Impact of intense, longitudinal retreatment with praziquantel on cure rates of schistosomiasis mansoni in a cohort of occupationally exposed adults in western Kenya
Tropical Medicine and International Health
Center for Tropical and Emerging Global Diseases, Department of Microbiology, University of Georgia, Athens, GA 30602, United States; Center for Tropical and Emerging Global Diseases, Department of Microbiology, University of Georgia, Athens, GA, United States; Department of Biology, University of New Mexico, Albuquerque, NM, United States; Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
Objective: To investigate trends in the efficacy of praziquantel (PZQ) suggestive of the emergence of drug resistance against Schistosoma mansoni infection after 12.5 years of intense, repeated use in a small geographic area along the shores of Lake Victoria. Methods: As part of a longitudinal study, 178 men occupationally exposed to schistosomes were repeatedly tested for S. mansoni infection at 4- to 6-week intervals and treated with PZQ at each reinfection. We compared cure rates by year of study and examined factors associated with cure failure in a multivariate logistic regression model. Results: Overall, the cure rate after a single dose of PZQ was 66%, ranging annually from 36% to 82%. In multivariate analysis, failure to cure after 1 PZQ dose was significantly associated with high intensity of infection and having fewer previous exposures to dying worms. Even after adjustment for these factors, treatments administered in 2006 were significantly more likely to result in cure failures than treatments administered in 2004, the year in which PZQ efficacy was highest. While cure rates varied over the course of 12 years, there was no consistent downward trend towards decreased efficacy over time. In years for which malacological data were available, periods of low PZQ efficacy coincide with high rates of S. mansoni infection in nearby snail populations. Conclusion: We did not find a pattern of cure failures consistent with development of clinical resistance to PZQ in our intensely treated cohort. © 2009 Blackwell Publishing Ltd.
praziquantel; drug; drug resistance; infectious disease; multivariate analysis; numerical model; occupational exposure; population structure; regression analysis; snail; adult; article; cohort analysis; disease transmission; drug efficacy; egg; human; Kenya; longitudinal study; major clinical study; male; occupational exposure; parasite identification; parasite prevalence; repeated drug dose; Schistosoma mansoni; schistosomiasis; single drug dose; snail; treatment failure; treatment outcome; Adult; Animals; Anthelmintics; Drug Resistance; HIV Infections; Humans; Liver Diseases, Parasitic; Logistic Models; Longitudinal Studies; Male; Multivariate Analysis; Parasite Egg Count; Praziquantel; Schistosomiasis mansoni; Africa; East Africa; Kenya; Sub-Saharan Africa; Gastropoda; Schistosoma mansoni