Journal Article

The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda

Akello, Mirriam, Abayo, Elson, Nakawungu, Prossy Kabuubi, Kaweesa, James, Tumusiime, Josephine, Sanya, Richard E., Oduru, Gloria, van Ree, Ronald, Kakooza, Fred Muwonge, Nampijja, Margaret, Nash, Stephen, Kabagenyi, Joyce, Mpairwe, Harriet, Kizindo, Robert, Spaans, Remy Hoek, Verweij, Jaco, Webb, Emily L., Elliott, Alison M., Niwagaba, Emmanuel, Zziwa, Christopher, Tukahebwa, Edridah, Nkurunungi, Gyaviira, O’Hara, Geraldine, Nakazibwe, Esther, Lubyayi, Lawrence

2019

Overview

Abstract Background The prevalence of allergy-related diseases is increasing in low-income countries. Parasitic helminths, common in these settings, may be protective. We hypothesized that intensive, community-wide, anthelminthic mass drug administration (MDA) would increase allergy-related diseases, while reducing helminth-related morbidity. Methods In an open, cluster-randomized trial (ISRCTN47196031), we randomized 26 high-schistosomiasis-transmission fishing villages in Lake Victoria, Uganda, in a 1:1 ratio to receive community-wide intensive (quarterly single-dose praziquantel plus albendazole daily for 3 days) or standard (annual praziquantel plus 6 monthly single-dose albendazole) MDA. Primary outcomes were recent wheezing, skin prick test positivity (SPT), and allergen-specific immunoglobulin E (asIgE) after 3 years of intervention. Secondary outcomes included helminths, haemoglobin, and hepatosplenomegaly. Results The outcome survey comprised 3350 individuals. Intensive MDA had no effect on wheezing (risk ratio [RR] 1.11, 95% confidence interval [CI] 0.64–1.93), SPT (RR 1.10, 95% CI 0.85–1.42), or asIgE (RR 0.96, 95% CI 0.82–1.12). Intensive MDA reduced Schistosoma mansoni infection intensity: the prevalence from Kato Katz examinations of single stool samples from each patient was 23% versus 39% (RR 0.70, 95% CI 0.55–0.88), but the urine circulating cathodic antigen test remained positive in 85% participants in both trial arms. Hookworm prevalence was 8% versus 11% (RR 0.55, 95% CI 0.31–1.00). There were no differences in anemia or hepatospenomegaly between trial arms. Conclusions Despite reductions in S. mansoni intensity and hookworm prevalence, intensive MDA had no effect on atopy, allergy-related diseases, or helminth-related pathology. This could be due to sustained low-intensity infections; thus, a causal link between helminths and allergy outcomes cannot be discounted. Intensive community-based MDA has a limited impact in high-schistosomiasis-transmission fishing communities, in the absence of other interventions. Clinical Trials Registration ISRCTN47196031. In a cluster-randomized trial of intensive versus standard anthelminthic treatment, intensive treatment reduced Schistosoma mansoni intensity and hookworm prevalence, but did not effect atopy, allergy-related diseases, or helminth-related pathology. Additional interventions are required to reduce transmission in schistosomiasis hot spots.

• Publisher: Oxford University Press
• Subject: Adolescent / Adult / Albendazole - therapeutic use / and Commentaries / Animals / Anthelmintics - administration & dosage / Anthelmintics - therapeutic use / ARTICLES AND COMMENTARIES / Child / Child, Preschool / Family Characteristics / Female / Helminthiasis - drug therapy / Helminthiasis - epidemiology / Hookworm Infections - drug therapy / Hookworm Infections - epidemiology / Humans / Hypersensitivity - epidemiology / Hypersensitivity - etiology / Infant / Infant, Newborn / Lakes / Male / Mass Drug Administration / Middle Aged / Morbidity / Prevalence / Schistosomiasis - drug therapy / Schistosomiasis - epidemiology / Treatment Outcome / Uganda - epidemiology / Young Adult