TY - JOUR

T1 - Towards interruption of schistosomiasis transmission in sub-Saharan Africa

T2 - developing an appropriate environmental surveillance framework to guide and to support 'end game' interventions

AU - Stothard, J Russell

AU - Campbell, Suzy J

AU - Osei-Atweneboana, Mike Y

AU - Durant, Timothy

AU - Stanton, Michelle C

AU - Biritwum, Nana-Kwadwo

AU - Rollinson, David

AU - Ombede, Dieudonné R Eloundou

AU - Tchuem-Tchuenté, Louis-Albert

PY - 2017/1/14

Y1 - 2017/1/14

N2 - Schistosomiasis is a waterborne parasitic disease in sub-Saharan Africa, particularly common in rural populations living in impoverished conditions. With the scale-up of preventive chemotherapy, national campaigns will transition from morbidity- to transmission-focused interventions thus formal investigation of actual or expected declines in environmental transmission is needed as 'end game' scenarios arise. Surprisingly, there are no international or national guidelines to do so in sub-Saharan Africa. Our article therefore provides an introduction to key practicalities and pitfalls in the development of an appropriate environmental surveillance framework. In this context, we discuss how strategies need to be adapted and tailored to the local level to better guide and support future interventions through this transition. As detection of egg-patent infection in people becomes rare, careful sampling of schistosome larvae in freshwater and in aquatic snails with robust species-specific DNA assays will be required. Appropriate metrics, derived from observed prevalence(s) as compared with predetermined thresholds, could each provide a clearer insight into contamination- and exposure-related dynamics. Application could be twofold, first to certify areas currently free from schistosomiasis transmission or second to red-flag recalcitrant locations where extra effort or alternative interventions are needed.

AB - Schistosomiasis is a waterborne parasitic disease in sub-Saharan Africa, particularly common in rural populations living in impoverished conditions. With the scale-up of preventive chemotherapy, national campaigns will transition from morbidity- to transmission-focused interventions thus formal investigation of actual or expected declines in environmental transmission is needed as 'end game' scenarios arise. Surprisingly, there are no international or national guidelines to do so in sub-Saharan Africa. Our article therefore provides an introduction to key practicalities and pitfalls in the development of an appropriate environmental surveillance framework. In this context, we discuss how strategies need to be adapted and tailored to the local level to better guide and support future interventions through this transition. As detection of egg-patent infection in people becomes rare, careful sampling of schistosome larvae in freshwater and in aquatic snails with robust species-specific DNA assays will be required. Appropriate metrics, derived from observed prevalence(s) as compared with predetermined thresholds, could each provide a clearer insight into contamination- and exposure-related dynamics. Application could be twofold, first to certify areas currently free from schistosomiasis transmission or second to red-flag recalcitrant locations where extra effort or alternative interventions are needed.

KW - Africa South of the Sahara

KW - Animals

KW - Epidemiological Monitoring

KW - Fresh Water

KW - Humans

KW - Population Surveillance

KW - Schistosoma

KW - Schistosomiasis

KW - Snails

KW - Journal Article

KW - Review

U2 - 10.1186/s40249-016-0215-9

DO - 10.1186/s40249-016-0215-9

M3 - Review article

C2 - 28088239

VL - 6

JO - Infectious diseases of poverty

JF - Infectious diseases of poverty

SN - 2049-9957

IS - 1

M1 - 10

ER -