Lilian Beck

Avaliação das ações de controle da esquistossomose implementadas entre 1977 e 1996 na área endêmica de Pernambuco, Brasil

This study assesses the evolution of schistosomiasis in the endemic area of Pernambuco, using data from five campaigns of chemotherapy control carried out by national health programmes from 1977 to 1996. Analysis of the data showed that: a) the proportion of municipalities with prevalence above 25% was significantly higher in the coastal-forest zone than in the zone of transitional vegetation Agreste in the four evaluations made in the endemic area; b) the prevalence of infection decreased in both zones even when the interval between campaigns were more than five years. The last survey (1996) indicated a predominance of municipalities with prevalences below 25%. However, the majority of these municipalities had localities with prevalence above 50%. A proposal is presented for the identification of the problematic localities, where complementary measures to chemotherapy, such as systematic snail control, improved sanitation, health education and community mobilization, are still necessary.

Replacing oxamniquine by praziquantel against Schistosoma mansoni infection in a rural community from the sugar-cane zone of Northeast Brazil: an epidemiological follow-up

A group of 52 villagers was followed-up for three years regarding Schistosoma mansoni infection. All villagers were periodically surveyed by the Kato-Katz method. In March 1997 and March 1998 the positives were treated with oxamniquine (15-20 mg/kg), and in March 1999, with praziquantel (60 mg/kg). All infection indices decreased substantially between March 1999 and March 2000: prevalence of infection (from 32.7% to 21.2%), prevalence of moderate/heavy infection (from 7.7% to 1.9%), intensity of infection (from 23.1 epg to 7.4 epg) and reinfection (from 35.7% to 14.3%). Negativation increased from 53.8 to 82.4. An optimistic prognostic is assumed in the short term for the introduction of praziquantel in the study area.

Discriminating acute from chronic human schistosomiasis mansoni.

Specific immunoglobulin (IgA, IgG and IgM) responses to different antigen targets (soluble eggs antigen--SEA, soluble worm adult protein--SWAP and keyhole limpet hole--KLH) were measured by enzyme linked immunosorbent assay (ELISA) in patients with acute and chronic schistosomiasis, as well as patients without schistosomiasis. SEA IgA and KLH IgM presented high discriminatory powers to distinguish acute from chronic schistosomiasis, with calculated areas under the curve (AUCs) of 0.88 and 0.82, respectively, obtained from receiver operating characteristic (ROC) curve. On the other hand, these tests, particularly SEA IgA were not useful to distinguish schistosomiasis (including the acute and chronic forms) from individuals without this disease, but infected with other intestinal parasites (Ascaris lumbricoides, Trichuris trichiura and hookworm). By contrast, SWAP IgG and SEA IgG were able to discriminate schistosomiasis patients from healthy individuals and patients infected with other parasites (AUCs of 0.96 and 0.85, respectively). Thus, it is possible to use a combination of serological tests, such as SEA IgA and SWAP IgG, to simultaneously establish the diagnosis of schistosomiasis and discriminate the acute from the chronic forms of the disease.

The prevalence of schistosomiasis in school-aged children as an appropriate indicator of its prevalence in the community

School-aged children (6-15 years) from the endemic area of Pernambuco were evaluated both as a target group for and an indicator of schistosomiasis control in the community. Parasitological data were drawn from baseline stool surveys of whole populations that were obtained to diagnose Schistosoma mansoni infection. Nineteen representative localities were selected for assessing the prevalence of schistosomiasis among individuals in the following age groups: 0-5, 6-15, 16-25, 26-40 and 41-80 years. For each locality, the prevalence in each age group was compared to that of the overall population using contingency table analysis. To select a reference group, the operational difficulties of conducting residential surveys were considered. School-aged children may be considered to be the group of choice as the reference group for the overall population for the following reasons: (i) the prevalence of schistosomiasis in this age group had the highest correlation with the prevalence in the overall population (r = 0.967), (ii) this age group is particularly vulnerable to infection and plays an important role in parasite transmission and (iii) school-aged children are the main target of the World Health Organization in terms of helminth control. The Schistosomiasis Control Program should consider school-aged children both as a reference group for assessing the need for intervention at the community level and as a target group for integrated health care actions of the Unified Health System that are focused on high-risk groups.

Longitudinal Study on the Natural Infection of Biomphalaria straminea and B. glabrata by Schistosoma mansoni in an Endemic Area of Schistosomiasis in Pernambuco, Brazil

The abundance of snail hosts and the rates of infection with Schistosoma mansoni were monitored monthly for four years in two representative localities subjected to repeated chemotherapy of infected persons. Snail abundance varied from 1.0 to 4.4 collected per person/minute/station for Biomphalaria straminea and from 0.1 to 7.0 for B. glabrata. Infection rates of snails in nature varied from 0% to 15% for the former and from 0% to 70% for the latter species. Human infection increased from 35.5% to 61.9% in the locality occupied by B. straminea, and decreased from 40.3% to 20.8% in that occupied by B. glabrata. No relationship could be detected between human infection and the snail variables. Despite seasonal variations, natural infection persisted throughout the monitoring period in both snail species. It reached remarkably high levels in B. straminea when compared to those obtained by other authors probably because of differences in methodology. It is recommended that longitudinal studies should be carried out focally and periodically to avoid underestimating the prevalence of schistosome infection in snails.

Evaluation of tests based on the antibody response to keyhole limpet haemocyanin and soluble egg antigen to differentiate acute and chronic human schistosomiasis mansoni

Specific IgG and IgM responses to soluble egg antigen (SEA) and keyhole limpet haemocyanin (KLH) were measured by ELISA in patients with acute and chronic schistosomiasis. The tests based upon IgM and IgG antibodies responses to KLH presented the best diagnostic discrimination, and can be used in conjunction with clinical and epidemiological data to the differential diagnosis of acute schistosomiasis.

Aspectos bionômicos de Squamatoides trivittatus (Diptera, Sarcophagidae) sob condições de laboratório

Experiments with Squamatoides trivitattus were carried out in two different controlled temperatures (16±1°C/50-60% RH and 27±1°C/70-80% RH). The viability of larvae and pupae at 27°C was 89.82% and 92.75% respectively. Larvae did not develop at 16°C. Larval development lasted for 20±4 hr, 16±8 hr and 60±7 hr for the first, second and third instars, respectively, completing a total of 96±6 hr. The mean pupal period lasted for 15.7±1.6 days. In longevity tables for the adults, life-expectancy for 50% of the colony submitted to 16°C was of 1.78 weeks for males and 2.42 for females. At 27°C a life-expectancy of 1.15 weeks for males and 0.78 week for females was recorded. The average life-spans for males and females at 16°C were 3.5±2.0 and 3.8±2.6 weeks, respectively, and 1.9±1.2 weeks for both sexes. At 27°C, the longevity recorded was of 2.1±1.3 weeks for males and 1.7±1.1 week for females.

School-based and community-based actions for scaling-up diagnosis and treatment of schistosomiasis toward its elimination in an endemic area of Brazil

This study evaluated a school-based and a community-based scheme for diagnosis, treatment and follow-up of schistosomiasis mansoni among school-aged children in views of resolution CD49.R19 of the Pan American Health Organization toward the elimination of schistosomiasis as a public health problem in the Americas and subsequent commitments endorsed by the Brazilian government. The school-aged population from a representative municipality of the endemic area of Northeastern Brazil was randomly allocated to either school-based or community-based scheme. The two schemes were compared with regard to coverage of diagnosis by the Kato-Katz method (KK) at baseline, treatment of the positives for Schistosoma mansoni with praziquantel, treatment of the positives for soil-transmitted helminthes (STH) with mebendazole, as well as follow-up of treatment efficacy and reinfection assessed respectively at four and 12 months after treatment. Nutritional status of the positives for S. mansoni was assessed at baseline and re-assessed at 12 months after treatment. Coverage of diagnosis and treatment was satisfactory (>75%) in both schemes. Diagnosis coverage at baseline and at 12 months was significantly higher in the community scheme, whereas treatment coverage did not differ significantly between the two schemes either at baseline or at 12 months. The number of children covered per day was significantly higher in the schools than in the community at baseline but not at follow-up, when daily coverage was higher in the community. With regard to S. mansoni, overall treatment efficacy rate at four months was 90.8%, and reinfection rate at 12 months was 21.6%. For STH, overall treatment efficacy was 45.4% and reinfection, 32.8%. The nutritional status of the positives for S. mansoni at baseline did not change significantly at 12 months post-treatment. Actions targeted at this particularly vulnerable high-risk group should combine school-based and community-based interventions as well as preventive measures to reduce transmission.

Assessment of schistosomiasis in the semi-arid Northeast region of Brazil: the São Francisco River large-scale water transposition project

UNLABELLED INTRODUCTION Risk of schistosomiasis expansion to semi-arid northeastern Brazil under the influence of the Integration Project of the São Francisco River (IPSFR) was assessed. METHODS Stool examinations of schoolchildren, epidemiological investigation, and survey of the local host snail Biomphalaria straminea were performed in five IPSFR municipalities. RESULTS Six of 4,770 examined schoolchildren were egg-positive for Schistosoma mansoni. Biomphalaria straminea was widespread, but not naturally infected with S. mansoni. Snails experimentally exposed to two laboratory S. mansoni strains yielded infection indices of 1-4.5%. CONCLUSIONS There is evidence of active schistosomiasis transmission in the area; thus, intensive surveillance actions are required.

Directives for Schistosomiasis Control in Endemic Areas of Brazil

The World Health Organization (WHO, 2010) estimates that 7.1 million people are infected with Schistsosoma mansoni in the Americas, 95% of which in Brazil. Resolution CD49.R19 of the Pan American Health Organization (PAHO, 2009) urged Member States to commit themselves to eliminate or reduce neglected diseases and other infections related to poverty for which tools exist, to levels so that these diseases are no longer considered public health problems by year 2015. The resolution considered schistosomiasis as one of the diseases whose prevalence can be drastically reduced in the Americas with available cost-effective interventions, and approved goals and strategies to be adopted by the countries according to their health policies, epidemiological situation and health service structure. The present chapter firstly compares similarities and differences in the main goals and primary strategies between the current recommendations of the Brazilian Schistomiasis Control Programme (PCE), Ministry of Health (MS), and those of CD49.R19, with particular emphasis on improving coverage of diagnosis and treatment. Secondly, it examines data from a representative endemic area to provide evidence that an approach including schoolbased diagnosis and treatment would enable short-term improved access to and coverage of the control actions targeted at the school-aged group. Thirdly, it applies spatial analysis to evaluate baseline and post-treatment prevalence data from an endemic locality to show the feasibility of mapping re-infection risk areas based on the identified “hot spots”, thus contributing to improve preventive measures such as environmental sanitation and snail control. Finally, it will be argued that the current MS strategy can be further improved towards the goal of drastically reducing prevalence in the foreseeable future taking into account the epidemiological situation and health service structure without compromising the country’s health policies.