10 July 2014

Preschoolers in Brazil

Dr. Otávio Pieri is a researcher at the Oswaldo Cruz Foundation, with a research focus on schistosomiasis. He explains what is happening in Brazil, and the importance of ensuring the right treatment for the preschool age group.

What progress has been made in Brazil up to this point with schistosomiasis?

Schistosomiasis is a very longstanding cause of serious disease in Brazil, and attempts to control it have been extensive. Those attempts have included not only medication but also measures such as snail control using molluscicides. Nothing to date has been entirely successful and, unfortunately, we still have a major problem: around 400 people die in Brazil every year as a result of infection. This is a disease that really should have been eliminated by now, but it is still present in endemic areas and we estimate that something like 2 million Brazilians are currently entitled to treatment. This has become a ‘silent’ disease – we don’t really see the pictures of children with large bellies any more – but schistosomiasis is still causing very severe or even lethal cases, with long-term implications for some sufferers including liver and spleen damage.

What is being done about it now?

Brazil is the most seriously affected of all countries in the Americas, and the Brazilian government has now adopted the WHO resolution on elimination of schistosomiasis. It is committed both internally and externally to ending public health problems associated with the parasite by the year 2020, and has developed a plan of action designed specifically to meet that commitment – the first time this has happened. There is now an explicit government agenda to develop and register a pediatric formulation for praziquantel, something that has been our ambition for over a decade now.

Why is a pediatric formulation important?

Older people can often survive with the parasite in their bodies, but it is very detrimental to younger children because of problems with immunity. We usually treat children at school age, but the preschool group (4-5 years) often needs praziquantel treatment, not least because their behavior puts them at high risk – for example, re-infection is common even after treatment, because of repeated contact with contaminated water. Unfortunately, the size of the current praziquantel pill, and its taste, mean that preschoolers find the treatment very distressing. We urgently need a formulation that facilitates treatment, and stimulates preschoolers to want to take it. This would solve a big issue in the field. We think that around 5% of the 2 million people entitled to treatment are preschoolers. So maybe 100,000 preschoolers in Brazil are in need of a suitable praziquantel treatment.

How will you get treatment to this group?

The Brazilian government has just passed a bill aiming to put every child in the 4-5 years age group into crèches by 2016. This has made the group a target not only for education but also for government-sponsored health measures. It means we have a great opportunity, depending only on the availability of a suitable formulation.

What is the Consortium’s role?

The goal of the Pediatric Praziquantel Consortium is to make a distribution-friendly praziquantel formulation locally, with a long bench life. The Consortium has made important progress on developing a new pediatric formulation. I am confident that it can deliver the drug we need, for use not only in Brazil but in other areas such as Africa, provided the right funding is in place.

What do you see happening next?

My personal view is that it is indeed achievable to eliminate schistosomiasis as a public health problem in Brazil by 2020. This doesn’t mean total eradication of schistosomes, but rather constant monitoring. One such strategy would be to use stool surveys to find and treat infected people, so that we can achieve a very low level of infection. A pediatric formulation will be an important part of this strategy.