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    Disruptions to schistosomiasis programmes due to COVID-19 MESHD: an analysis of potential impact and mitigation strategies

    Authors: KLODETA KURA; Diepreye Ayabina; Jaspreet Toor; T. Deirdre Hollingsworth; Roy M Anderson

    doi:10.1101/2020.10.26.20219543 Date: 2020-10-27 Source: medRxiv

    Background: The 2030 goal for schistosomiasis MESHD is elimination as a public health problem (EPHP), with mass drug administration (MDA) of praziquantel to school-aged children ( SAC MESHD) a central pillar of the strategy. However, due to COVID-19 MESHD, many mass treatment campaigns for schistosomiasis MESHD have been halted with uncertain implications for the programmes. Method: We use mathematical modelling to explore how postponement of MDA and various mitigation strategies affect achievement of the EPHP goal for Schistosoma mansoni MESHD and S. haematobium. Results: In moderate and some high prevalence settings, the disruption may delay the goal by up to two years. In some high prevalence settings EPHP is not achievable with current strategies, and so the disruption will not impact this. Here, increasing SAC coverage and treating adults can achieve the goal. The impact of MDA disruption and the appropriate mitigation strategy varies according to the baseline prevalence prior to treatment, the burden of infection in adults and stage of the programme. Conclusions: Schistosomiasis MDA programmes in medium and high prevalence areas should restart as soon as is feasible, and mitigation strategies may be required in some settings.

    Parasites and their protection against COVID-19 MESHD- Ecology or Immunology?

    Authors: Kenneth Ssebambulidde; Ivan Segawa; Kelvin M Abuga; Vivian Nakate; Anthony Kayiira; Jayne Ellis; Lillian Tugume; Agnes N Kiragga; David B Meya

    doi:10.1101/2020.05.11.20098053 Date: 2020-05-18 Source: medRxiv

    Background: Despite the high infectivity of SARS-CoV-2, the incidence of COVID-19 MESHD in Africa has been slower than predicted. We aimed to investigate a possible association between parasitic infections MESHD and COVID-19 MESHD. Methods: An ecological study in which we analysed WHO data on COVID-19 MESHD cases in comparison to WHO data on helminths and malaria MESHD cases using correlation, regression, and Geographical Information Services analyses. Results: Of the global 3.34 million COVID-19 MESHD cases and 238,628 deaths as at May 4th 2020, Africa reported 0.029/3.3 million (0.88%) cases and 1,064/238,628 (0.45%) deaths. In 2018, Africa reported 213/229 million (93%) of all malaria MESHD cases, 204/229 million (89%) of schistosomiasis MESHD cases, and 271/1068 million (25%) of soil-transmitted helminth cases globally. In contrast, Europe reported 1.5/3.3 million (45%) of global COVID-19 MESHD cases and 142,667/238,628 (59%) deaths. Europe had 5.8/1068 million (0.55%) soil-transmitted helminths cases and no malaria MESHD/schistosomiasis cases in 2018. We found an inverse correlation between the incidence of COVID-19 MESHD and malaria MESHD (r -0.17, p =0.002) and COVID-19 MESHD and soil-transmitted helminths (r -0.25, p <0.001). Malaria MESHD-endemic countries were less likely to have COVID-19 MESHD (OR 0.51, 95% CI 0.29-0.90; p =0.02). Similarly, countries endemic for soil-transmitted helminths were less likely to have COVID-19 MESHD (OR 0.24, 95% CI 0.13-0.44; p <0.001), as were countries endemic for schistosomiasis MESHD (OR 0.22, 95% CI 0.11-0.45; p<0.001). Conclusions: One plausible hypothesis for the comparatively low COVID-19 MESHD cases/deaths in parasite-endemic areas is immunomodulation induced by parasites. Studies to elucidate the relationship between parasitic infections MESHD and susceptibility to COVID-19 MESHD at an individual level are warranted.

    An outbreak of intestinal schistosomiasis, alongside increasing urogenital schistosomiasis prevalence, in primary school children on the shoreline of Lake Malawi, Mangochi District, Malawi

    Authors: Sekeleghe Kayuni; Angus M. O’Ferrall; Hamish Baxter; Josie Hesketh; Bright Mainga; David Lally; Mohammad H. Al-Harbi; E. James LaCourse; Lazarus Juziwelo; Janelisa Musaya; Peter Makaula; John Russell Stothard

    doi:10.21203/rs.3.rs-26662/v3 Date: 2020-05-03 Source: ResearchSquare

    Background: Intestinal schistosomiasis was not considered endemic in Lake Malawi until November 2017 when populations of Biomphalaria pfeifferi were first reported; in May 2018, emergence of intestinal schistosomiasis MESHD was confirmed. This emergence was in spite of ongoing control of urogenital schistosomiasis MESHD by preventive chemotherapy. Our current study sought to ascertain whether intestinal schistosomiasis MESHD is transitioning from emergence to outbreak, to judge if stepped-up control interventions are needed.Methods: During late-May 2019, three cross-sectional surveys of primary school children for schistosomiasis MESHD were conducted using a combination of rapid diagnostic tests, parasitological examinations and applied morbidity-markers; 1) schistosomiasis dynamics were assessed at Samama (n = 80) and Mchoka (n = 80) schools, where Schistosoma mansoni was first reported, 2) occurrence of S. mansoni was investigated at two non-sampled schools, Mangochi Orphan Education and Training (MOET) (n = 60) and Koche (n = 60) schools, where B. pfeifferi was nearby, and 3) rapid mapping of schistosomiasis MESHD, and B. pfeifferi, conducted across a further 8 shoreline schools (n = 240). After data collection, univariate analyses and Chi-square testing were performed, followed by binary logistic regression using generalized linear models, to investigate epidemiological associations.Results: In total, 520 children from 12 lakeshore primary schools were examined, mean prevalence of S. mansoni by ‘positive’ urine circulating cathodic antigen (CCA)-dipsticks was 31.5% (95% Confidence Interval (CI): 27.5–35.5). Upon comparisons of infection prevalence in May 2018, significant increases at Samama (Relative Risk (RR) = 1.7, 95% CI: 1.4–2.2) and Mchoka (RR = 2.7, 95% CI: 1.7–4.3) schools were observed. Intestinal schistosomiasis MESHD was confirmed at MOET (18.3%) and Koche (35.0%) schools, and in all rapid mapping schools, ranging from 10.0% to 56.7%. Several populations of B. pfeifferi were confirmed, with two new eastern shoreline locations noted. Mean prevalence of urogenital schistosomiasis MESHD was 24.0% (95% CI: 20.3–27.7). Conclusions: We notify that intestinal schistosomiasis MESHD, once considered non-endemic in Lake Malawi, is now transitioning from emergence to outbreak. Once control interventions can resume after coronavirus disease 2019 MESHD ( COVID-19 MESHD) suspensions, we recommend stepped-up preventive chemotherapy, with increased community-access to treatments, alongside renewed efforts in appropriate environmental control. 

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