Cost and community acceptability of enhanced antibiotic distribution approaches for trachoma in the Republic of South Sudan: enhancing the A in SAFE (ETAS) study protocol.

BACKGROUND: The World Health Organization targeted trachoma for global elimination as a public health problem by 2030. Reaching elimination thresholds by the year 2030 in the Republic of South Sudan will be a considerable challenge, as the country currently has many counties considered hyper-endemic (> 30% trachomatous inflammation-follicular [TF]) that have yet to receive interventions. Evidence from randomized trials, modeling, and population-based surveys suggests that enhancements may be needed to the standard-of-care annual mass drug administration (MDA) to reach elimination thresholds in a timely manner within highly endemic areas. We describe a protocol for a study to determine the cost and community acceptability of enhanced antibiotic strategies for trachoma in South Sudan. METHODS: The Enhancing the A in SAFE (ETAS) study is a community randomized intervention costing and community acceptability study. Following a population-based trachoma prevalence survey in 1 county, 30 communities will be randomized 1:1 to receive 1 of 2 enhanced MDA interventions, with the remaining communities receiving standard-of-care annual MDA. The first intervention strategy will consist of a community-wide MDA followed by 2 rounds of targeted treatment to children ages 6 months to 9 years, 2 weeks and 4 weeks after the community MDA. The second strategy will consist of a community-wide biannual MDA approximately 6 to 8 months apart. The costing analysis will use a payer perspective and identify the total cost of the enhanced interventions and annual MDA. Community acceptability will be assessed through MDA coverage monitoring and mixed-methods research involving community stakeholders. A second trachoma-specific survey will be conducted 12 months following the original survey. DISCUSSION: ETAS has received ethical clearance and is expected to be conducted between 2022 and 2023. Results will be shared through subsequent manuscripts. The study's results will provide information to trachoma programs on whether enhanced interventions are affordable and acceptable to communities. These results will further help in the design of future trachoma-specific antibiotic efficacy trials. Enhanced MDA approaches could help countries recover from delays caused by conflict or humanitarian emergencies and could also assist countries such as South Sudan in reaching trachoma elimination as a public health problem by 2030. TRIAL REGISTRATION: This trial was registered on December 1st, 2022 (clinicaltrails.org: NCT05634759).

The timeline of public health responses for COVID-19 in Japan (December 2019-September 2022)

Since the first report of the outbreak of a Viral pneumonia of unknown cause in Wuhan, China at the end of 2019, the global community has been engaged in confronting a pandemic of the novel coronavirus infection for two years and nine months (roughly 1,000 days), up to the present. In Japan, public health responses such as non-pharmaceutical interventions, emergency measures, an expansion of the public health care system, and mass vaccination have been implemented to address various issues that have arisen in repeated waves. This article provides a timeline of the key public health events and measures that have been taken, mainly by the national government in Japan.

Elimination of human onchocerciasis: progress report, 2021

This progress report provides an update on the progress made towards eliminating nnchocerciasis (river blindness) by the World Health Organization (WHO) as part of its road map on neglected tropical diseases for 2021-2030. The report highlights that the goal is to eliminate the need for mass drug administration of ivermectin in at least one focus in 34 countries by 2030, in more than 50% of the population in at least 16 countries and in the entire endemic population in at least 12 countries. However, challenges remain in achieving these goals, including incomplete mapping of all transmission zones, co-endemicity of onchocerciasis and loiasis, a potential decrease in sensitivity to ivermectin, uncoordinated cross-border work, suboptimal programme implementation and inadequate technical and financial resources. COVID-19 has also delayed national programmes, with millions of doses of preventive chemotherapy that should have been distributed expiring. The report also provides regional highlights, including that in 2021, 23 countries reported having treated a total of 142.3 million people for onchocerciasis, representing 58.1% of global coverage, and that the African region faces the greatest challenge with 99% of the global burden of the disease in this region.

Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo.

BACKGROUND: Angumu health zone in Ituri, Democratic Republic of Congo, is a highly malaria-endemic area with an overburdened health system and hosting internally displaced persons (IDP). The World Health Organization recommends mass drug administration (MDA) for malaria in complex emergencies. Therefore, three MDA rounds were implemented by Ministry of Public Health and Médecins sans Frontières from September 2020 to January 2021 in four health areas selected for epidemiological (high malaria incidence) and logistic reasons. Reported mortality and morbidity were compared in locations where MDA has been performed and locations where it has not. METHODS: A non-randomized controlled population-based retrospective mortality survey was conducted in March 2021. Two-stage cluster sampling was used in villages; all IDP sites were surveyed with systematic random sampling. The main (mortality rates) and secondary (morbidity) outcomes were estimated and compared between locations where MDA had been conducted and where it had not, using mixed Poisson and binomial regression models respectively. RESULTS: Data was collected for 2554 households and 15470 individuals, of whom 721 died in the 18-month recall period. The under-five mortality rate (U5MR) decreased in the locations where MDA had been implemented from 2.32 [1.48-3.16] "before" the MDA to 1.10 [0.5-1.71] deaths/10,000 children under 5 years/day "after", whereas it remained stable from 2.74 [2.08-3.40] to 2.67 [1.84-3.50] deaths/10,000 children/day in the same time periods in locations where MDA had not been implemented. The U5MR and malaria-specific mortality was significantly higher in non-MDA locations after MDA was implemented (aRR = 2.17 [1.36-3.49] and 2.60 [1.56-4.33], respectively, for all-cause and malaria-specific mortality among children < 5 years). Morbidity (all age and < 5 years, all cause or malaria-specific) appeared lower in MDA locations 2.5 months after last round: reported malaria-specific morbidity was 14.7% [11-18] and 25.0% [19-31] in villages and IDP sites where MDA had been implemented, while it was 30.4% [27-33] and 49.3% [45-54] in villages and IDP sites with no MDA. CONCLUSIONS: Despite traditional limitations associated with non-randomized controlled retrospective surveys, the documented sharp decrease of under-5 mortality and morbidity shows that MDA has the potential to become an important malaria-control tool in emergency settings. Based on these results, new MDA rounds, along with indoor residual spraying campaigns, have been planned in the health zone in 2022. A set of surveys will be conducted before, during and after these rounds to confirm the effect observed in 2021 and assess its duration.

A Post-Lockdown Assessment of Albendazole Treatment Coverage in Mass Drug Administration Campaigns Implemented Before and During COVID-19 Pandemic in Ekiti, Southwest Nigeria.

Objective: This study assessed the coverage of albendazole (ALB) in mass drug administration (MDA) programs implemented before (2019) and during the (2020 and 2021) COVID-19 pandemic in Ekiti State, Nigeria. Methods: Standardized questionnaires were administered to 1,127 children across three peri-urban communities to ascertain if they received and swallowed ALB across the years. Reasons, why ALB was not received, were documented and analyzed in SPSS. 20.0. Results: In 2019, the medicine reach was between 42.2%-57.8%, however, during the pandemic, the reach significantly reduced to 12.3%-18.6%, and increased to 28.5%-35.2% in 2021 (p < 0.000). About 19.6%-27.2% of the participants have missed 1 MDA, while 26.9%-37.8% and 22.4%-32.8% have missed 2 and 3 MDAs, respectively. The majority who did not receive ALB (60.8%-75%) claimed drug distributors never came, while about 14.9%-20.3% mentioned they did not hear about MDA. However, individual compliance towards swallowing was above 94% across the study years (p < 0.00). Conclusion: These results highlight the need to explore the perceptions of those who have consistently missed MDAs, and also understand the health-system-related issues including those imposed by the pandemic affecting MDA.

Coverage and compliance of mass drug administration in lymphatic filariasis amidst the COVID-19 pandemic: A community based epidemiological study.

Background: Despite the target of elimination of lymphatic filariasis by 2015, a few districts of West Bengal including Bankura district failed to achieve it. Under-coverage and unsupervised consumption of medicines during mass drug administration (MDA) campaign were implicated for the failure. Thereby, directly observed therapy (DOT) and mop up by repeated home visits for MDA were adopted. Objective: The objective of this study is to assess the coverage of anti-filarial medicines distribution and rate of consumption as well as to find out the causes of nonconsumption. Materials and Methods: A cross-sectional survey was conducted in three sub-centers each of three blocks and three wards of Bankura municipality of Bankura district, WB, India, selected through the stratified random sampling method. Information was collected interviewing inhabitants of the house hold selected through the systematic random sampling technique. Results: Overall, appropriate medicine distribution was 82.9% with 95.3% of correct consumption of both medicines under supervision. 91.87% of the respondents were aware about Lymphatic filariasis (LF) of which 89.95% reported swelling of leg/foot/hand, 9.57% as pain, 6.22% fever, and 1.44% reported swelling of testis as symptoms of LF. Altogether 10.6% individual, who consumed any medicine (527), reported AEs, out of that 66.1%, 19.6%, and 14.3% complained of dizziness/headache, nausea/vomiting, and drowsiness, respectively, and 28.6% of them sought consultation with health workers. Conclusion: Substantial supervised consumption in the form DOT in this round too leads to the fact that the effective coverage of MDA has reached the target. It seemed that some segment of the beneficiary is remaining as persistent noncomplaints. Mass mobilization for motivating this persistent defaulter section is the need of the hour.

Les misérables: a Parallel Between Antimicrobial Resistance and COVID-19 in Underdeveloped and Developing Countries.

Purpose of Review: The COVID-19 pandemic has been responsible for more than 6.3 million deaths worldwide. During the pandemic, the indiscriminate use of antibiotics has increased, contributing to the spread of multidrug-resistant bacteria. In this review, we aim to determine the spread and impact of antibiotic treatments in patients with COVID-19, focusing on underdeveloped and developing countries. Recent Findings: Meta-analysis revealed that bacterial co-infections and secondary infections are relatively rare in COVID-19 patients, corresponding to less than 20% of hospitalized patients. Even so, most of these patients have received antibiotic treatments. Summary: This review discusses how the COVID-19 pandemic could increase the emergence of multidrug-resistant strains to currently available antibiotics. Initially, we discussed the spread and impact of multidrug resistance of ESKAPE pathogens associated with nosocomial infections and analyzed their risk of secondary infections in patients with COVID-19. Then we highlight three factors related to the spread of resistant bacteria during the current pandemic: overprescription of antibiotics followed by self-medication. Finally, we discussed the lack of availability of diagnostic tests to discriminate the etiologic agent of a disease. All these factors lead to inappropriate use of antibiotics and, therefore, to an increase in the prevalence of resistance, which can have devastating consequences shortly. The data compiled in this study underscore the importance of epidemiological surveillance of hospital isolates to provide new strategies for preventing and controlling infections caused by multidrug-resistant bacteria. In addition, the bibliographic research also highlights the need for an improvement in antibiotic prescribing in the health system.

Progress in eliminating onchocerciasis in the WHO region of the Americas: disruption of ivermectin mass drug administration in the Yanomami focus area due to the COVID-19 pandemic

This article describes how the COVID-19 pandemic significantly reduced provision of treatment in the Yanomami focus area (YFA) in 2020, especially in the Bolivarian Republic of Venezuela. The distribution of ivermectin for mass treatment (MDA) to prevent onchocerciasis was affected worldwide by the COVID-19 pandemic in 2020, as were MDA programs for other neglected tropical diseases (NTDs). On 1 April 2020, WHO recommended that mass treatment campaigns, active case-finding, and population-based surveys for NTDs be postponed until further notice to reduce the risk of COVID-19 transmission associated with large-scale community health interventions. The Carter Center, which provides major funding to MDA in the Bolivarian Republic of Venezuela, temporarily halted its activities in 2020 due to an administrative problem and, once the COVID-19 pandemic had taken hold, in order to adhere to WHO recommendations, its own policies, and the policies of other donor organizations. Ivermectin treatment continued to be offered in Brazil, supported by the government, with essential health services such as vaccination and malaria control. On 27 July 2021, WHO released new interim guidance for NTD programs. This included a risk-benefit analysis to figure out if activities could be resumed safely and detailed standards for reducing risk with all known precautions (such as wearing masks, socialdistance, hand sanitizing and/or handwashing, limiting live meetings and group size). The program in the Bolivarian Republic of Venezuela followed these instructions and made a plan to get back to work safely, which was what WHO wanted.

Global programme to eliminate lymphatic filariasis: progress report, 2020

This article describes the Global Programme to Eliminate Lymphatic Filariasis (GPELF), which aims to stop the spread of infection by mass drug administration (MDA) and ease the suffering of patients through morbidity management and disability prevention (MMDP). In 2020, LFMDA treated 21.6 million 2-4-year-olds and 98.5 million 5-14-year-olds. Given the impact of LF MDA on soil-transmitted helminth (STH) infections, WHO advises adding STH infection assessment into transmission assessment surveys (TAS) to increase NTD intervention efficiency. Once preTAS and TAS standards are met, an IU's population no longer needs MDA. 692 million people didn't need MDA. This 49% decline in LF cases is a huge step toward meeting the Sustainable Development Goal (SDG). Thirteen countries and 171 IUs performed TASs in 2020. A total of 4316 TAS have been conducted in EUs, which are greater or smaller than IUs. 100% of EUs passed a TAS, according to 2020 reports (the proportion of children who tested positive for LF infection was below the threshold for considering transmission unsustainable). Several 2020 TAS were postponed because to COVID-19 pandemic restrictions. Despite a global epidemic, GPELF achieved progress in 2020, demonstrating the resolve and inventiveness of national LFprogrammes to end this illness.

Elimination of human onchocerciasis: progress report, 2020

In this report, four countries (Colombia, Ecuador, Guatemala, and Mexico) have completed the WHO-recommended process for verification of the interruption of human onchocerciasis transmission, and many others have ceased mass drug administration (MDA), completed post-treatment surveillance (PTS), or both in at least one transmission area on their territory. Interruption of transmission enabled governments to preserve the benefits acquired over many years of effective MDA with Ivermectin and to discontinue MDA permanently, thereby protecting populations living in endemic areas from morbidity and infection. The eradication of human onchocerciasis would contribute significantly to achieving Sustainable Development Goal (SDG) 3.3, which calls for the eradication of neglected tropical diseases (NTDs) by 2030. All countries endemic for onchocerciasis have reported instances of COVID-19. The impact of the pandemic on NTD interventions has been discussed elsewhere. In many countries, scheduled MDA rounds were postponed due to efforts to prevent the spread of SARS-CoV-2 in onchocerciasis-endemic nations. In 2020, 26.9% fewer patients were treated for onchocerciasis than in 2019. MDA was implemented in fewer nations and implementation units in 2020 (1096 versus 1538 in 2019), resulting in a 27.7% decrease in global geographical coverage. The WHO Global Health Observatory provides access to data submitted by governments.

Mass drug administration for lymphatic filariasis elimination amidst COVID-19 pandemic in Odisha, India: A step towards achieving SDG-3.

Sustainable Development Goal-3 (SDG) aims to eliminate lymphatic filariasis by 2030 through >65% coverage and compliance of mass drug administration (MDA), the preventive chemotherapy strategy of delivering anthelminthic drugs. However, the ongoing COVID-19 pandemic has disrupted such programmes, yet MDA was administered during February 2021 in Odisha, India. We aimed to assess the coverage and compliance of the present round of MDA amidst the pandemic and explore factors for non-compliance in Cuttack district of Odisha, a filariasis endemic area. Community-based participants enrolled through multistage stratified sampling were administered a semi-structured questionnaire following COVID-19 protocols. The coverage of MDA was 93.2% whereas consumption was 73.7%. Participants reported that healthcare workers were motivated and satisfactorily explained the benefits of MDA but still fear of side-effects was the major cause of non-compliance. Nonetheless, this recent round of MDA was effective, despite challenges posed by the ongoing pandemic.

Development of New Strategies for Malaria Chemoprophylaxis: From Monoclonal Antibodies to Long-Acting Injectable Drugs.

Drug discovery for malaria has traditionally focused on orally available drugs that kill the abundant, parasitic blood stage. Recently, there has also been an interest in injectable medicines, in the form of monoclonal antibodies (mAbs) with long-lasting plasma half-lives or long-lasting depot formulations of small molecules. These could act as prophylactic drugs, targeting the sporozoites and other earlier parasitic stages in the liver, when the parasites are less numerous, or as another intervention strategy targeting the formation of infectious gametocytes. Generally speaking, the development of mAbs is less risky (costly) than small-molecule drugs, and they have an excellent safety profile with few or no off-target effects. Therefore, populations who are the most vulnerable to malaria, i.e., pregnant women and young children would have access to such new treatments much faster than is presently the case for new antimalarials. An analysis of mAbs that were successfully developed for oncology illustrates some of the feasibility aspects, and their potential as affordable drugs in low- and middle-income countries.

Community-based trial assessing the impact of annual versus semiannual mass drug administration with ivermectin plus albendazole and praziquantel on helminth infections in northwestern Liberia.

We assessed the impact of three annual vs five semiannual rounds of mass drug administration (MDA) with ivermectin plus albendazole followed by praziquantel for the control or elimination of lymphatic filariasis (LF), onchocerciasis, soil-transmitted helminth (STH) infections and schistosomiasis in Lofa County, Liberia. The study started in 2012 and was interrupted in 2014 during the Ebola virus outbreak. Repeated cross-sectional surveys were conducted in individuals 5 years and older to measure infection markers. Wuchereria bancrofti antigenemia prevalences decreased from 12.5 to 1.2% (90% reduction) and from 13.6 to 4.2% (69% reduction) one year after three rounds of annual or five rounds of semiannual MDA, respectively. Mixed effects logistic regression models showed decreases in odds of antigenemia positivity were 91 and 74% at that time in the annual and semiannual treatment zones, respectively (p < 0.001). Semiannual MDA was slightly more effective for reducing Onchocerca volvulus microfiladermia prevalence and at follow-up 3 were 74% (from 14.4 to 3.7%) and 83% (from 23.6 to 4.5%) in the annual and semiannual treatment zones, respectively. Both treatment schedules had similar beneficial effects on hookworm prevalence. Thus, annual and semiannual MDA with ivermectin and albendazole had similar beneficial impacts on LF, onchocerciasis, and STH in this setting. In contrast, MDA with praziquantel had little impact on hyperendemic Schistosoma mansoni in the study area. Results from a long-term follow-up survey showed that improvements in infection parameters were sustained by routine annual MDA provided by the Liberian Ministry of Health after our study endpoint.

Community Drug Distributor Knowledge, Attitudes, and Motivation Surrounding Mass Drug Administration for Soil-Transmitted Helminths in India.

Background: DeWorm3 is an ongoing multi-country community-based cluster-randomized trial assessing the feasibility of interrupting transmission of soil-transmitted helminths (STH) with community-wide mass drug administration (cMDA). In Tamil Nadu, India, community drug distributors (CDDs) worked with DeWorm3 field staff to counsel community members and deliver door-to-door deworming treatment. As CDDs were likely to influence successful delivery of cMDA, we describe drivers of CDDs' knowledge, attitudes, and motivation toward delivery of cMDA. Methods: In this convergent mixed-methods study, a questionnaire on STH and cMDA was administered to 104 CDDs and 17 focus group discussions (FGDs) were conducted. Key outcomes in the quantitative and qualitative analyses included CDDs' knowledge about STH and cMDA and attitudes toward cMDA for STH. Univariate and multivariable logistic regression analyses were performed to determine the strength of associations between independent and outcome variables. The FGDs were analyzed using a priori thematic coding. Results: CDDs who completed at least secondary school education [adjusted odds ratio (aOR): 2.71, 95% CI: 1.16-6.33] and had prior experience in health programs (aOR: 2.72, 95% CI: 1.15-6.44) were more knowledgeable about STH and cMDA. CDDs belonging to the scheduled castes and scheduled tribes (aOR: 2.37, 95% CI: 1.04-5.39), and to households engaged in a skilled occupation (aOR: 2.77, 95% CI: 1.21-6.34) had a more positive attitude toward cMDA for STH. The FGDs showed that while there were myths and misconceptions about STH, many CDDs believed that the adult population in their communities were infected with STH, and that a door-to-door drug delivery strategy would be optimal to reach adults. Conclusions: Educational and socioeconomic backgrounds and experience in health programs should be considered while designing CDD trainings. Along with cMDA delivery for STH, as CDD do share community myths and misconceptions around STH, they should be proactively addressed during the CDD training to strengthen competency in counseling.

Identity change, uncertainty and mistrust in relation to fear and risk of COVID-19. (Special Issue: COVID-19 one year on.)

The COVID-19 pandemic produced threats not only to physical and psychological health but also to the very fabric of family, work and social life. Individuals differ markedly in their ability to cope with such threats. Drawing on Identity Process Theory, our study examines identity processes that shape emotional and attitudinal responses to COVID-19. Survey data were collected from 251 adults in the UK during July 2020. Identity resilience, trust in science and scientists, fear of COVID-19 and perceived own risk of infection were measured. Respondents then watched a video clip designed to focus their thinking further upon the disease. Immediately after, levels of feeling afraid, uncertainty about self-protection, mistrust of anyone offering COVID-19 advice, and perceptions of identity change were indexed. A structural equation model of the relationship between these variables was tested and proved a good fit for the data. Identity resilience is negatively related to fear of COVID-19, which in turn is positively related to perceived own risk of COVID-19. Lower identity resilience is associated with greater uncertainty and feeling more afraid. Greater identity change is associated with higher mistrust, uncertainty and feeling more afraid. Trust in science and scientists correlates positively with perceived own risk of COVID-19 and negatively with mistrust of those offering advice on preventive behaviour. This study shows the usefulness of the identity resilience concept in modelling responses to health hazards. It also illustrates that focusing, even for a short time, on the characteristics of such a hazard can elicit perceived identity changes. Arousing fear is unlikely to initiate self-protection in those who are already fearful or who have less identity resilience. Fostering greater general trust in science and scientists, though difficult, will be valuable, particularly in encouraging public acceptance of mass vaccination against the virus when misinformation and conspiracy theories about it abound.

Lessons from the field: delivering trachoma mass drug administration safely in a COVID-19 context.

The first coronavirus disease 2019 (COVID-19) interim guidance released by the World Health Organization recommended suspension of non-urgent community health interventions, including mass drug administration (MDA) for neglected tropical diseases. However, with no end in sight for the COVID-19 pandemic, it was crucial to find ways to restart MDA while testing measures to reduce the risk of COVID-19 transmission between health workers, volunteers and communities. Consequently, guidelines were developed for delivering MDA safely in a COVID-19 context and the training and implementation were assessed through an observation checklist. The study also gathered data on the feasibility of using the MDA platform to disseminate COVID-19 health education. The results suggest that delivering MDA safely in a COVID-19 context is possible but revealed significant challenges in using the MDA platform for COVID-19 education.

A COVID-19 prophylaxis? Lower incidence associated with prophylactic administration of ivermectin.

As COVID-19 (coronavirus disease 2019) continues to rapidly spread throughout the world, the incidence varies greatly among different countries. These differences raise the question whether nations with a lower incidence share any medical commonalities that could be used not only to explain that lower incidence but also to provide guidance for potential treatments elsewhere. Such a treatment would be particularly valuable if it could be used as a prophylactic against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) transmission, thereby effectively slowing the spread of the disease while we await the wide availability of safe and effective vaccines. Here, we show that countries with routine mass drug administration of prophylactic chemotherapy including ivermectin have a significantly lower incidence of COVID-19. Prophylactic use of ivermectin against parasitic infections is most common in Africa and we hence show that the reported correlation is highly significant both when compared among African nations as well as in a worldwide context. We surmise that this may be connected to ivermectin's ability to inhibit SARS-CoV-2 replication, which likely leads to lower infection rates. However, other pathways must exist to explain the persistence of such an inhibitory effect after serum levels of ivermectin have declined. It is suggested that ivermectin be evaluated for potential off-label prophylactic use in certain cases to help bridge the time until a safe and effective vaccine becomes available.

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

BACKGROUND: The 2030 goal for schistosomiasis is elimination as a public health problem (EPHP), with mass drug administration (MDA) of praziquantel to school-age children (SAC) as a central pillar of the strategy. However, due to coronavirus disease 2019, many mass treatment campaigns for schistosomiasis have been halted, with uncertain implications for the programmes. METHODS: We use mathematical modelling to explore how postponement of MDA and various mitigation strategies affect achievement of the EPHP goal for Schistosoma mansoni and S. haematobium. RESULTS: For both S. mansoni and S. haematobium in moderate- and some high-prevalence settings, the disruption may delay the goal by up to 2 y. 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 the 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.

What does the COVID-19 pandemic mean for the next decade of onchocerciasis control and elimination?

BACKGROUND: Mass drug administration (MDA) of ivermectin for onchocerciasis has been disrupted by the coronavirus disease 2019 (COVID-19) pandemic. Mathematical modelling can help predict how missed/delayed MDA will affect short-term epidemiological trends and elimination prospects by 2030. METHODS: Two onchocerciasis transmission models (EPIONCHO-IBM and ONCHOSIM) are used to simulate microfilarial prevalence trends, elimination probabilities and age profiles of Onchocerca volvulus microfilarial prevalence and intensity for different treatment histories and transmission settings, assuming no interruption, a 1-y (2020) interruption or a 2-y (2020-2021) interruption. Biannual MDA or increased coverage upon MDA resumption are investigated as remedial strategies. RESULTS: Programmes with shorter MDA histories and settings with high pre-intervention endemicity will be the most affected. Biannual MDA is more effective than increasing coverage for mitigating COVID-19's impact on MDA. Programmes that had already switched to biannual MDA should be minimally affected. In high-transmission settings with short treatment history, a 2-y interruption could lead to increased microfilarial load in children (EPIONCHO-IBM) and adults (ONCHOSIM). CONCLUSIONS: Programmes with shorter (annual MDA) treatment histories should be prioritised for remedial biannual MDA. Increases in microfilarial load could have short- and long-term morbidity and mortality repercussions. These results can guide decision-making to mitigate the impact of COVID-19 on onchocerciasis elimination.

Implications of the COVID-19 pandemic in eliminating trachoma as a public health problem.

BACKGROUND: Progress towards elimination of trachoma as a public health problem has been substantial, but the coronavirus disease 2019 (COVID-19) pandemic has disrupted community-based control efforts. METHODS: We use a susceptible-infected model to estimate the impact of delayed distribution of azithromycin treatment on the prevalence of active trachoma. RESULTS: We identify three distinct scenarios for geographic districts depending on whether the basic reproduction number and the treatment-associated reproduction number are above or below a value of 1. We find that when the basic reproduction number is <1, no significant delays in disease control will be caused. However, when the basic reproduction number is >1, significant delays can occur. In most districts, 1 y of COVID-related delay can be mitigated by a single extra round of mass drug administration. However, supercritical districts require a new paradigm of infection control because the current strategies will not eliminate disease. CONCLUSIONS: If the pandemic can motivate judicious, community-specific implementation of control strategies, global elimination of trachoma as a public health problem could be accelerated.