Schistosoma haematobium treatment in 1-5 year old children: safety and efficacy of the antihelminthic drug praziquantel

Francisca Mutapi, Nadine Rujeni, Claire Bourke, Kate Mitchell, Laura Appleby, Norman Nausch, Nicholas Midzi, Takafira Mduluza, Francisca Mutapi, Nadine Rujeni, Claire Bourke, Kate Mitchell, Laura Appleby, Norman Nausch, Nicholas Midzi, Takafira Mduluza

Abstract

Background: Morbidity due to schistosomiasis is currently controlled by treatment of schistosome infected people with the antihelminthic drug praziquantel (PZQ). Children aged up to 5 years are currently excluded from schistosome control programmes largely due to the lack of PZQ safety data in this age group. This study investigated the safety and efficacy of PZQ treatment in such children.

Methods: Zimbabwean children aged 1-5 years (n = 104) were treated with PZQ tablets and side effects were assessed by questionnaire administered to their caregivers within 24 hours of taking PZQ. Treatment efficacy was determined 6 weeks after PZQ administration through schistosome egg counts in urine. The change in infection levels in the children 1-5 years old (n = 100) was compared to that in 6-10 year old children (n = 435).

Principal findings: Pre-treatment S. haematobium infection intensity in 1-5 year olds was 14.6 eggs/10 ml urine and prevalence was 21%. Of the 104 children, 3.8% reported side effects within 24 hours of taking PZQ treatment. These were stomach ache, loss of appetite, lethargy and inflammation of the face and body. PZQ treatment significantly reduced schistosome infection levels in 1-5 year olds with an egg reduction rate (ERR) of 99% and cure rate (CR) of 92%. This was comparable to the efficacy of praziquantel in 6-10 year olds where ERR was 96% and CR was 67%. INTERPRETATION/SIGNIFICANCE: PZQ treatment is as safe and efficacious in children aged 1-5 years as it is in older children aged 6-10 years in whom PZQ is the drug of choice for control of schistosome infections.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. Schistosoma haematobium infection intensity in…
Figure 1. Schistosoma haematobium infection intensity in the study villages.
Arithmetic mean of schistosome infection intensity for each age group. Bars represent standard error of the mean.
Figure 2. Schistosoma haematobium infection prevalence in…
Figure 2. Schistosoma haematobium infection prevalence in the study villages.
Infection prevalence for each age group. Bars represent 95% CI.
Figure 3. Praziquantel efficacy in reducing infection…
Figure 3. Praziquantel efficacy in reducing infection intensity in different age groups.
Comparison of treatment efficacy in 1–5 year old children vs. 6–10 year old children. Infection intensity before treatment is shown in black and those 6 weeks after treatment are shown in white Bars represent standard error of the mean. Test-statistic values are from paired T tests.
Figure 4. Praziquantel efficacy in reducing infection…
Figure 4. Praziquantel efficacy in reducing infection prevalence in different age groups.
Comparison of PZQ treatment between 1–5 year old children vs. 6–10 year old children. Infection prevalence before treatment is shown in black and those 6 weeks after treatment are shown in white. Bars represent 95% CI. Test-statistic values are from χ2 tests.

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