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Schistosomiasis in children: a major public health problem
Schistosomiasis (also known as bilharzia) is one of the most prevalent parasitic diseases worldwide and a very important one in terms of public health burden and economic impact. It is a poverty-related disease that leads to chronic illness and is classified by the World Health Organization (WHO) as one of 21 neglected tropical diseases (NTDs). Preschool-age children have been left untreated in public health programs due to the lack of a suitable child-friendly treatment.
People become infected with schistosomiasis when they come into contact with fresh water infested with schistosomes – the larval forms (cercariae) of parasitic blood flukes released by freshwater snails. The microscopic worms live in veins and drain the urinary tract and intestines. Most of the eggs they lay are trapped in tissue and the body’s reaction to them can cause massive damage.
Impacts
The threat posed by schistosomiasis is substantial. The WHO estimates that at least 251.4 million people required treatment in 2021, of which more than 90% live in Africa2. The disease affects a large proportion of children under 14 years of age, including at least 50 million preschool-age children3. In this very young age group, the prevalence of infection may exceed 60% in some endemic regions4.
Left untreated, schistosomiasis can lead to anemia(4,5), stunted growth(6,7), reduced learning ability as a result of impaired cognition(8-10), and chronic inflammation of the organs. The latter can be fatal in the most serious cases. If contracted at an early age, all of these impacts can have long-lasting ramifications and lead to major financial losses to infected individuals and to various public health programs.
Critical treatment gap
Preschool-age children have a high risk of infection with schistosomiasis, and there is a pressing need to treat them. They play a role in local disease transmission and an active infection acquired at such an early age might worsen the severity of the disease.
An estimated 50 million preschool-age children are at risk of schistosomiasis. It's essential to treat this high-risk group as an early childhood development intervention against accumulated morbidities.
The need for a child-friendly treatment
The existing drug of choice for the treatment of schistosomiasis is praziquantel, developed in the 1970s. A WHO-recommended global strategy to control schistosomiasis already exists: preventive chemotherapy involves yearly administration of praziquantel to entire populations at risk. Tablets (usually 600 mg) are given as a single oral dose, but the current formulation is only suitable for adults and school-aged children. Younger children usually cannot swallow the existing tablets because of their large size and bitter taste. More importantly, an appropriate treatment with praziquantel for these children using the optimal dosing, and that encourages compliance, does not yet exist.
Our contribution
The Pediatric Praziquantel Consortium has developed a new treatment that is suitable for preschool-age children, 3 months to 6 years of age. The new treatment is a small (150 mg), dispersible or orodispersible tablet with an acceptable taste. It also withstands the challenges presented by a tropical climate.
Find out more about our new pediatric treatment, our development & registration program, and our access strategy. Visit our timeline to find out where we stand in our journey to fight schistosomiasis in preschool-age children.
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2World Health Organization, 1 February 2023. Schistosomiasis Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/schistosomiasis
3Trends in Parasitology (Volume 36, Issue 7, July 2020)
4WHO Report of a meeting to review the results of studies on the treatment of schistosomiasis in preschool-age children
5Butler SE, Muok EM, Montgomery P, et al. Mechanism of Anemia in Schistosoma mansoni–Infected School Children in Western Kenya. Am J Trop Med Hyg. 2021; 87(5):862-7.
6Osakunor DNM, Mduluza T, Midzi N, et al. Global Health Dynamics of paediatric urogenital schistosome infection, morbidity and treatment: a longitudinal study among preschool children in Zimbabwe. BMJ Glob Health. 2018; 3:e000661.
7Raj E, Calvo-Urbano B, Heffernan, et al. Systematic review to evaluate a potential association between helminth infection and physical stunting in children. Parasites & Vetors. 2022; 15:135.
8Ezemama AE, Bustinduy AL, Nkwata AK, et al. Cognitive deficits and educational loss in children with schistosome infection - A systematic review and meta-analysis. PLoS Negl Trop Dis. 2018; 12(1): e0005524.
9Jukes M. Heavy schistosomiasis associated with poor short-term memory and slower reaction times in Tanzanian schoolchildren. Trop Med Int Health. 2002; 7(2):104-17.
10Mutapi F, Pfavayi L, Oskaunor D, et al. Assessing early child development and its association with stunting and schistosome infections in rural Zimbabwean children using Griffith Scales of Childe Development. PLoS Negl Trop Dis. 2021; 15(8):e0009660.