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Objective To determine if the prevalence of schistosomiasis in children aged 9- 12 years is associated with the prevalence in 5-8-year-olds and adults after preventive chemotherapy in schools or the community. Methods We combined data from four community-randomized, preventive chemotherapy trials in treatment-naive populations in Cote d'Ivoire, Kenya and the United Republic of Tanzania during 2010-2016 according to the number of praziquantel treatments and the delivery method. Schistosoma mansoni infection was sought on two slides prepared from each participant's first stool using the Kato-Katz technique. We assessed associations between S. mansoni prevalence in 9-12-year-olds and 5- 8-year-olds and adults in the community before and after treatment using Bayesian regression models. Findings Stool samples from 47 985 5-8-year-olds, 81 077 9-12-year-olds and 20 492 adults were analysed. We found associations between the prevalence in 9-12-year-olds and that in 5-8-year-olds and adults after preventive treatment, even when only school-age children were treated. When the prevalence in 9-12-year-olds was under 10%, the prevalence in 5-8-year-olds was consistently under 10%. When the prevalence in 9-12-year-olds was under 50%, the prevalence in adults after two or four rounds of preventive chemotherapy was 10%-15% lower than before chemotherapy. Post-chemotherapy age-group associations were consistent with pre-chemotherapy associations in this analysis and previous studies. Conclusion The prevalence of S. mansoni infection in 9-12-year-olds was associated with the prevalence in other age groups and could be used to guide community treatment decisions. Abstracts in [phrase omitted], Francais, [phrase omitted] and Espanol at the end of each article. [phrase omitted] Objectif Determiner si la prevalence de la schistosomiase chez les enfants de 9 a 12 ans est associee a celle observee chez les 5-8 ans et les adultes apres une chimiotherapie preventive au sein des ecoles ou de la communaute. Methodes Nous avons regroupe les donnees provenant de quatre essais randomises de chimiotherapie preventive menes en milieu communautaire aupres de populations n'ayant jamais ete traitees en Cote d'Ivoire, au Kenya et en Republique-Unie de Tanzanie entre 2010 et 2016, en fonction du nombre de traitements au praziquantel et du mode d'administration. Une infection a Schistosoma mansoni a ete recherchee sur deux lames preparees a partir des premieres selles de chaque participant, a l'aide de la technique de Kato-Katz. Nous avons employe des modeles de regression bayesienne qui nous ont permis d'identifier un rapport entre la prevalence de S. mansoni au sein de la communaute chez les 9-12 ans d'une part, et chez les 5-8 ans et les adultes de l'autre, avant et apres traitement. Resultats Les echantillons de selles de 47 985 enfants ages de 5 a 8 ans, 81 077 enfants de 9 a 12 ans et 20 492 adultes ont ete analyses. Nous avons constate qu'apres un traitement preventif, la prevalence chez les 9-12 ans ainsi que chez les 5-8 ans et les adultes etait liee, meme quand seuls les enfants d'age scolaire etaient traites. Lorsque la prevalence chez les 9-12 ans etait inferieure a 10%, celle chez les 5-8 ans etait systematiquement sous les 10%. Lorsque la prevalence chez les 9-12 ans etait inferieure a 50%, celle chez les adultes apres deux ou quatre traitements par chimiotherapie preventive etait 10 a 15% plus faible qu'avant toute chimiotherapie. Les liens par categorie d'age en post-chimiotherapie etaient coherents avec ceux en pre-chimiotherapie, tant dans la presente analyse que dans de precedentes etudes. Conclusion La prevalence de l'infection a S. mansoni chez les 9-12 ans etait associee a la prevalence dans d'autres categories d'age, ce qui pourrait servir a orienter les decisions de prise en charge au sein de la communaute. [phrase omitted] Objetivo Determinar si la prevalencia de la esquistosomiasis en ninos de 9 a 12 anos esta asociada con la prevalencia en ninos de 5 a 8 anos y adultos tras la quimioterapia preventiva en escuelas o en la comunidad. Metodos Se combinaron datos de cuatro ensayos aleatorizados a nivel comunitario de quimioterapia preventiva en poblaciones sin tratamiento en Costa de Marfil, Kenia y la Republica Unida de Tanzania entre 2010 y 2016 segun el numero de tratamientos con praziquantel y el metodo de administracion. La infeccion por Schistosoma mansoni se busco en dos laminillas preparadas a partir de las primeras heces de cada participante mediante la tecnica de Kato-Katz. Se evaluaron las asociaciones entre la prevalencia de S. mansoni en ninos de 9 a 12 anos y de 5 a 8 anos y adultos en la comunidad antes y despues del tratamiento mediante modelos de regresion bayesiana. Resultados Se analizaron muestras de heces de 47 985 ninos de 5 a 8 anos, 81 077 ninos de 9 a 12 anos y 20 492 adultos. Se encontraron asociaciones entre la prevalencia en ninos de 9 a 12 anos y la de ninos de 5 a 8 anos y adultos tras el tratamiento preventivo, incluso cuando solo se trato a ninos en edad escolar. Cuando la prevalencia en ninos de 9 a 12 anos era inferior al 10%, la prevalencia en ninos de 5 a 8 anos era siempre inferior al 10%. Cuando la prevalencia en ninos de 9 a 12 anos era inferior al 50%, la prevalencia en adultos despues de dos o cuatro ciclos de quimioterapia preventiva era entre un 10% y un 15% inferior que antes de la quimioterapia. Las asociaciones entre grupos de edad tras la quimioterapia fueron coherentes con las asociaciones previas a la quimioterapia en este analisis y en estudios anteriores. Conclusion La prevalencia de la infeccion por S. mansoni en ninos de 9 a 12 anos se asocio con la prevalencia en otros grupos de edad. Ademas, podria utilizarse para orientar las decisiones de tratamiento en la comunidad., Introduction Control programmes for schistosomiasis, the human disease caused by worms of the genus Schistosoma, focus on collecting and evaluating data from school-age children. (1) The use of school-age children [...]

Schistosomiasis is among the most common parasitic diseases in the world, with over 142 million people infected in low- and middle-income countries. Measuring population-level transmission is centrally important in guiding schistosomiasis control programs. Traditionally, human Schistosoma mansoni infections have been detected using stool microscopy, which is logistically difficult at program scale and has low sensitivity when people have low infection burdens. We compared serological measures of transmission based on antibody response to S. mansoni soluble egg antigen (SEA) with stool-based measures of infection among 3,663 preschool-age children in an area endemic for S. mansoni in western Kenya. We estimated force of infection among children using the seroconversion rate and examined how it varied geographically and by age. At the community level, serological measures of transmission aligned with stool-based measures of infection (ρ = 0.94), and serological measures provided more resolution for between-community differences at lower levels of infection. Force of infection showed a clear gradient of transmission with distance from Lake Victoria, with 94% of infections and 93% of seropositive children in communities

Background: The standard diagnosis of Ascaris lumbricoides and other soil-transmitted helminth (STH) infections relies on the detection of worm eggs by copromicroscopy. However, this method is dependent on worm patency and shows only limited accuracy in low-intensity infection settings. We aimed to decipher the diagnostic accuracy of different antibodies using various Ascaris antigens in reference to copromicroscopy and quantitative PCR (qPCR), four months after national STH preventative chemotherapy among school children in western Kenya. Methodology: STH infection status of 390 school children was evaluated via copromicroscopy (Kato-Katz and mini-FLOTAC) and qPCR. In parallel, Ascaris-specific antibody profiles against larval and adult worm lysates, and adult worm excretory-secretory (ES) products were determined by enzyme-linked immunosorbent assay. Antibody cross-reactivity was evaluated using the closely related zoonotic roundworm species Toxocara cati and Toxocara canis. The diagnostic accuracy of each antibody was evaluated using receiver operating curve analysis and the correspondent area under the curve (AUC). Principal findings: Ascaris was the predominant helminth infection with an overall prevalence of 14.9% (58/390). The sensitivity of mini-FLOTAC and Kato-Katz for Ascaris diagnosis reached only 53.5% and 63.8%, respectively compared to qPCR. Although being more sensitive, qPCR values correlated with microscopic egg counts (R = -0.71, P<0.001), in contrast to antibody levels. Strikingly, IgG antibodies recognizing the ES products of adult Ascaris worms reliably diagnosed active Ascaris infection as determined by qPCR and microscopy, with IgG1 displaying the highest accuracy (AUC = 0.83, 95% CI: 0.75–0.91). Conclusion: IgG1 antibody responses against adult Ascaris-ES products hold a promising potential for complementing the standard fecal and molecular techniques employed for monitoring Ascaris infections. This is of particular importance in the context of deworming programs as the antibody diagnostic accuracy was independent of egg counts. Author summary: Ascaris lumbricoides is the most common human intestinal helminth globally, affecting a quarter of the world's population. Microscopic methods are used to diagnose and monitor Ascaris infections. However, these methods are unsatisfactory for diagnosing low-intensity infections, are prone to human error, their accuracy is greatly affected by the heterogeneous distribution of worm eggs and are limited to detecting only patent infections. qPCR offers an attractive alternative with regard to sensitivity and high-throughput capacity but is also limited by worm patency. Here, we compared the diagnostic accuracy of different antibodies using Ascaris antigen lysates as well as Ascaris excretory/secretory (ES) products using copromicroscopy and qPCR as reference. Our data show that IgG1 antibody responses directed against ES antigens of adult Ascaris worms, but not against the infective third-stage larval or adult worm extracts, reliably decipher between Ascaris-infected and Ascaris-negative participants independent of the microscopic egg counts. Our study is the first to report strong IgG1 responses directed against ES products of adult worms and their potential value as markers for an active Ascaris infection. Our results indicate the potential to develop an antibody-based Ascaris-immunoassay utilizing Ascaris-ES antigens to complement the monitoring of reinfections and transmission dynamics. [ABSTRACT FROM AUTHOR]

Using a 2 x 2 factorial design, we investigated the combined impact of protein deficiency (PD) and gastrointestinal nematode infection during late pregnancy and lactation on resting metabolic rate (RMR), body composition and bone mineralization, neonatal growth, and the regulatory hormones [corticosterone, leptin, and insulin-like growth factor-1 (IGF1)] and proinflammatory cytokines [interleukin (IL)-1[beta] and IL-6] that may drive these processes. Pregnant CD1 mice, fed either a protein-sufficient (PS; 24%) or protein-deficient (PD; 6%) isocaloric diet, were infected 4 times with either 0 (sham) or 100 Heligmosomoides baked larvae beginning on d 14 of pregnancy. Dams were killed on d 20 postpartum and pups on d 2, 7, 14, and 21. Diet and infection had largely independent effects. The PD diet elevated corticosterone and upregulated leptin concentration in maternal serum, which was associated with reduced food intake leading to lower body mass, RMR, and body temperature. Infection reduced food intake but elevated maternal serum IL-1[beta] and IL-6 and did not affect corticosterone, leptin, RMR, or body temperature. The PD diet decreased maternal bone area and bone mineral content. Infection lowered maternal bone mineral density, consistent with elevated IL-1[beta] and IL-6. The elevated serum IL1[beta] and lower IGF-1 in pups of PD dams and lower serum leptin and IGF-1 in pups of infected dams were both consistent with the lower pup body mass and shorter crown-rump length. This mouse model provides a novel framework to study the impact of diet and nematode infection on bone. J. Nutr. 140: 1638-1645, 2010. doi: 10.3945/jn.110.125013.

Abstract Background Intestinal schistosomiasis continues to be a significant cause of morbidity among communities located around Lake Victoria and on its islands. Although epidemiological surveys have been conducted in other areas bordering the lake in western Kenya, Mbita district and its adjacent islands have never been surveyed, largely due to logistical challenges in accessing these areas. Consequently, there is a paucity of data on prevalence of schistosomiasis and soil-transmitted helminth (STH) infections that are endemic in this region. Methods This cross-sectional study determined the prevalence, intensity of infection and geographical distribution of schistosome and STH infections among 4,065 children aged 5–19 years in 84 primary schools in Mbita and nearby islands of Lake Victoria (Mfangano, Ringiti, Rusinga and Takawiri), in western Kenya. Single stool samples were collected and examined for eggs of Schistosoma mansoni and STHs (Hookworms, Ascaris lumbricoides and Trichuris trichiura) using the Kato-Katz technique. Primary schools were mapped using geographical information system data on PDAs and prevalence maps generated using ArcView GIS software. Results Overall, 65.6% (95% CI = 64.2-67.1%) of children were infected with one or more helminth species; 12.4% (95% CI = 11.4-13.4%) of children were infected with one or more STH species. Mean school prevalence of S. mansoni infection was 60.5% (95% CI = 59.0-62.0%), hookworms 8.4% (95% CI = 7.6-9.3%), A. lumbricoides 3.3% (95% CI = 2.7-3.8%), and T. trichiura 1.6% (95% CI = 1.2-2.0%). Interestingly, the mean S. mansoni prevalence was 2-fold higher on the islands (82%) compared to the mainland (41%) (z = 5.8755, P P S. mansoni prevalence while prevalence of STHs was more homogenously distributed. Conclusions The very high prevalence of schistosomiasis in Mbita and the 4 islands is quite alarming, and indicates an urgent and critical need for control interventions. Findings from this survey indicate the need to implement treatment in remote areas not previously covered by mass drug administration programs.

Abstract Background Although schistosomiasis is generally considered a rural phenomenon, infections have been reported within urban settings. Based on observations of high prevalence of Schistosoma mansoni infection in schools within the informal settlements of Kisumu City, a follow-up malacological survey incorporating 81 sites within 6 informal settlements of the City was conducted to determine the presence of intermediate host snails and ascertain whether active transmission was occurring within these areas. Methods Surveyed sites were mapped using a geographical information system. Cercaria shedding was determined from snails and species of snails identified based on shell morphology. Vegetation cover and presence of algal mass at the sites was recorded, and the physico-chemical characteristics of the water including pH and temperature were determined using a pH meter with a glass electrode and a temperature probe. Results Out of 1,059 snails collected, 407 (38.4%) were putatively identified as Biomphalaria sudanica, 425 (40.1%) as Biomphalaria pfeifferi and 227 (21.5%) as Bulinus globosus. The spatial distribution of snails was clustered, with few sites accounting for most of the snails. The highest snail abundance was recorded in Nyamasaria (543 snails) followed by Nyalenda B (313 snails). As expected, the mean snail abundance was higher along the lakeshore (18 ± 12 snails) compared to inland sites (dams, rivers and springs) (11 ± 32 snails) (F1, 79 = 38.8, P < 0.0001). Overall, 19 (1.8%) of the snails collected shed schistosome cercariae. Interestingly, the proportion of infected Biomphalaria snails was higher in the inland (2.7%) compared to the lakeshore sites (0.3%) (P = 0.0109). B. sudanica was more abundant in sites along the lakeshore whereas B. pfeifferi and B. globosus were more abundant in the inland sites. Biomphalaria and Bulinus snails were found at 16 and 11 out of the 56 inland sites, respectively. Conclusions The high abundance of Biomphalaria and Bulinus spp. as well as observation of field-caught snails shedding cercariae confirmed that besides Lake Victoria, the local risk for schistosomiasis transmission exists within the informal settlements of Kisumu City. Prospective control interventions in these areas need to incorporate focal snail control to complement chemotherapy in reducing transmission.

Abstract Background High coverage of insecticide-treated bed nets in Asembo and low coverage in Seme, two adjacent communities in western Nyanza Province, Kenya; followed by expanded coverage of bed nets in Seme, as the Kenya national malaria programme rolled out; provided a natural experiment for quantification of changes in relative abundance of two primary malaria vectors in this holoendemic region. Both belong to the Anopheles gambiae sensu lato (s.l.) species complex, namely A. gambiae sensu stricto (s.s.) and Anopheles arabiensis. Historically, the former species was proportionately dominant in indoor resting collections of females. Methods Data of the relative abundance of adult A. gambiae s.s. and A. arabiensis sampled from inside houses were obtained from the literature from 1970 to 2002 for sites west of Kisumu, Kenya, to the region of Asembo ca. 50 km from the city. A sampling transect was established from Asembo (where bed net use was high due to presence of a managed bed net distribution programme) eastward to Seme, where no bed net programme was in place. Adults of A. gambiae s.l. were sampled from inside houses along the transect from 2003 to 2009, as were larvae from nearby aquatic habitats, providing data over a nearly 40 year period of the relative abundance of the two species. Relative proportions of A. gambiae s.s. and A. arabiensis were determined for each stage by identifying species by the polymerase chain reaction method. Household bed net ownership was measured with surveys during mosquito collections. Data of blood host choice, parity rate, and infection rate for Plasmodium falciparum in A. gambiae s.s. and A. arabiensis were obtained for a sample from Asembo and Seme from 2005. Results Anopheles gambiae s.s. adult females from indoor collections predominated from 1970 to 1998 (ca. 85%). Beginning in 1999, A. gambiae s.s decreased proportionately relative to A. arabiensis, then precipitously declined to rarity coincident with increased bed net ownership as national bed net distribution programmes commenced in 2004 and 2006. By 2009, A. gambiae s.s. comprised proportionately ca. 1% of indoor collections and A. arabiensis 99%. In Seme compared to Asembo in 2003, proportionately more larvae were A. gambiae s.s., larval density was higher, and more larval habitats were occupied. As bed net use rose in Seme, the proportion of A. gambiae larvae declined as well. These trends continued to 2009. Parity and malaria infection rates were lower in both species in Asembo (high bed net use) compared to Seme (low bed net use), but host choice did not vary within species in both communities (predominantly cattle for A. arabiensis, humans for A. gambiae s.s.). Conclusions A marked decline of the A. gambiae s.s. population occurred as household ownership of bed nets rose in a region of western Kenya over a 10 year period. The increased bed net coverage likely caused a mass effect on the composition of the A. gambiae s.l. species complex, resulting in the observed proportionate increase in A. arabiensis compared to its closely related sibling species, A. gambiae s.s. These observations are important in evaluating the process of regional malaria elimination, which requires sustained vector control as a primary intervention.

Abstract Background Identification of Anopheles gambiae s.s. and Anopheles arabiensis from field-collected Anopheles gambiae s.l. is often necessary in basic and applied research, and in operational control programmes. The currently accepted method involves use of standard polymerase chain reaction amplification of ribosomal DNA (rDNA) from the 3' 28S to 5' intergenic spacer region of the genome, and visual confirmation of amplicons of predicted size on agarose gels, after electrophoresis. This report describes development and evaluation of an automated, quantitative PCR method based upon TaqMan™ single nucleotide polymorphism (SNP) genotyping. Methods Standard PCR, and TaqMan SNP genotyping with newly designed primers and fluorophore-labeled probes hybridizing to sequences of complementary rDNA specific for either An. gambiae s.s. or An. arabiensis, were conducted in three experiments involving field-collected An. gambiae s.l. from western Kenya, and defined laboratory strains. DNA extraction was from a single leg, sonicated for five minutes in buffer in wells of 96-well PCR plates. Results TaqMan SNP genotyping showed a reaction success rate, sensitivity, and species specificity comparable to that of standard PCR. In an extensive field study, only 29 of 3,041 (0.95%) were determined to be hybrids by TaqMan (i.e., having rDNA sequences from both species), however, all but one were An. arabiensis by standard PCR, suggesting an acceptably low (ca. 1%) error rate for TaqMan genotyping in mistakenly identifying species hybrids. Conclusion TaqMan SNP genotyping proved to be a sensitive and rapid method for identification of An. gambiae s.l. and An. arabiensis, with a high success rate, specific results, and congruence with the standard PCR method.