with the Low Perception of the Community Members About their Susceptibility to Lymphatic Filariasis in Ankobra, Ghana

2020 ◽  
Vol 20 (2) ◽  
pp. 167-174
Author(s):  
Ilo Dicko ◽  
Yaya Ibrahim Coulibaly ◽  
Modibo Sangaré ◽  
Bismark Sarfo ◽  
Priscillia Awo Nortey
Keyword(s):  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Health Workers ◽  
Compliance Rate ◽  
Cross Sectional Study ◽  
Cluster Sampling ◽  
Cross Sectional ◽  
Improve Compliance ◽  
Degree Of Association

Background: Lymphatic filariasis (LF) is a parasitic disease that has been targeted for elimination through the Mass Drug Administration (MDA.) Although the MDA started in the Ankobra community in Ghana in 2000, LF prevalence as reported in 2014 was relatively high (4.5%). Non-compliance to the MDA has been associated with the persistent LF prevalence in endemic regions. Objective: This study determined the factors associated with the non-compliance to the MDA among patients living in the Ankobra community, Ghana. Methods: A cross-sectional study using a one-stage cluster sampling method was used to collect data between June and July, 2017 in Ankobra. Questionnaires were used to collect data from health workers, the MDA drug distributors and study participants in Ankobra. Data analysis was performed using STATA 14. Logistic regression was used to measure the degree of association between the dependent (non-compliance) and independent variables. Non-compliance rate was defined as the percentage of individuals who self-reported that they did not actually swallow the drugs provided during the MDA. Results: The MDA coverage and non-compliance rates were 73.5% (147/200) and 33.33% (49/147) respectively. The main reason for non-compliance was fear of drug adverse events (75.51%, 37/49). Thought of “not being susceptible to LF” was significantly associated with the non-compliance (aOR= 2.83, [CI= 1.15, 6.98]). Conclusion: Health education about the susceptibility of residents getting LF disease in endemic community must be intensified to improve compliance to MDA medication ingestion and thus meet the Global Elimination of Lymphatic Filariasis by 2020.

scholarly journals Feasibility of onchocerciasis elimination using a “test-and-not-treat” strategy in Loa loa co-endemic areas

2020 ◽  
Author(s):  
David J Blok ◽  
Joseph Kamgno ◽  
Sebastien D Pion ◽  
Hugues C Nana-Djeunga ◽  
Yannick Niamsi-Emalio ◽  
...  
Keyword(s):  
Adverse Events ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Treatment Duration ◽  
Loa Loa ◽  
Serious Adverse Events ◽  
Endemic Areas ◽  
The Individual ◽  
The Impact ◽  
Main Strategy

Abstract Background Mass drug administration (MDA) with ivermectin is the main strategy for onchocerciasis elimination. Ivermectin is generally safe but associated with serious adverse events in individuals with high Loa loa microfilarial densities (MFD). Therefore, ivermectin MDA is not recommended in areas where onchocerciasis is hypo-endemic and L. loa is co-endemic. To eliminate onchocerciasis in those areas, a test-and-not-treat (TaNT) strategy has been proposed. We investigated whether onchocerciasis elimination can be achieved using TaNT and the required duration. Methods We used the individual-based model ONCHOSIM to predict the impact of TaNT on onchocerciasis microfilarial (mf) prevalence. We simulated pre-control mf prevalence levels from 2-40%. The impact of TaNT was simulated under varying levels of participation, systematic non-participation and exclusion from ivermectin due to high L. loa MFD. For each scenario, we assessed the time to elimination, defined as bringing onchocerciasis mf prevalence below 1.4%. Results In areas with 30-40% pre-control mf prevalence, the model predicted that it would take between 14 and 16 years to bring the mf prevalence below 1.4% using conventional MDA, assuming 65% participation. TaNT would increase the time to elimination by up to 1.5 years, depending on the level of systematic non-participation and the exclusion rate. At lower exclusion rates (≤2.5%), the delay would be less than six months. Conclusions Our model predicts that onchocerciasis can be eliminated using TaNT in L. loa co-endemic areas. The required treatment duration using TaNT would be only slightly longer than in areas with conventional MDA, provided that participation is good.

scholarly journals The impact of mass drug administration expansion to low onchocerciasis prevalence settings in case of connected villages

2021 ◽  
Vol 15 (5) ◽  
pp. e0009011
Author(s):  
Anneke S. de Vos ◽  
Wilma A. Stolk ◽  
Luc E. Coffeng ◽  
Sake J. de Vlas
Keyword(s):  
Intermediate Host ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Human Populations ◽  
Individual Based Model ◽  
Low Prevalence ◽  
The Impact ◽  
Local Transmission

Background The existence of locations with low but stable onchocerciasis prevalence is not well understood. An often suggested yet poorly investigated explanation is that the infection spills over from neighbouring locations with higher infection densities. Methodology We adapted the stochastic individual based model ONCHOSIM to enable the simulation of multiple villages, with separate blackfly (intermediate host) and human populations, which are connected through the regular movement of the villagers and/or the flies. With this model we explore the impact of the type, direction and degree of connectedness, and of the impact of localized or full-area mass drug administration (MDA) over a range of connected village settings. Principal findings In settings with annual fly biting rates (ABR) below the threshold needed for stable local transmission, persistence of onchocerciasis prevalence can well be explained by regular human traffic and/or fly movement from locations with higher ABR. Elimination of onchocerciasis will then theoretically be reached by only implementing MDA in the higher prevalence area, although lingering infection in the low prevalence location can trigger resurgence of transmission in the total region when MDA is stopped too soon. Expanding MDA implementation to the lower ABR location can therefore shorten the duration of MDA needed. For example, when prevalence spill-over is due to human traffic, and both locations have about equal populations, then the MDA duration can be shortened by up to three years. If the lower ABR location has twice as many inhabitants, the reduction can even be up to six years, but if spill-over is due to fly movement, the expected reduction is less than a year. Conclusions/Significance Although MDA implementation might not always be necessary in locations with stable low onchocerciasis prevalence, in many circumstances it is recommended to accelerate achieving elimination in the wider area.

scholarly journals Can direct smear results that are routinely collected at health centre level be used for monitoring the impact of mass drug administration with praziquantel on schistosomiasis in Burundi? A preliminary assessment.

2020 ◽  
Author(s):  
Paul BIZIMANA ◽  
Katja POLMAN ◽  
Giuseppina ORTU ◽  
Meryam KRIT ◽  
Frédéric NSABIYUMVA ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Health Centre ◽  
Health Information System ◽  
Routine Data ◽  
Direct Smear ◽  
Incidence Data ◽  
Intestinal Schistosomiasis ◽  
The Impact ◽  
Health Centre Level

Abstract Background : Intestinal schistosomiasis is still a public health problem in Burundi. Since 2008, annual mass drug administration with praziquantel have been rolled out in 11 endemic districts. The national programme relies on school-based surveys with Kato-Katz to monitor the impact of mass drug administration. We explored whether routine data on intestinal schistosomiasis as determined by direct fecal smears at health centre level could be used. Methods : From the Burundian National Health Information System, we collected routine incidence data on intestinal schistosomiasis as determined by direct smear examination in all 45 sanitary districts between 2011 and 2015. A temporal trends analysis was performed using a mixed negative binomial regression. Sanitary districts with mass drug administration campaigns with praziquantel (n=11) were compared with those without (n=34). In addition, prevalence data on intestinal schistosomiasis based on Kato-Katz results from a school-based national mapping in 2014 were compared with the incidence data in health centres based on direct smear results, in the same 45 sanitary districts. Findings : In the 11 sanitary districts applying mass drug administration with praziquantel, the incidence rate decreased significantly for the years 2014 (β 2014 =-0.826, p=0.010) and 2015 (β 2015 =-1.294, p<0.001) and for the five-year period (β=-0.286, p<0.001), whereas in the 34 districts where mass drug administration was not delivered, there was no significant decrease over time (β=-0.087, p=0.219). In most of the 45 sanitary districts, the low prevalences based on Kato-Katz in schoolchildren were confirmed by low incidence rates based on direct smear in the health centres. Conclusions : National Health Information System surveillance data, based on routinely collected direct smear results at health centre level, may be able to monitor the impact of mass drug administration with praziquantel on intestinal schistosomiasis in Burundi. Control and elimination of intestinal schistosomiasis call for integration of adequate diagnosis and treatment into routine activities of primary health care facilities, as recommended by the World Health Organization since more than 20 years. When moving towards elimination, more sensitive tests, such as the Point-of-care Circulating Cathodic Antigen assay are desirable. Keywords : Direct smear, Health centre, Mass drug administration, Monitoring, Praziquantel, Routine data, Schistosomiasis, Burundi

scholarly journals Impact of seven years of mass drug administration and recrudescence of Schistosoma haematobium infections after one year of treatment gap in Zanzibar: Repeated cross-sectional studies

2021 ◽  
Vol 15 (2) ◽  
pp. e0009127
Author(s):  
Lydia Trippler ◽  
Shaali Makame Ame ◽  
Jan Hattendorf ◽  
Saleh Juma ◽  
Salum Abubakar ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Odds Ratio ◽  
Schistosoma Haematobium ◽  
Treatment Gap ◽  
Urogenital Schistosomiasis ◽  
Cross Sectional ◽  
Reagent Strips ◽  
One Year ◽  
Low Prevalence

Background Considerable progress towards the elimination of urogenital schistosomiasis was made by the Zanzibar Elimination of Schistosomiasis Transmission project from 2012 till 2016, when biannual praziquantel mass drug administration (MDA) alone or with additional snail control or behaviour change interventions were implemented. Annual MDA was continued in 2017 and 2018, but not in 2019, imposing a 16-month treatment gap. We monitored the Schistosoma haematobium prevalence from 2012 till 2020 and assessed recrudescence patterns with focus on 2020. Methodology Repeated cross-sectional surveys were conducted from 2011/12 till 2020 in 90 communities and 90 schools in Zanzibar. Annually, around 4,500 adults and up to 20,000 schoolchildren were surveyed. The S. haematobium prevalence was detected by urine filtration and reagent strips. In 2020, risk factors for infection were investigated using generalized estimated equation models. Principal findings In adults, the apparent S. haematobium prevalence was 3.9% in 2011 and 0.4% in 2020. In schoolchildren, the prevalence decreased from 6.6% in 2012 to 1.2% in 2019 with vicissitudes over the years. Prominent recrudescence of infection from 2.8% in 2019 to 9.1% (+225%) in 2020 was observed in 29 schools with historically moderate prevalences (≥10%). Compared with 2019, reinfection in 2020 was particularly striking in boys aged 9–16 years. Being male was a risk factor for infection in 2020 (adults: odds ratio (OR): 6.24, 95% confidence interval (95% CI): 1.96–19.60; schoolchildren: OR: 2.06, 95% CI: 1.52–2.78). Living near to a natural freshwater body significantly increased the odds of infection in adults (OR: 2.90, CI: 1.12–7.54). Conclusions/Significance After 11 rounds of MDA over 7 years and a 16-month treatment gap, the urogenital schistosomiasis prevalence considerably rebounded in hotspot areas. Future elimination efforts in Zanzibar should focus on re-intensifying MDA plus additional interventions in hotspot areas. In low-prevalence areas, the strategy might be adapted from MDA to targeted surveillance-response.

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