High prevalence of soil-transmitted helminths in Southern Belize-highlighting opportunity for control interventions.

OBJECTIVE: To assess prevalence and intensity of soil-transmitted helminths (STH) in school age children of two southern districts as baseline information prior to implement a deworming program against intestinal parasites as part of an integrated country development plan. METHODS: Children randomly selected from urban and rural schools in Southern Belize provided one stool sample each, analysed by the Kato-Katz method to assess prevalence and intensity of STH infections. Epi Info software was used for data analysis; Chi-square test and Fischer exact test were applied to compare group proportions; P<0.05 was considered of statistical significance; descriptive statistics were expressed as percentages. RESULTS: A total of 500 children from 10 schools participated in the study from May to December 2005. Prevalence of STH ranged between 40% and 82% among schools, with a median of 59.2%; the majority of light intensity, and with 2.2% high intensity infection. Trichuris and Ascaris infections presented similar frequency in children aged from 6 to 9 years old; hookworm infections tended to be more frequent in the older group 10 to 12 years old. Statistical significances (P≤0.01) were found in children in rural schools infected with any species of STH, in moderate Trichuris infections, in hookworm infections in rural areas with strong Mayan presence and in Ascaris infections in children of Mayan origin. CONCLUSIONS: High prevalence of STH in Southern Belize provided sound ground for implementing an integrated deworming control program.

Administration of triclabendazole is safe and effective in controlling fascioliasis in an endemic community of the Bolivian Altiplano.

BACKGROUND: The Bolivian northern Altiplano is characterized by a high prevalence of Fasciola hepatica infection. In order to assess the feasibility, safety and efficacy of large-scale administration of triclabendazole as an appropriate public health measure to control morbidity associated with fascioliasis, a pilot intervention was implemented in 2008. MATERIALS AND METHODS: Schoolchildren from an endemic community were screened for fascioliasis and treated with a single administration of triclabendazole (10 mg/kg). Interviews to assess the occurrence of adverse events were conducted on treatment day, one week later, and one month after treatment. Further parasitological screenings were performed three months after treatment and again two months later (following a further treatment) in order to evaluate the efficacy of the intervention. RESULTS: Ninety infected children were administered triclabendazole. Adverse events were infrequent and mild. No serious adverse events were reported. Observed cure rates were 77.8% after one treatment and 97.8% after two treatments, while egg reduction rates ranged between 74% and 90.3% after one treatment, and between 84.2% and 99.9% after two treatments. The proportion of high-intensity infections (≥ 400 epg) decreased from 7.8% to 1.1% after one treatment and to 0% after two treatments. CONCLUSION: Administration of triclabendazole is a feasible, safe and efficacious public health intervention in an endemic community in the Bolivian Altiplano, suggesting that preventive chemotherapy can be applied to control of fascioliasis. Further investigations are needed to define the most appropriate frequency of treatment.

The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination.

The neglected tropical diseases (NTDs) represent some of the most common infections of the poorest people living in the Latin American and Caribbean region (LAC). Because they primarily afflict the disenfranchised poor as well as selected indigenous populations and people of African descent, the NTDs in LAC are largely forgotten diseases even though their collective disease burden may exceed better known conditions such as of HIV/AIDS, tuberculosis, or malaria. Based on their prevalence and healthy life years lost from disability, hookworm infection, other soil-transmitted helminth infections, and Chagas disease are the most important NTDs in LAC, followed by dengue, schistosomiasis, leishmaniasis, trachoma, leprosy, and lymphatic filariasis. On the other hand, for some important NTDs, such as leptospirosis and cysticercosis, complete disease burden estimates are not available. The NTDs in LAC geographically concentrate in 11 different sub-regions, each with a distinctive human and environmental ecology. In the coming years, schistosomiasis could be eliminated in the Caribbean and transmission of lymphatic filariasis and onchocerciasis could be eliminated in Latin America. However, the highest disease burden NTDs, such as Chagas disease, soil-transmitted helminth infections, and hookworm and schistosomiasis co-infections, may first require scale-up of existing resources or the development of new control tools in order to achieve control or elimination. Ultimately, the roadmap for the control and elimination of the more widespread NTDs will require an inter-sectoral approach that bridges public health, social services, and environmental interventions.