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Editor’s Choice Articles

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

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11 pages, 1237 KiB  
Article
Epidemiological Interface of Sylvatic and Dog Rabies in the North West Province of South Africa
by Ayla J. Malan, Andre Coetzer, Claude T. Sabeta and Louis H. Nel
Trop. Med. Infect. Dis. 2022, 7(6), 90; https://doi.org/10.3390/tropicalmed7060090 - 5 Jun 2022
Cited by 4 | Viewed by 3125
Abstract
Rabies is a viral zoonosis that causes an estimated 59,000 preventable human fatalities every year. While more than 120 countries remain endemic for dog-mediated rabies, the burden is the highest in Africa and Asia where 99% of human rabies cases are caused by [...] Read more.
Rabies is a viral zoonosis that causes an estimated 59,000 preventable human fatalities every year. While more than 120 countries remain endemic for dog-mediated rabies, the burden is the highest in Africa and Asia where 99% of human rabies cases are caused by domestic dogs. One such rabies-endemic country is South Africa where an estimated 42 preventable human deaths occur every year. Although canine rabies had been well described for most of the provinces in South Africa, the epidemiology of rabies within the North West Province had not been well defined prior to this investigation. As such, the aim of this study was to use nucleotide sequence analyses to characterise the extant molecular epidemiology of rabies in the North West Province of South Africa—with specific focus on the interface between dogs and sylvatic species. To this end, Rabies lyssavirus isolates originating from the North West Province were subjected to molecular epidemiological analyses relying on the Bayesian Markov Chain Monte Carlo methodology on two distinct gene regions, viz. the G-L intergenic region and partial nucleoprotein gene. Our results provided strong evidence in support of an endemic cycle of canine rabies in the East of the province, and three independent endemic cycles of sylvatic rabies spread throughout the province. Furthermore, evidence of specific events of virus spill-over between co-habiting sylvatic species and domestic dogs was found. These results suggest that the elimination of canine-mediated rabies from the province will rely not only on eliminating the disease from the dog populations, but also from the co-habiting sylvatic populations using oral rabies vaccination campaigns. Full article
(This article belongs to the Section Neglected and Emerging Tropical Diseases)
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16 pages, 2804 KiB  
Article
Systematic Surveillance of Rickettsial Diseases in 27 Hospitals from 26 Provinces throughout Vietnam
by Nguyen Vu Trung, Le Thi Hoi, Tran Mai Hoa, Dang Thi Huong, Ma Thi Huyen, Vuong Quang Tien, Dao Thi Tuyet Mai, Nguyen Thi Thu Ha, Nguyen Van Kinh, Christina M. Farris and Allen L. Richards
Trop. Med. Infect. Dis. 2022, 7(6), 88; https://doi.org/10.3390/tropicalmed7060088 - 31 May 2022
Cited by 7 | Viewed by 2680
Abstract
In Vietnam, the public health burden of rickettsial infections continues to be underestimated due to knowledge gaps in the epidemiology of these diseases. We conducted a systematic study among 27 hospitals from 26 provinces in eight ecological regions throughout Vietnam to investigate the [...] Read more.
In Vietnam, the public health burden of rickettsial infections continues to be underestimated due to knowledge gaps in the epidemiology of these diseases. We conducted a systematic study among 27 hospitals from 26 provinces in eight ecological regions throughout Vietnam to investigate the prevalence, distribution, and clinical characteristics of rickettsial diseases. We recruited 1834 patients in the study from April 2018 to October 2019. The findings showed that rickettsial diseases were common among undifferentiated febrile patients, with 564 (30.8%) patients positive by qPCR for scrub typhus, murine typhus or spotted fever. Scrub typhus (484, 85.8%) was the most common rickettsial disease, followed by murine typhus (67, 11.9%) and spotted fever (10, 1.8%). Rickettsial diseases were widely distributed in all regions of Vietnam and presented with nonspecific clinical manifestations. Full article
(This article belongs to the Special Issue Advances in Vector-Borne Diseases: Celebrating the First Impact Factor of TMID and in Memory of Sir Patrick Manson (1844-1922))
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6 pages, 575 KiB  
Perspective
The Emergence of Japanese Encephalitis in Australia and the Implications for a Vaccination Strategy
by Luis Furuya-Kanamori, Narayan Gyawali, Deborah J. Mills, Leon E. Hugo, Gregor J. Devine and Colleen L. Lau
Trop. Med. Infect. Dis. 2022, 7(6), 85; https://doi.org/10.3390/tropicalmed7060085 - 29 May 2022
Cited by 18 | Viewed by 4555
Abstract
Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia. Until 2022, only six locally transmitted human JE cases had been reported in Australia; five in northern Queensland and one in the Northern Territory. Thus, JE was mainly considered to be [...] Read more.
Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia. Until 2022, only six locally transmitted human JE cases had been reported in Australia; five in northern Queensland and one in the Northern Territory. Thus, JE was mainly considered to be a disease of travellers. On 4 March 2022, JE was declared a ‘Communicable Disease Incident of National Significance’ when a locally acquired human case was confirmed in southern Queensland. By 11 May 2022, 41 human JE cases had been notified in four states in Australia, in areas where JE has never been detected before. From this perspective, we discuss the potential reasons for the recent emergence of the JE virus in Australia in areas where JE has never been previously reported as well as the implications of and options for mass immunisation programs if the outbreak escalates in a JE virus-immunologically naïve population. Full article
(This article belongs to the Special Issue Advances in Vector-Borne Diseases: Celebrating the First Impact Factor of TMID and in Memory of Sir Patrick Manson (1844-1922))
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2 pages, 159 KiB  
Editorial
Eliminating Cholera Incidence and Mortality: Unfulfilled Tasks
by David Nalin
Trop. Med. Infect. Dis. 2022, 7(5), 69; https://doi.org/10.3390/tropicalmed7050069 - 9 May 2022
Viewed by 1755
Abstract
Impressive advances have been made in new cholera vaccine development and vaccination control strategies [...] Full article
(This article belongs to the Special Issue Cholera Control in 2021: Bioecology, Immunology, Current and Future Vaccines and Treatment Options)
9 pages, 392 KiB  
Article
Dengue and COVID-19: Managing Undifferentiated Febrile Illness during a “Twindemic”
by Liang En Wee, Edwin Philip Conceicao, Jean Xiang-Ying Sim, May Kyawt Aung, Aung Myat Oo, Yang Yong, Shalvi Arora and Indumathi Venkatachalam
Trop. Med. Infect. Dis. 2022, 7(5), 68; https://doi.org/10.3390/tropicalmed7050068 - 7 May 2022
Cited by 4 | Viewed by 2929
Abstract
Background: During the COVID-19 pandemic, distinguishing dengue from COVID-19 in endemic areas can be difficult, as both may present as undifferentiated febrile illness. COVID-19 cases may also present with false-positive dengue serology. Hospitalisation protocols for managing undifferentiated febrile illness are essential in mitigating [...] Read more.
Background: During the COVID-19 pandemic, distinguishing dengue from COVID-19 in endemic areas can be difficult, as both may present as undifferentiated febrile illness. COVID-19 cases may also present with false-positive dengue serology. Hospitalisation protocols for managing undifferentiated febrile illness are essential in mitigating the risk from both COVID-19 and dengue. Methods: At a tertiary hospital contending with COVID-19 during a dengue epidemic, a triage strategy of routine COVID-19 testing for febrile patients with viral prodromes was used. All febrile patients with viral prodromes and no epidemiologic risk for COVID-19 were first admitted to a designated ward for COVID-19 testing, from January 2020 to December 2021. Results: A total of 6103 cases of COVID-19 and 1251 cases of dengue were managed at our institution, comprising a total of 3.9% (6103/155,452) and 0.8% (1251/155,452) of admissions, respectively. A surge in dengue hospitalisations in mid-2020 corresponded closely with the imposition of a community-wide lockdown. A total of 23 cases of PCR-proven COVID-19 infection with positive dengue serology were identified, of whom only two were true co-infections; both had been appropriately isolated upon admission. Average length-of-stay for dengue cases initially admitted to isolation during the pandemic was 8.35 days (S.D. = 6.53), compared with 6.91 days (S.D. = 8.61) for cases admitted outside isolation (1.44 days, 95%CI = 0.58–2.30, p = 0.001). Pre-pandemic, only 1.6% (9/580) of dengue cases were admitted initially to isolation-areas; in contrast, during the pandemic period, 66.6% (833/1251) of dengue cases were initially admitted to isolation-areas while awaiting the results of SARS-CoV-2 testing. Conclusions: During successive COVID-19 pandemic waves in a dengue-endemic country, coinfection with dengue and COVID-19 was uncommon. Routine COVID-19 testing for febrile patients with viral prodromes mitigated the potential infection-prevention risk from COVID-19 cases, albeit with an increased length-of-stay for dengue hospitalizations admitted initially to isolation. Full article
(This article belongs to the Special Issue COVID-19: Current Status and Future Prospects)
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21 pages, 423 KiB  
Review
2.5 Million Annual Deaths—Are Neonates in Low- and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality
by Flavia Rosa-Mangeret, Anne-Caroline Benski, Anne Golaz, Persis Z. Zala, Michiko Kyokan, Noémie Wagner, Lulu M. Muhe and Riccardo E. Pfister
Trop. Med. Infect. Dis. 2022, 7(5), 64; https://doi.org/10.3390/tropicalmed7050064 - 21 Apr 2022
Cited by 25 | Viewed by 4843
Abstract
(1) Background: Every year, 2.5 million neonates die, mostly in low- and middle-income countries (LMIC), in total disregard of their fundamental human rights. Many of these deaths are preventable. For decades, the leading causes of neonatal mortality (prematurity, perinatal hypoxia, and infection) have [...] Read more.
(1) Background: Every year, 2.5 million neonates die, mostly in low- and middle-income countries (LMIC), in total disregard of their fundamental human rights. Many of these deaths are preventable. For decades, the leading causes of neonatal mortality (prematurity, perinatal hypoxia, and infection) have been known, so why does neonatal mortality fail to diminish effectively? A bottom-up understanding of neonatal morbi-mortality and neonatal rights is essential to achieve adequate progress, and so is increased visibility. (2) Methods: We performed an overview on the leading causes of neonatal morbi-mortality and analyzed the key interventions to reduce it with a bottom-up approach: from the clinician in the field to the policy maker. (3) Results and Conclusions: Overall, more than half of neonatal deaths in LMIC are avoidable through established and well-known cost-effective interventions, good quality antenatal and intrapartum care, neonatal resuscitation, thermal care, nasal CPAP, infection control and prevention, and antibiotic stewardship. Implementing these requires education and training, particularly at the bottom of the healthcare pyramid, and advocacy at the highest levels of government for health policies supporting better newborn care. Moreover, to plan and follow interventions, better-quality data are paramount. For healthcare developments and improvement, neonates must be acknowledged as humans entitled to rights and freedoms, as stipulated by international law. Most importantly, they deserve more respectful care. Full article
(This article belongs to the Special Issue Neglected Diseases and Human Rights)
17 pages, 3385 KiB  
Review
Schistosomiasis at the Crossroad to Elimination: Review of Eclipsed Research with Emphasis on the Post-Transmission Agenda
by Michal Giboda, Robert Bergquist and Jürg Utzinger
Trop. Med. Infect. Dis. 2022, 7(4), 55; https://doi.org/10.3390/tropicalmed7040055 - 31 Mar 2022
Cited by 5 | Viewed by 3327
Abstract
While chronic schistosomiasis is pathologically well defined, the acute form of the disease is less well understood. It is generally agreed that early lesions, such as lung nodules and bladder polyps, are reversible, which impedes identification of the time elapsed since exposure. The [...] Read more.
While chronic schistosomiasis is pathologically well defined, the acute form of the disease is less well understood. It is generally agreed that early lesions, such as lung nodules and bladder polyps, are reversible, which impedes identification of the time elapsed since exposure. The intermediate stage between the acute and the chronic forms of schistosomiasis requires further investigation, as does the clinical stage due to lesions remaining after treatment. With current schistosomiasis control efforts gradually progressing to elimination, there is a need to focus on post-transmission schistosomiasis, which not only refers to remaining lesions from previous infections, but also accounts for the potential presence of surviving worms after treatment. This issue is particularly salient for migrants from endemic to non-endemic countries and should be kept in mind for returning expatriates from schistosomiasis-endemic countries. Negative stool examination or urine filtration are generally taken as indicative of cure since rectoscopy for Schistosoma mansoni infection, or cystoscopy for S. haematobium infection, are rarely performed. However, pathology of affected organs may persist indefinitely, while potentially remaining live worms could produce additional pathology. Hence, post-transmission schistosomiasis can prevail for years after elimination of the disease, and thus, warrant further attention. Full article
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16 pages, 1177 KiB  
Review
Immune Responses in Leishmaniasis: An Overview
by Ana Caroline Costa-da-Silva, Danielle de Oliveira Nascimento, Jesuino R. M. Ferreira, Kamila Guimarães-Pinto, Leonardo Freire-de-Lima, Alexandre Morrot, Debora Decote-Ricardo, Alessandra Almeida Filardy and Celio Geraldo Freire-de-Lima
Trop. Med. Infect. Dis. 2022, 7(4), 54; https://doi.org/10.3390/tropicalmed7040054 - 31 Mar 2022
Cited by 38 | Viewed by 9195
Abstract
Leishmaniasis is a parasitic, widespread, and neglected disease that affects more than 90 countries in the world. More than 20 Leishmania species cause different forms of leishmaniasis that range in severity from cutaneous lesions to systemic infection. The diversity of leishmaniasis forms is [...] Read more.
Leishmaniasis is a parasitic, widespread, and neglected disease that affects more than 90 countries in the world. More than 20 Leishmania species cause different forms of leishmaniasis that range in severity from cutaneous lesions to systemic infection. The diversity of leishmaniasis forms is due to the species of parasite, vector, environmental and social factors, genetic background, nutritional status, as well as immunocompetence of the host. Here, we discuss the role of the immune system, its molecules, and responses in the establishment, development, and outcome of Leishmaniasis, focusing on innate immune cells and Leishmania major interactions. Full article
(This article belongs to the Special Issue Feature Papers in Tropical Medicine and Infectious Disease)
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5 pages, 554 KiB  
Case Report
Detection of SARS-CoV-2 Antigens in the AV-Node of a Cardiac Conduction System—A Case Report
by Hrvoje Jakovac, Antun Ferenčić, Christophe Stemberger, Bojana Mohar Vitezić and Dražen Cuculić
Trop. Med. Infect. Dis. 2022, 7(3), 43; https://doi.org/10.3390/tropicalmed7030043 - 4 Mar 2022
Cited by 7 | Viewed by 4533
Abstract
Mounting evidence indicates that new arrhythmic events frequently occur during and after coronavirus disease (COVID-19), posing additional mortality risk in older-aged and critically ill patients. However, the underlying mechanisms and cardio pathological substrates of COVID-related arrhythmias have not been clarified yet. Here, we [...] Read more.
Mounting evidence indicates that new arrhythmic events frequently occur during and after coronavirus disease (COVID-19), posing additional mortality risk in older-aged and critically ill patients. However, the underlying mechanisms and cardio pathological substrates of COVID-related arrhythmias have not been clarified yet. Here, we report findings of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens and genes in the atrioventricular node (AV-node) of a cardiac conduction system, pointing to its direct infection as a possible arrhythmogenic factor. Full article
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9 pages, 235 KiB  
Article
Telehealth Reduces Missed Appointments in Pediatric Patients with Tuberculosis Infection
by Angela Zhao, Nirali Butala, Casey Morgan Luc, Richard Feinn and Thomas S. Murray
Trop. Med. Infect. Dis. 2022, 7(2), 26; https://doi.org/10.3390/tropicalmed7020026 - 14 Feb 2022
Cited by 4 | Viewed by 3387
Abstract
Pediatric patients with untreated tuberculosis infection (TBI), also called latent TBI, are at risk of progression to active TB disease. The primary aim of this study was to identify factors associated with higher rates of missed appointments and failure to complete therapy for [...] Read more.
Pediatric patients with untreated tuberculosis infection (TBI), also called latent TBI, are at risk of progression to active TB disease. The primary aim of this study was to identify factors associated with higher rates of missed appointments and failure to complete therapy for pediatric patients with TBI. A secondary aim was to determine the impact of the COVID-19 pandemic and the rise of telehealth on TBI missed appointment rates. We first performed a retrospective chart review of 129 pediatric patients referred to the free Yale Pediatric Winchester Chest Tuberculosis Clinic from 2016–2019. Associations between demographic/clinical variables and missed appointments/failure to complete therapy were analyzed using univariate and bivariate chi-square tests. Language, lack of primary provider, and distance to clinic were the main contributors to missed appointments and poor treatment adherence. There was an association between the number of missed appointments and failure to complete treatment (p = 0.050). A second cohort of 29 patients was analyzed from January–December 2021 when telehealth was offered for follow-up appointments. Of these follow-up visits, 54% were conducted via telehealth, and the clinic’s missed appointment rate dropped significantly from 16.9% to 5.8% during this time frame (p = 0.037). These data demonstrate that telehealth is accepted as an alternative by patients for follow-up TBI visits. Full article
(This article belongs to the Special Issue Holistic Approach to Tuberculosis Detection, Treatment and Prevention: Emerging Evidence and Strategies from the Field)
11 pages, 669 KiB  
Article
Evaluating the Quality of Latent Tuberculosis Infection Screening in Ireland: A Single-Centre Retrospective Cohort Study
by James O’Connell, Joy Oguntuase, Brian Li, Cora McNally, Debbi Stanistreet, Samuel McConkey and Eoghan de Barra
Trop. Med. Infect. Dis. 2022, 7(2), 19; https://doi.org/10.3390/tropicalmed7020019 - 28 Jan 2022
Cited by 2 | Viewed by 2922
Abstract
Ireland is a country with a low incidence of tuberculosis (TB) (5.6 cases per 100,000 population in 2019) that should be aiming for TB elimination (fewer than 1 case per million of population). To achieve TB elimination in low-incidence countries, programmatic latent tuberculosis [...] Read more.
Ireland is a country with a low incidence of tuberculosis (TB) (5.6 cases per 100,000 population in 2019) that should be aiming for TB elimination (fewer than 1 case per million of population). To achieve TB elimination in low-incidence countries, programmatic latent tuberculosis infection (LTBI) management is important. This requires high-quality latent tuberculosis infection (LTBI) screening. Aim: To assess the quality of LTBI screening in a tertiary centre in Ireland using a framework. Methods: A retrospective review of the health care records of patients screened for TB in a tertiary centre in Ireland using an interferon-gamma release assay (IGRA) between 2016 and 2018 was performed. Three domains from the Institute of Medicine framework for health care quality, effectiveness, efficiency, and equity, were applied to measure the quality of LTBI screening. Results: Forty patients had LTBI and an indication for treatment, of whom 20% (8/40) were not offered treatment by the health care provider, 2.5% (1/40) did not accept treatment, and 10% (4/40) did not complete treatment. Seventy-five percent (6/8) of patients not offered treatment were non-Irish. The cost of screening per LTBI case identified was EUR 2048. Conclusions: This study evaluated the quality of LTBI screening using a framework and identified that LTBI screening in this tertiary centre needs to be scaled and expanded, and that treatment initiation needs to be improved, particularly among non-Irish nationals. Full article
(This article belongs to the Collection Infection Prevention and Control: Practical and Educational Advances)
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17 pages, 2891 KiB  
Article
Predictive Risk Mapping of Schistosomiasis in Madagascar Using Ecological Niche Modeling and Precision Mapping
by Mark A. Deka
Trop. Med. Infect. Dis. 2022, 7(2), 15; https://doi.org/10.3390/tropicalmed7020015 - 19 Jan 2022
Cited by 11 | Viewed by 5422
Abstract
Schistosomiasis is a neglected tropical disease (NTD) found throughout tropical and subtropical Africa. In Madagascar, the condition is widespread and endemic in 74% of all administrative districts in the country. Despite the significant burden of the disease, high-resolution risk maps have yet to [...] Read more.
Schistosomiasis is a neglected tropical disease (NTD) found throughout tropical and subtropical Africa. In Madagascar, the condition is widespread and endemic in 74% of all administrative districts in the country. Despite the significant burden of the disease, high-resolution risk maps have yet to be produced to guide national control programs. This study used an ecological niche modeling (ENM) and precision mapping approach to estimate environmental suitability and disease transmission risk. The results show that suitability for schistosomiasis is widespread and covers 264,781 km2 (102,232 sq miles). Covariates of significance to the model were the accessibility to cities, distance to water, enhanced vegetation index (EVI), annual mean temperature, land surface temperature (LST), clay content, and annual precipitation. Disease transmission risk is greatest in the central highlands, tropical east coast, arid-southwest, and northwest. An estimated 14.9 million people could be at risk of schistosomiasis; 11.4 million reside in rural areas, while 3.5 million are in urban areas. This study provides valuable insight into the geography of schistosomiasis in Madagascar and its potential risk to human populations. Because of the focal nature of the disease, these maps can inform national surveillance programs while improving understanding of areas in need of medical interventions. Full article
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8 pages, 1254 KiB  
Article
Integrated Tuberculosis and COVID-19 Activities in Karachi and Tuberculosis Case Notifications
by Amyn A. Malik, Hamidah Hussain, Rabia Maniar, Nauman Safdar, Amal Mohiuddin, Najam Riaz, Aneeta Pasha, Salman Khan, Syed Saleem Hasan Kazmi, Ershad Kazmi and Saira Khowaja
Trop. Med. Infect. Dis. 2022, 7(1), 12; https://doi.org/10.3390/tropicalmed7010012 - 15 Jan 2022
Cited by 15 | Viewed by 3817
Abstract
As the COVID-19 pandemic surged, lockdowns led to the cancellation of essential health services. As part of our Zero TB activities in Karachi, we adapted our approach to integrate activities for TB and COVID-19 to decrease the impact on diagnosis and linkage to [...] Read more.
As the COVID-19 pandemic surged, lockdowns led to the cancellation of essential health services. As part of our Zero TB activities in Karachi, we adapted our approach to integrate activities for TB and COVID-19 to decrease the impact on diagnosis and linkage to care for TB treatment. We implemented the following: (1) integrated COVID-19 screening and testing within existing TB program activities, along with the use of an artificial intelligence (AI) software reader on digital chest X-rays; (2) home delivery of medication; (3) use of telehealth and mental health counseling; (4) provision of PPE; (5) burnout monitoring of health workers; and (6) patient safety and disinfectant protocol. We used programmatic data for six districts of Karachi from January 2018 to March 2021 to explore the time trends in case notifications, the impact of the COVID-19 pandemic, and service adaptations in the city. The case notifications in all six districts in Karachi were over 80% of the trend-adjusted expected notifications with three districts having over 90% of the expected case notifications. Overall, Karachi reached 90% of the expected case notifications during the COVID-19 pandemic. The collaborative efforts by the provincial TB program and private sector partners facilitated this reduced loss in case notifications. Full article
(This article belongs to the Special Issue Holistic Approach to Tuberculosis Detection, Treatment and Prevention: Emerging Evidence and Strategies from the Field)
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6 pages, 563 KiB  
Commentary
One Health Approach: A Data-Driven Priority for Mitigating Outbreaks of Emerging and Re-Emerging Zoonotic Infectious Diseases
by Busayo I. Ajuwon, Katrina Roper, Alice Richardson and Brett A. Lidbury
Trop. Med. Infect. Dis. 2022, 7(1), 4; https://doi.org/10.3390/tropicalmed7010004 - 29 Dec 2021
Cited by 6 | Viewed by 3120
Abstract
This paper discusses the contributions that One Health principles can make in improving global response to zoonotic infectious disease. We highlight some key benefits of taking a One Health approach to a range of complex infectious disease problems that have defied a more [...] Read more.
This paper discusses the contributions that One Health principles can make in improving global response to zoonotic infectious disease. We highlight some key benefits of taking a One Health approach to a range of complex infectious disease problems that have defied a more traditional sectoral approach, as well as public health policy and practice, where gaps in surveillance systems need to be addressed. The historical examples demonstrate the scope of One Health, partly from an Australian perspective, but also with an international flavour, and illustrate innovative approaches and outcomes with the types of collaborative partnerships that are required. Full article
(This article belongs to the Topic Zoonoses in Tropical Countries)
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14 pages, 1503 KiB  
Article
Environmental and Household-Based Spatial Risks for Tungiasis in an Endemic Area of Coastal Kenya
by Ayako Hyuga, Peter S. Larson, Morris Ndemwa, Sheru W. Muuo, Mwatasa Changoma, Mohamed Karama, Kensuke Goto and Satoshi Kaneko
Trop. Med. Infect. Dis. 2022, 7(1), 2; https://doi.org/10.3390/tropicalmed7010002 - 23 Dec 2021
Cited by 3 | Viewed by 3638
Abstract
Tungiasis is a cutaneous parasitosis caused by an embedded female sand flea. The distribution of cases can be spatially heterogeneous even in areas with similar risk profiles. This study assesses household and remotely sensed environmental factors that contribute to the geographic distribution of [...] Read more.
Tungiasis is a cutaneous parasitosis caused by an embedded female sand flea. The distribution of cases can be spatially heterogeneous even in areas with similar risk profiles. This study assesses household and remotely sensed environmental factors that contribute to the geographic distribution of tungiasis cases in a rural area along the Southern Kenyan Coast. Data on household tungiasis case status, demographic and socioeconomic information, and geographic locations were recorded during regular survey activities of the Health and Demographic Surveillance System, mainly during 2011. Data were joined with other spatial data sources using latitude/longitude coordinates. Generalized additive models were used to predict and visualize spatial risks for tungiasis. The household-level prevalence of tungiasis was 3.4% (272/7925). There was a 1.1% (461/41,135) prevalence of infection among all participants. A significant spatial variability was observed in the unadjusted model (p-value < 0.001). The number of children per household, earthen floor, organic roof, elevation, aluminum content in the soil, and distance to the nearest animal reserve attenuated the odds ratios and partially explained the spatial variation of tungiasis. Spatial heterogeneity in tungiasis risk remained even after a factor adjustment. This suggests that there are possible unmeasured factors associated with the complex ecology of sand fleas that may contribute to the disease’s uneven distribution. Full article
(This article belongs to the Special Issue Spatial Epidemiology of Infectious Diseases)
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10 pages, 291 KiB  
Review
Chagas Disease in People with HIV: A Narrative Review
by Eva H. Clark and Caryn Bern
Trop. Med. Infect. Dis. 2021, 6(4), 198; https://doi.org/10.3390/tropicalmed6040198 - 9 Nov 2021
Cited by 10 | Viewed by 3488
Abstract
Many questions remain unanswered regarding the epidemiology, pathophysiology, diagnosis, treatment, and monitoring of Trypanosoma cruzi infection in people with HIV (PWH). The reported prevalence of T. cruzi infection in PWH living in endemic countries ranges from 1–28% and is likely similar in at-risk [...] Read more.
Many questions remain unanswered regarding the epidemiology, pathophysiology, diagnosis, treatment, and monitoring of Trypanosoma cruzi infection in people with HIV (PWH). The reported prevalence of T. cruzi infection in PWH living in endemic countries ranges from 1–28% and is likely similar in at-risk US populations. While classic cardiac and gastrointestinal presentations of chronic Chagas disease occur in PWH, PWH are additionally at risk for a severe and often fatal form of T. cruzi-mediated disease called reactivation disease. T. cruzi reactivation typically occurs in PWH with low CD4 counts and poor virologic control. National HIV guidelines in several endemic South American countries recommend that all PWH be screened for T. cruzi infection at the time of HIV diagnosis; however, this recommendation is not widely implemented. The early detection of T. cruzi infection in PWH is critical as the sequelae of Chagas disease, including T. cruzi reactivation, may be preventable through the restoration of robust cellular immunity via the initiation of antiretroviral therapy and the appropriate use of antitrypanosomal therapy. Full article
(This article belongs to the Special Issue The Global Burden of Disease of Chagas Disease (American Trypanosomiasis))
11 pages, 929 KiB  
Article
Measuring Catastrophic Costs Due to Tuberculosis in Myanmar
by Si Thu Aung, Aung Thu, Htin Lin Aung and Min Thu
Trop. Med. Infect. Dis. 2021, 6(3), 130; https://doi.org/10.3390/tropicalmed6030130 - 14 Jul 2021
Cited by 13 | Viewed by 4920
Abstract
Background: This is the first survey to use the World Health Organization (WHO) methodology to document the magnitude and main drivers of tuberculosis (TB) patient costs in order to guide policies on cost mitigation and to produce a baseline measure for the percentage [...] Read more.
Background: This is the first survey to use the World Health Organization (WHO) methodology to document the magnitude and main drivers of tuberculosis (TB) patient costs in order to guide policies on cost mitigation and to produce a baseline measure for the percentage of TB-affected households experiencing catastrophic costs in Myanmar. Methods: A nationally representative cross-sectional survey was administered to 1000 TB patients in health facilities from December 2015 to February 2016, focusing on costs of TB treatment (direct and indirect), household income, and coping strategies. A total cost was estimated for each household by extrapolating reported costs and comparing them to household income. If the proportion of total costs exceeded 20% of the annual household income, a TB-affected household was deemed to have faced catastrophic costs. Results: 60% of TB-affected households faced catastrophic costs in Myanmar. On average, total costs were USD 759, and the largest proportion of this total was accounted for by patient time (USD 365), followed by food costs (USD 200), and medical expenses (USD 130). Low household wealth quintile and undergoing MDR-TB treatment were both significant predictors for households facing catastrophic costs. Conclusions: The high proportion of TB-affected households experiencing catastrophic costs suggests the need for TB-specific social protection programs in patient-centered healthcare. The survey findings have led the government and donors to increase support for MDR-TB patients. The significant proportion of total spending attributable to lost income and food or nutritional supplements suggests that income replacement programs and/or food packages may ameliorate the burdensome costs. Full article
(This article belongs to the Special Issue Holistic Approach to Tuberculosis Detection, Treatment and Prevention: Emerging Evidence and Strategies from the Field)
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13 pages, 1196 KiB  
Article
Implementation of an Effective Decentralised Programme for Detection, Treatment and Prevention of Tuberculosis in Children
by John Paul Dongo, Stephen M. Graham, Joseph Nsonga, Fred Wabwire-Mangen, Elizabeth Maleche-Obimbo, Ezekiel Mupere, Rodrigo Nyinoburyo, Jane Nakawesi, Gerald Sentongo, Pauline Amuge, Anne Detjen, Frank Mugabe, Stavia Turyahabwe, Moorine P. Sekadde and Stella Zawedde-Muyanja
Trop. Med. Infect. Dis. 2021, 6(3), 131; https://doi.org/10.3390/tropicalmed6030131 - 14 Jul 2021
Cited by 14 | Viewed by 4988
Abstract
Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child [...] Read more.
Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child TB at the referral level is a major challenge in the prevention, detection and treatment of TB in children. In 2015, the DETECT Child TB Project was implemented in two districts of Uganda and involved decentralisation of healthcare services for child TB from tertiary to primary healthcare facilities, along with establishing linkages to support community-based household contact screening and management. The intervention resulted in improved case finding of child and adult TB cases, improved treatment outcomes for child TB and high uptake and completion of TPT for eligible child contacts. A detailed description of the development and implementation of this project is provided, along with findings from an external evaluation. The ongoing mentorship and practical support for health workers to deliver optimal services in this context were critical to complement the use of training and training tools. A summary of the project’s outcomes is provided along with the key challenges identified and the lessons learnt. Full article
(This article belongs to the Special Issue Holistic Approach to Tuberculosis Detection, Treatment and Prevention: Emerging Evidence and Strategies from the Field)
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15 pages, 628 KiB  
Review
A Rapid Review on the Efficacy and Safety of Pharmacological Treatments for Chagas Disease
by Cody J Malone, Immaculate Nevis, Eduardo Fernández and Ana Sanchez
Trop. Med. Infect. Dis. 2021, 6(3), 128; https://doi.org/10.3390/tropicalmed6030128 - 12 Jul 2021
Cited by 10 | Viewed by 5166
Abstract
Chagas disease remains a neglected tropical disease, causing significant burden in the Americas and countries that receive immigrants from endemic nations. Current pharmaceutical treatments are suboptimal, not only varying drastically in efficacy, depending on the stage of disease, but also presenting significant risk [...] Read more.
Chagas disease remains a neglected tropical disease, causing significant burden in the Americas and countries that receive immigrants from endemic nations. Current pharmaceutical treatments are suboptimal, not only varying drastically in efficacy, depending on the stage of disease, but also presenting significant risk of adverse events. The objective of this review is to provide a timely update on the efficacy and safety of current trypanocidals. Eligible studies published from January 2015 to December 2020 were retrieved by one reviewer from six electronic databases. Ana-lysis was done with review management software and risk of bias was assessed using tools appropriate for the type of study (i.e., experimental or observational). Thirteen studies (10 observational and three RCTs) were included in the analysis. All 13 studies tested Benznidazole (BNZ) or Nifurtimox (NFX), and two studies also tested Posaconazole (POS) or E1224 (Ravucanazole). BNZ was found to be the most efficacious trypanocidal drug compared to Nifurtimox, POS, and E1224; it also resulted in the highest percentage of adverse effects (AEs) and treatment discontinuation due to its toxicity. Adults experienced higher frequency of neurological AEs while taking BNZ or NFX compared to children. Children had a higher frequency of general AEs compared to adults while taking BNZ. Overall, BNZ is still the most efficacious, but development of new, less toxic drugs is paramount for the quality of life of patients. Studies testing combination therapies and shorter regimens are needed, as is the devising of better clinical parameters and laboratory biomarkers to evaluate treatment efficacy. Considering the variability in methodology and reporting of the studies included in the present analysis, we offer some recommendations for the improvement and replicability of clinical studies investigating pharmacological treatment of Chagas disease. These include full disclosure of methodology, standardization of outcome measures, and always collecting and reporting data on both the efficacy of trypanocidals and on safety outcomes. Full article
(This article belongs to the Special Issue The Global Burden of Disease of Chagas Disease (American Trypanosomiasis))
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15 pages, 3539 KiB  
Article
Elevated Pediatric Chagas Disease Burden Complicated by Concomitant Intestinal Parasites and Malnutrition in El Salvador
by Melissa S. Nolan, Kristy O. Murray, Rojelio Mejia, Peter J. Hotez, Maria Jose Villar Mondragon, Stanley Rodriguez, Jose Ricardo Palacios, William Ernesto Murcia Contreras, M. Katie Lynn, Myriam E. Torres and Maria Carlota Monroy Escobar
Trop. Med. Infect. Dis. 2021, 6(2), 72; https://doi.org/10.3390/tropicalmed6020072 - 7 May 2021
Cited by 8 | Viewed by 7011
Abstract
The eradication of the vector Rhodnius prolixus from Central America was heralded as a victory for controlling transmission of Trypanosoma cruzi, the parasite that causes Chagas disease. While public health officials believed this milestone achievement would effectively eliminate Chagas disease, case reports [...] Read more.
The eradication of the vector Rhodnius prolixus from Central America was heralded as a victory for controlling transmission of Trypanosoma cruzi, the parasite that causes Chagas disease. While public health officials believed this milestone achievement would effectively eliminate Chagas disease, case reports of acute vector transmission began amassing within a few years. This investigation employed a cross-sectional serosurvey of children either presenting with fever for clinical care or children living in homes with known triatomine presence in the state of Sonsonate, El Salvador. Over the 2018 calendar year, a 2.3% Chagas disease seroprevalence among children with hotspot clustering in Nahuizalco was identified. Positive serology was significantly associated with dogs in the home, older participant age, and a higher number of children in the home by multivariate regression. Concomitant intestinal parasitic infection was noted in a subset of studied children; 60% having at least one intestinal parasite and 15% having two or more concomitant infections. Concomitant parasitic infection was statistically associated with an overall higher parasitic load detected in stool by qPCR. Lastly, a four-fold higher burden of stunting was identified in the cohort compared to the national average, with four-fifths of mothers reporting severe food insecurity. This study highlights that polyparasitism is common, and a systems-based approach is warranted when treating Chagas disease seropositive children. Full article
(This article belongs to the Special Issue The Global Burden of Disease of Chagas Disease (American Trypanosomiasis))
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20 pages, 4913 KiB  
Article
A One Health Approach to Investigating Leptospira Serogroups and Their Spatial Distributions among Humans and Animals in Rio Grande do Sul, Brazil, 2013–2015
by Noemi Polo, Gustavo Machado, Rogerio Rodrigues, Patricia Nájera Hamrick, Claudia Munoz-Zanzi, Martha Maria Pereira, Marilina Bercini, Loeci Natalina Timm and Maria Cristina Schneider
Trop. Med. Infect. Dis. 2019, 4(1), 42; https://doi.org/10.3390/tropicalmed4010042 - 27 Feb 2019
Cited by 17 | Viewed by 7432
Abstract
Leptospirosis is an endemic zoonotic disease in Brazil and is widespread throughout rural populations in the state of Rio Grande do Sul. This study aimed to identify presumptive infecting Leptospira serogroups in human and animal cases and describe their occurrences within the ecoregions [...] Read more.
Leptospirosis is an endemic zoonotic disease in Brazil and is widespread throughout rural populations in the state of Rio Grande do Sul. This study aimed to identify presumptive infecting Leptospira serogroups in human and animal cases and describe their occurrences within the ecoregions of the state by animal species. Data for human and animal leptospirosis cases were gathered from the government’s passive surveillance systems and presumptive infecting serogroups were identified based on a two-fold titer difference in serogroups in the microscopic agglutination test (MAT) panel. A total of 22 different serogroups were reported across both human and animal cases. Serogroup Icterohaemorrhagiae was the most common among humans, while serogroup Sejroe predominated among animal cases, particularly bovines. Each ecoregion had a large distribution of cases, with 51% of the human cases in the Parana–Paraiba ecoregion, and 81% of the animal cases in the Savannah ecoregion. Identifying and mapping the serogroups circulating using the One Health approach is the first step for further understanding the distribution of the disease in the state. This study has the potential to aid in guiding public health and agricultural practices, furthering the need for a human vaccine in high-risk populations to complement control and prevention efforts. Full article
(This article belongs to the Special Issue Zoonoses and One Health)
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29 pages, 5256 KiB  
Review
Asian Schistosomiasis: Current Status and Prospects for Control Leading to Elimination
by Catherine A. Gordon, Johanna Kurscheid, Gail M. Williams, Archie C. A. Clements, Yuesheng Li, Xiao-Nong Zhou, Jürg Utzinger, Donald P. McManus and Darren J. Gray
Trop. Med. Infect. Dis. 2019, 4(1), 40; https://doi.org/10.3390/tropicalmed4010040 - 26 Feb 2019
Cited by 87 | Viewed by 16726
Abstract
Schistosomiasis is an infectious disease caused by helminth parasites of the genus Schistosoma. Worldwide, an estimated 250 million people are infected with these parasites with the majority of cases occurring in sub-Saharan Africa. Within Asia, three species of Schistosoma cause disease. Schistosoma japonicum [...] Read more.
Schistosomiasis is an infectious disease caused by helminth parasites of the genus Schistosoma. Worldwide, an estimated 250 million people are infected with these parasites with the majority of cases occurring in sub-Saharan Africa. Within Asia, three species of Schistosoma cause disease. Schistosoma japonicum is the most prevalent, followed by S. mekongi and S. malayensis. All three species are zoonotic, which causes concern for their control, as successful elimination not only requires management of the human definitive host, but also the animal reservoir hosts. With regard to Asian schistosomiasis, most of the published research has focused on S. japonicum with comparatively little attention paid to S. mekongi and even less focus on S. malayensis. In this review, we examine the three Asian schistosomes and their current status in their endemic countries: Cambodia, Lao People’s Democratic Republic, Myanmar, and Thailand (S. mekongi); Malaysia (S. malayensis); and Indonesia, People’s Republic of China, and the Philippines (S. japonicum). Prospects for control that could potentially lead to elimination are highlighted as these can inform researchers and disease control managers in other schistosomiasis-endemic areas, particularly in Africa and the Americas. Full article
(This article belongs to the Special Issue Prospects for Schistosomiasis Elimination)
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22 pages, 1423 KiB  
Review
Bats and Viruses: Emergence of Novel Lyssaviruses and Association of Bats with Viral Zoonoses in the EU
by Rebecca Shipley, Edward Wright, David Selden, Guanghui Wu, James Aegerter, Anthony R Fooks and Ashley C Banyard
Trop. Med. Infect. Dis. 2019, 4(1), 31; https://doi.org/10.3390/tropicalmed4010031 - 7 Feb 2019
Cited by 50 | Viewed by 10537
Abstract
Bats in the EU have been associated with several zoonotic viral pathogens of significance to both human and animal health. Virus discovery continues to expand the existing understating of virus classification, and the increased interest in bats globally as reservoirs or carriers of [...] Read more.
Bats in the EU have been associated with several zoonotic viral pathogens of significance to both human and animal health. Virus discovery continues to expand the existing understating of virus classification, and the increased interest in bats globally as reservoirs or carriers of zoonotic agents has fuelled the continued detection and characterisation of new lyssaviruses and other viral zoonoses. Although the transmission of lyssaviruses from bat species to humans or terrestrial species appears rare, interest in these viruses remains, through their ability to cause the invariably fatal encephalitis—rabies. The association of bats with other viral zoonoses is also of great interest. Much of the EU is free of terrestrial rabies, but several bat species harbor lyssaviruses that remain a risk to human and animal health. Whilst the rabies virus is the main cause of rabies globally, novel related viruses continue to be discovered, predominantly in bat populations, that are of interest purely through their classification within the lyssavirus genus alongside the rabies virus. Although the rabies virus is principally transmitted from the bite of infected dogs, these related lyssaviruses are primarily transmitted to humans and terrestrial carnivores by bats. Even though reports of zoonotic viruses from bats within the EU are rare, to protect human and animal health, it is important characterise novel bat viruses for several reasons, namely: (i) to investigate the mechanisms for the maintenance, potential routes of transmission, and resulting clinical signs, if any, in their natural hosts; (ii) to investigate the ability of existing vaccines, where available, to protect against these viruses; (iii) to evaluate the potential for spill over and onward transmission of viral pathogens in novel terrestrial hosts. This review is an update on the current situation regarding zoonotic virus discovery within bats in the EU, and provides details of potential future mechanisms to control the threat from these deadly pathogens. Full article
(This article belongs to the Special Issue Emerging Tropical Pathogens of Bats)
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13 pages, 1534 KiB  
Review
Artemether and Praziquantel: Origin, Mode of Action, Impact, and Suggested Application for Effective Control of Human Schistosomiasis
by Robert Bergquist and Hala Elmorshedy
Trop. Med. Infect. Dis. 2018, 3(4), 125; https://doi.org/10.3390/tropicalmed3040125 - 19 Dec 2018
Cited by 38 | Viewed by 4510
Abstract
The stumbling block for the continued, single-drug use of praziquantel (PZQ) against schistosomiasis is less justified by the risk of drug resistance than by the fact that this drug is inactive against juvenile parasites, which will mature and start egg production after chemotherapy. [...] Read more.
The stumbling block for the continued, single-drug use of praziquantel (PZQ) against schistosomiasis is less justified by the risk of drug resistance than by the fact that this drug is inactive against juvenile parasites, which will mature and start egg production after chemotherapy. Artemisinin derivatives, currently used against malaria in the form of artemisinin-based combination therapy (ACT), provide an opportunity as these drugs are not only active against malaria plasmodia, but surprisingly also against juvenile schistosomes. An artemisinin/PZQ combination would be complementary, and potentially additive, as it would kill two schistosome life cycle stages and thus confer a transmission-blocking modality to current chemotherapy. We focus here on single versus combined regimens in endemic settings. Although the risk of artemisinin resistance, already emerging with respect to malaria therapy in Southeast Asia, prevents use in countries where ACT is needed for malaria care, an artemisinin-enforced praziquantel treatment (APT) should be acceptable in regions of North Africa (including Egypt), the Middle East, China, and Brazil that are not endemic for malaria. Thanks to recent progress with respect to high-resolution diagnostics, based on circulating schistosome antigens in humans and molecular approaches for snail surveys, it should be possible to keep areas scheduled for schistosomiasis elimination under surveillance, bringing rapid response to bear on problems arising. The next steps would be to investigate where and for how long APT should be applied to make a lasting impact. A large-scale field trial in an area with modest transmission should tell how apt this approach is. Full article
(This article belongs to the Special Issue Prospects for Schistosomiasis Elimination)
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10 pages, 1503 KiB  
Article
Field Evaluation of a Loop-Mediated Isothermal Amplification (LAMP) Platform for the Detection of Schistosoma japonicum Infection in Oncomelania hupensis Snails
by Zhi-Qiang Qin, Jing Xu, Ting Feng, Shan Lv, Ying-Jun Qian, Li-Juan Zhang, Yin-Long Li, Chao Lv, Robert Bergquist, Shi-Zhu Li and Xiao-Nong Zhou
Trop. Med. Infect. Dis. 2018, 3(4), 124; https://doi.org/10.3390/tropicalmed3040124 - 15 Dec 2018
Cited by 43 | Viewed by 6196
Abstract
Schistosoma infection in snails can be monitored by microscopy or indirectly by sentinel mice. As both these approaches can miss infections, more sensitive tests are needed, particularly in low-level transmission settings. In this study, loop-mediated isothermal amplification (LAMP) technique, designed to detect a [...] Read more.
Schistosoma infection in snails can be monitored by microscopy or indirectly by sentinel mice. As both these approaches can miss infections, more sensitive tests are needed, particularly in low-level transmission settings. In this study, loop-mediated isothermal amplification (LAMP) technique, designed to detect a specific 28S ribosomal Schistosoma japonicum (Sj28S) gene with high sensitivity, was compared to microscopy using snail samples from 51 areas endemic for schistosomiasis in five Chinese provinces. In addition, the results were compared with those from polymerase chain reaction (PCR) by adding DNA sequencing as a reference. The testing of pooled snail samples with the LAMP assay showed that a dilution factor of 1/50, i.e., one infected snail plus 49 non-infected ones, would still result in a positive reaction after the recommended number of amplification cycles. Testing a total of 232 pooled samples, emanating from 4006 snail specimens, showed a rate of infection of 6.5%, while traditional microscopy found only 0.4% positive samples in the same materials. Parallel PCR analysis confirmed the diagnostic accuracy of the LAMP assay, with DNA sequencing even giving LAMP a slight lead. Microscopy and the LAMP test were carried out at local schistosomiasis-control stations, demonstrating that the potential of the latter assay to serve as a point-of-care (POC) test with results available within 60–90 min, while the more complicated PCR test had to be carried out at the National Institute of Parasitic Diseases (NIPD) in Shanghai, China. In conclusion, LAMP was found to be clearly superior to microscopy and as good as, or better than, PCR. As it can be used under field conditions and requires less time than other techniques, LAMP testing would improve and accelerate schistosomiasis control. Full article
(This article belongs to the Special Issue Prospects for Schistosomiasis Elimination)
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4 pages, 629 KiB  
Editorial
“Farewell to the God of Plague”: The Importance of Political Commitment Towards the Elimination of Schistosomiasis
by Jin Chen, Jing Xu, Robert Bergquist, Shi-Zhu Li and Xiao-Nong Zhou
Trop. Med. Infect. Dis. 2018, 3(4), 108; https://doi.org/10.3390/tropicalmed3040108 - 3 Oct 2018
Cited by 28 | Viewed by 3749
Abstract
Schistosomiasis control in China has always been conducted with strong political leadership and support at the highest level of government [1] [...] Full article
(This article belongs to the Special Issue Prospects for Schistosomiasis Elimination)
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9 pages, 220 KiB  
Review
When Should the Emphasis on Schistosomiasis Control Move to Elimination?
by W. Evan Secor and Daniel G. Colley
Trop. Med. Infect. Dis. 2018, 3(3), 85; https://doi.org/10.3390/tropicalmed3030085 - 15 Aug 2018
Cited by 21 | Viewed by 4868
Abstract
The stated goal of the World Health Organization’s program on schistosomiasis is paraphrased as follows: to control morbidity and eliminate transmission where feasible. Switching from a goal of controlling morbidity to interrupting transmission may well be currently feasible in some countries in the [...] Read more.
The stated goal of the World Health Organization’s program on schistosomiasis is paraphrased as follows: to control morbidity and eliminate transmission where feasible. Switching from a goal of controlling morbidity to interrupting transmission may well be currently feasible in some countries in the Caribbean, some areas in South America, northern Africa, and selected endemic areas in sub-Saharan Africa where there have been improvements in sanitation and access to clean water. However, in most of sub-Saharan Africa, where programmatic interventions still consist solely of annual mass drug administration, such a switch in strategies remains premature. There is a continued need for operational research on how best to reduce transmission to a point where interruption of transmission may be achievable. The level of infection at which it is feasible to transition from control to elimination must also be defined. In parallel, there is also a need to develop and evaluate approaches for achieving and validating elimination. There are currently neither evidence-based methods nor tools for breaking transmission or verifying that it has been accomplished. The basis for these statements stems from numerous studies that will be reviewed and summarized in this article; many, but not all of which were undertaken as part of SCORE, the Schistosomiasis Consortium for Operational Research and Evaluation. Full article
(This article belongs to the Special Issue Prospects for Schistosomiasis Elimination)
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