scholarly journals Early lessons from schistosomiasis mass drug administration programs

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 1157 ◽  
Author(s):  
W. Evan Secor
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Age Groups ◽  
Health Impact ◽  
Diagnostic Tools ◽  
Practical Application ◽  
Schistosomiasis Control ◽  
The Public ◽  
Control Programs ◽  
Morbidity Control

Mass drug administration using praziquantel is the backbone of the current strategy for the control of schistosomiasis. As the theoretical plans have moved into practical application, certain challenges with this approach have surfaced, and it is likely that annual mass drug administration alone may not be sufficient to achieve program goals. However, mass drug administration is still the only available intervention that can be readily used in the wide variety of settings where schistosomiasis is endemic. The task then becomes how to improve this approach and identify what adjuncts to mass drug administration are effective, as programs move from morbidity control to elimination goals. Other aspects worthy of consideration include how best to employ new diagnostic tools to more easily identify where treatment is needed, and new formulations of praziquantel to extend the availability of treatment to all age groups. The aim of this review is to highlight both areas of challenge and of opportunity to improve the public health impact of schistosomiasis control programs.

scholarly journals Potential strategies for strengthening surveillance of lymphatic filariasis in American Samoa after mass drug administration: Reducing ‘number needed to test’ by targeting older age groups, hotspots, and household members of infected persons

2020 ◽  
Vol 14 (12) ◽  
pp. e0008916
Author(s):  
Colleen L. Lau ◽  
Meru Sheel ◽  
Katherine Gass ◽  
Saipale Fuimaono ◽  
Michael C. David ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Age Groups ◽  
American Samoa ◽  
Community Survey ◽  
Older Age ◽  
Antibody Prevalence ◽  
Surveillance Strategy

Under the Global Programme to Eliminate Lymphatic Filariasis (LF), American Samoa conducted mass drug administration (MDA) from 2000–2006. Despite passing Transmission Assessment Surveys (TAS) in 2011/2012 and 2015, American Samoa failed TAS-3 in 2016, with antigen (Ag) prevalence of 0.7% (95%CI 0.3–1.8%) in 6–7 year-olds. A 2016 community survey (Ag prevalence 6.2% (95%CI 4.4–8.5%) in age ≥8 years) confirmed resurgence. Using data from the 2016 survey, this study aims to i) investigate antibody prevalence in TAS-3 and the community survey, ii) identify risk factors associated with being seropositive for Ag and anti-filarial antibodies, and iii) compare the efficiency of different sampling strategies for identifying seropositive persons in the post-MDA setting. Antibody prevalence in TAS-3 (n = 1143) were 1.6% for Bm14 (95%CI 0.9–2.9%), 7.9% for Wb123 (95%CI 6.4–9.6%), and 20.2% for Bm33 (95%CI 16.7–24.3%); and in the community survey (n = 2507), 13.9% for Bm14 (95%CI 11.2–17.2%), 27.9% for Wb123 (95%CI 24.6–31.4%), and 47.3% for Bm33 (95%CI 42.1–52.6%). Multivariable logistic regression was used to identify risk factors for being seropositive for Ag and antibodies. Higher Ag prevalence was found in males (adjusted odds ratio [aOR] 3.01), age ≥18 years (aOR 2.18), residents of Fagali’i (aOR 15.81), and outdoor workers (aOR 2.61). Ag prevalence was 20.7% (95%CI 9.7–53.5%) in households of Ag-positive children identified in TAS-3. We used NNTestav (average number needed to test to identify one positive) to compare the efficiency of the following strategies for identifying persons who were seropositive for Ag and each antibody: i) TAS of 6–7 year-old children, ii) population representative surveys of older age groups, and iii) targeted surveillance of subpopulations at higher risk of being seropositive (older ages, householders of Ag-positive TAS children, and known hotspots). For Ag, NNTestav ranged from 142.5 for TAS, to <5 for households of index children. NNTestav was lower in older ages, and highest for Ag, followed by Bm14, Wb123 and Bm33 antibodies. We propose a multi-stage surveillance strategy, starting with population-representative sampling (e.g. TAS or population representative survey of older ages), followed by strategies that target subpopulations and/or locations with low NNTestav. This approach could potentially improve the efficiency of identifying remaining infected persons and residual hotspots. Surveillance programs should also explore the utility of antibodies as indicators of transmission.

scholarly journals Antimicrobial Resistance Following Azithromycin Mass Drug Administration: Potential Surveillance Strategies to Assess Public Health Impact

2019 ◽  
Vol 70 (7) ◽  
pp. 1501-1508 ◽  
Author(s):  
Ines Mack ◽  
Mike Sharland ◽  
James A Berkley ◽  
Nigel Klein ◽  
Surbhi Malhotra-Kumar ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Controlled Trial ◽  
Population Level ◽  
Health Impact ◽  
Childhood Mortality ◽  
World Health ◽  
Current Evidence ◽  
Multiresistant Pathogens ◽  
Microbiological Techniques

Abstract The reduction in childhood mortality noted in trials investigating azithromycin mass drug administration (MDA) for trachoma control has been confirmed by a recent large randomized controlled trial. Population-level implementation of azithromycin MDA may lead to selection of multiresistant pathogens. Evidence suggests that repeated azithromycin MDA may result in a sustained increase in macrolide and other antibiotic resistance in gut and respiratory bacteria. Current evidence comes from standard microbiological techniques in studies focused on a time-limited intervention, while MDA implemented for mortality benefits would likely repeatedly expose the population over a prolonged period and may require a different surveillance approach. Targeted short-term and long-term surveillance of resistance emergence to key antibiotics, especially those from the World Health Organization Access group, is needed throughout any implementation of azithromycin MDA, focusing on a genotypic approach to overcome the limitations of resistance surveillance in indicator bacteria.

scholarly journals The contribution of mass drug administration to global health: past, present and future

2014 ◽  
Vol 369 (1645) ◽  
pp. 20130434 ◽  
Author(s):  
Joanne P. Webster ◽  
David H. Molyneux ◽  
Peter J. Hotez ◽  
Alan Fenwick
Keyword(s):  
Global Health ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Neglected Tropical Diseases ◽  
World Health Organisation ◽  
Essential Medicines ◽  
World Health ◽  
Diagnostic Tools ◽  
Preventive Chemotherapy ◽  
High Coverage

Mass drug administration (MDA) is a means of delivering safe and inexpensive essential medicines based on the principles of preventive chemotherapy, where populations or sub-populations are offered treatment without individual diagnosis. High-coverage MDA in endemic areas aims to prevent and alleviate symptoms and morbidity on the one hand and can reduce transmission on the other, together improving global health. MDA is the recommended strategy of the World Health Organisation to control or eliminate several neglected tropical diseases (NTDs). More than 700 million people now receive these essential NTD medicines annually. The combined cost of integrated NTD MDA has been calculated to be in the order of $0.50 per person per year. Activities have recently been expanded due, in part, to the proposed attempt to eliminate certain NTDs in the coming two decades. More than 1.9 billion people need to receive MDA annually across several years if these targets are to be met. Such extensive coverage will require additional avenues of financial support, expanded monitoring and evaluation focusing on impact and drug efficacy, as well as new diagnostic tools and social science strategies to encourage adherence. MDA is a means to help reduce the burden of disease, and hence poverty, among the poorest sector of populations. It has already made significant improvements to global health and productivity and has the potential for further successes, particularly where incorporated into sanitation and education programmes. However logistical, financial and biological challenges remain.

scholarly journals Low 2018/19 vaccine effectiveness against influenza A(H3N2) among 15–64-year-olds in Europe: exploration by birth cohort

2019 ◽  
Vol 24 (48) ◽  
Author(s):  
Esther Kissling ◽  
Francisco Pozo ◽  
Silke Buda ◽  
Ana-Maria Vilcu ◽  
Alin Gherasim ◽  
...  
Keyword(s):  
Birth Cohort ◽  
Influenza A ◽  
Influenza Infection ◽  
Age Groups ◽  
Health Impact ◽  
Vaccine Effectiveness ◽  
Aged Group ◽  
The Public ◽  
Cohort Differences ◽  
Negative Study

Introduction Influenza A(H3N2) clades 3C.2a and 3C.3a co-circulated in Europe in 2018/19. Immunological imprinting by first childhood influenza infection may induce future birth cohort differences in vaccine effectiveness (VE). Aim The I-MOVE multicentre primary care test-negative study assessed 2018/19 influenza A(H3N2) VE by age and genetic subgroups to explore VE by birth cohort. Methods We measured VE against influenza A(H3N2) and (sub)clades. We stratified VE by usual age groups (0–14, 15–64, ≥ 65-years). To assess the imprint-regulated effect of vaccine (I-REV) hypothesis, we further stratified the middle-aged group, notably including 32–54-year-olds (1964–86) sharing potential childhood imprinting to serine at haemagglutinin position 159. Results Influenza A(H3N2) VE among all ages was −1% (95% confidence interval (CI): −24 to 18) and 46% (95% CI: 8–68), −26% (95% CI: −66 to 4) and 20% (95% CI: −20 to 46) among 0–14, 15–64 and ≥ 65-year-olds, respectively. Among 15–64-year-olds, VE against clades 3C.2a1b and 3C.3a was 15% (95% CI: −34 to 50) and −74% (95% CI: −259 to 16), respectively. VE was −18% (95% CI: −140 to 41), −53% (95% CI: −131 to −2) and −12% (95% CI: −74 to 28) among 15–31-year-olds (1987–2003), 32–54-year-olds (1964–86) and 55–64-year-olds (1954–63), respectively. Discussion The lowest 2018/19 influenza A(H3N2) VE was against clade 3C.3a and among those born 1964–86, corresponding to the I-REV hypothesis. The low influenza A(H3N2) VE in 15–64-year-olds and the public health impact of the I-REV hypothesis warrant further study.

scholarly journals Developing an implementation strategy for a praziquantel mass drug administration for children aged five years and below: A conceptual framework

2021 ◽  
Author(s):  
Mhlengi Vella Ncube ◽  
Tafadzwa Mindu ◽  
Moses John Chimbari
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Conceptual Framework ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Implementation Strategy ◽  
Resource Planning ◽  
Scenario Planning ◽  
Economic Evaluations ◽  
Schistosomiasis Control

Abstract Background: Children aged five years and below in schistosomiasis endemic areas spend several years living with the schistosome infections before they can be treated as they are excluded from school based mass drug administration programs. The WHO has recommended that these children be included in schistosomiasis preventive chemotherapy in endemic areas. Including these children in schistosomiasis control mass drug administration programs is a complicated task involving translating clinical studies into clinical practice processes, contextualizing clinical practice processes to the resources that are available in the community and economic evaluations. Methodology: We conducted a scoping search on google scholar and the concepts we searched for included implementation strategies, contextualization strategies, resource planning and economic evaluations in health care, risk and quality assessments. We then developed a conceptual framework and explained how the conceptual framework could be used to develop an implementation strategy for a mass drug administration for children aged five year and belowResults: The most common methods/frameworks that were identified in our search for health care implementation strategy development include the following: Donabedian framework, scoping review, FMEA, scenario planning, resource planning and economic evaluation of healthcare interventions and cost-effectiveness analysis.Conclusion: We concluded that the Donabedian framework can be modified and used in conjunction with scoping reviews, FMEA, scenario planning and economic evaluations to develop an implementation strategy for a schistosomiasis control MDA program for children aged five years old and below.

scholarly journals Risk factors for lymphatic filariasis and mass drug administration non-participation in Mandalay Region, Myanmar

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Benjamin F. R. Dickson ◽  
Patricia M. Graves ◽  
Ni Ni Aye ◽  
Thet Wai Nwe ◽  
Tint Wai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Survey Design ◽  
Age Groups ◽  
Household Survey ◽  
Male Gender ◽  
Night Time ◽  
Cross Sectional

Abstract Background Myanmar commenced a lymphatic filariasis (LF) elimination programme in 2000. Whilst the country has made considerable progress since then, a number of districts have demonstrated persistent transmission after many rounds of mass drug administration (MDA). The causes of unsuccessful MDA have been examined elsewhere; however, there remains little information on the factors that contribute in Myanmar. Methods We conducted an analysis of factors associated with persistent infection, LF-related hydrocoele and MDA participation in an area with ongoing transmission in 2015. A cross-sectional household survey was undertaken in 24 villages across four townships of Mandalay Region. Participants were screened for circulating filarial antigen (CFA) using immunochromatographic tests and, if positive, for microfilaria by night-time thick blood slide. Individuals 15 year and older were assessed for filariasis morbidity (lymphoedema and, if male, hydrocoele) by ultrasound-assisted clinical examination. A pre-coded questionnaire was used to assess risk factors for LF and for non-participation (never taking MDA). Significant variables identified in univariate analyses were included in separate step-wise multivariate logistic regressions for each outcome. Results After adjustment for covariates and survey design, being CFA positive was significantly associated with age [odds ratio (OR) 1.03, 95% CI 1.01–1.06), per year], male gender (OR 3.14, 1.27–7.76), elevation (OR 0.96, 0.94–0.99, per metre) and the density of people per household room (OR 1.59, 1.31–1.92). LF-related hydrocoele was associated with age (OR 1.06, 1.03–1.09, per year) and residing in Amarapura Township (OR 8.93, 1.37–58.32). Never taking MDA was associated with male gender [OR 6.89 (2.13–22.28)] and age, particularly in females, with a significant interaction term. Overall, compared to those aged 30–44 years, the proportion never taking MDA was higher in all age groups (OR highest in those < 5 years and > 60 years, ranging from 3.37 to 12.82). Never taking MDA was also associated with residing in Amarapura township (OR 2.48, 1.15–5.31), moving to one’s current village from another (OR 2.62, 1.12–6.11) and ever having declined medication (OR 11.82, 4.25–32.91). Decreased likelihood of never taking MDA was associated with a higher proportion of household members being present during the last MDA round (OR 0.16, 0.03–0.74) and the number visits by the MDA programme (OR 0.69, 0.48–1.00). Conclusions These results contribute to the understanding of LF and MDA participation-related risk factors and will assist Myanmar to improve its elimination and morbidity management programmes.

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