Obstacles in the management of soil transmitted helminthes: development of a comprehensive platform for the evaluation of new strategies.

KROLEWIECKI A, SOCÍAS E, ECHAZÚ A, CAJAL P, JUAREZ M, VILLALPANDO C, DÁVILA M, ABRIL M, ARIAS L, OLMEDO E TAPIA L, CIMINO R, GIL J, LAMMIE P, GOLD S.

Congreso; 7th European Congress on Tropical Medicine and International Health; 2011

Federation of European Societies for Tropical Medicine and International Health

Among the Neglected Tropical Diseases, soil transmitted helminthes (STH) are a group of diseases that disproportionately affect impoverished and pediatric populations with negative impact on growth, development and nutritional status. Currently, Mass Drug Administration (MDA) of antihelminthics is recommended for communities with STH prevalence ≥20%. In an ongoing pilot intervention in a hyperendemic area in northwestern Argentina, STH prevalence is being evaluated  through: 1) a comprehensive parasitologic stool examination in conjunction with  a newly developed recombinant antigen based ELISA (NIE-ELISA) for Strongyloides stercoralis (Stst), and 2) the administration of combination therapy with albendazole-ivermectin with the goal of establishing a strategy for the management of affected communities in the context of high Stst prevalence levels. In order to implement current WHO recommendations, we have engaged in a project that aims at tackling different aspects of this public health problem using a multidisciplinary approach. Aspects being assessed include the evaluation of strategies to define the importance of Stst and its morbidity, optimal diagnostics and treatment for this often overlooked STH; pediatric and co-formulations for simplified administration of MDA; and a standardized and validated model for monitoring drug efficacy and effectiveness. This project should help to define the role of the different diagnostic tests in the assessment of prevalence, patient management and drug efficacy, including the emergence of resistance. Inclusion of geographic information system and the description of social variables that characterize each community will also provide valuable information in the management of STH and selection of areas that might benefit from MDA. In summary, this project aims at helping to control STH through the improvements of particular aspects of the already identified fundamental areas of sanitation, deworming and health education.