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Elimination of Schistosomiasis: Is it possible and how do we do it?

Elimination of Schistosomiasis: Is it possible and how do we do it?. Mike French. What is elimination?. What is elimination?. What is elimination?. What is elimination?. What is elimination?. Already gone. Rinderpest (2011). Smallpox (1978). On their way. Polio (2020?).

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Elimination of Schistosomiasis: Is it possible and how do we do it?

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  1. Elimination of Schistosomiasis: Is it possible and how do we do it? Mike French

  2. What is elimination?

  3. What is elimination?

  4. What is elimination?

  5. What is elimination?

  6. What is elimination?

  7. Already gone Rinderpest (2011) Smallpox (1978) On their way Polio (2020?) Guinea Worm (2015?)

  8. * In all sentinel sites

  9. What do we need to get there?

  10. Complementary Approaches

  11. Complementary Approaches Water, Sanitation, and Hygiene

  12. Complementary Approaches Water, Sanitation, and Hygiene

  13. Complementary Approaches Water, Sanitation, and Hygiene

  14. Complementary Approaches Water, Sanitation, and Hygiene

  15. Water, Sanitation, and Hygiene (WASH)

  16. Water and sanitation, and schistosomiasis: a systematic review and meta-analysis Jack Grimes*, DrMichael R. Templeton*, Dr Wendy Harrison† *Department of Civil and Environmental Engineering, Imperial College London †Schistosomiasis Control Initiative, School of Public Health, Imperial College London jack.grimes@imperial.ac.uk

  17. WASH Definitions Sanitation Hygiene WAter Image credits: Aubrey Wade/WaterAid/Panos Image credits: UNICEF, UNICEFBANA2011-01020Shafiqul http://www.unicef.bg/en/article/On-Global-Handwashing-Day-UNICEF-says-It-s-not-complicated-but-it-s-crucial/375 Image credits: WSSCC http://www.wsscc.org/resources/resource-photo/toilets-south-africa#3 Jack Grimes, Dr Michael R. Templeton, Dr Wendy Harrison

  18. ‘Safe’ water source associated with significantly less Schistosomainfection Overall Schistosomaand water: OR = 0.53 (95% CI: 0.47, 0.61) Jack Grimes, Dr Michael R. Templeton, Dr Wendy Harrison

  19. ‘Safe’ water source associated with significantly less Schistosomainfection S. haematobiumand water: OR = 0.57 (95% CI: 0.45, 0.71) S. mansoniand water: OR = 0.53 (95% CI: 0.45, 0.63) S. japonicumand water: OR = 0.37 (95% CI: 0.30, 0.46) Jack Grimes, Dr Michael R. Templeton, Dr Wendy Harrison

  20. Sanitation associated with significantly less S. mansoniinfection S. mansoniand sanitation: OR = 0.59 (95% CI: 0.47, 0.73) Jack Grimes, Dr Michael R. Templeton, Dr Wendy Harrison

  21. Sanitation associated with significantly less S. haematobiuminfection S. haematobiumand sanitation: OR = 0.69 (95% CI: 0.57, 0.84) Jack Grimes, Dr Michael R. Templeton, Dr Wendy Harrison

  22. Other Approaches: Snail Control and Behaviour ChangeS. haematobiumelimination in Zanzibar • Elimination of Schistosomiasis on Zanzibar (ZEST trial) – Lynsey Blair • S. haematobium • Randomized Control Trial Three arms: • Arm 1: MDA Alone (Control) • Arm 2: MDA plus Snail Control • Arm 3: MDA plus Behaviour Change • Midpoint of study

  23. Other Approaches: Snail Control, WASH, and Enhanced Treatment S. mansonielimination in Burundi/Rwanda Rwanda Burundi Randomized Control Trial: To be confirmed after schistosomiasis re-assessment 4 arms Arm 1: Control – Standard annual Treatment Arm 2: Enhanced treatment – Twice Yearly treatment Arm 3: Snail Control Arm 4: Water, Sanitation, and Hygiene

  24. S. haematobiumelimination in Niger Following 6 years of sentinel sites monitoring, Niger was classified as an ‘elimination’ ICOSA country Re-Mapping/Impact Surveys to assess local elimination and use focal treatment in areas no longer eligible for treatment Improving case detection at health centres & routine diagnosis Snail surveys. Identifying schistosome hybrids and animal reservoirs Innovative education activities such as mobile cinemas

  25. Vaccines • Meetings convened by GatesFoundation / National Institute of Health Meetings on the potential role of vaccines in elimination • No vaccines currently available • Several candidates in development, including one in Phase III trials, although several years off if at all • Likely to be offer imperfect protection

  26. Using Mathematical Models to Optimise the Use of Vaccines for Schistosomiasis Miss Arminder Deol Dr Michael French Dr Deirdre Hollingsworth Dr James Truscott

  27. Using Mathematical Models to Optimise the Use of Vaccines for Schistosomiasis : 1.  Modelling the impact of an actual/proposed vaccine in development Modelling could give: • Population impact • Cost-effectiveness 2. Using modelling to suggest the required characteristics of a vaccine Modelling could give: • Level of efficacy required • Which section of the life-cycle would be best to target • What proportion of the population to target • Who to target in the population Arminder Deol et al

  28. New Approaches Water, Sanitation, and Hygiene

  29. Extending Current Approaches – Closing the treatment gap

  30. Extending Current Approaches – Closing the treatment gap

  31. Extending Current Approaches – Closing the treatment gap How do we close the treatment gap? • Getting drugs to people – ensuring treatment coverage is as high as possible • Expanding the target population

  32. Closing the Treatment Gap – Doing the simple things well NTD Supply Chain Forum • Coalition of partners engaged in the donation of NTD drugs • Aim to identify and overcome challenges related to shipping and in-country transportation • Pharmaceutical Companies: GSK, Johnson and Johnson, Merck & Co., Merck KGaA, Eisai, Pfizer • WHO • global logistics company DHL • NGOs Children Without Worms and International Trachoma Initiative • Major body of work – overcoming clearance of drugs through customs and into national warehouses

  33. Closing the Treatment Gap – Doing the Simple things well NTD Supply Chain Forum

  34. Closing the Treatment Gap – Doing the Simple things well Project Last Mile • If you can get Coca Cola anywhere in the world why not life-saving medicines? • Launched in 2009 • Partnership between Coca Cola, Gates’ Foundation, Global Fund to fight Aids, Tb, and malaria • Yale’s Global Health Leadership Institute, Accenture Development Partners, and the Global Environment and Technology Foundation • Expanded to 10 African countries within five years

  35. Closing the Treatment Gap – Doing the Simple things well Project Last Mile

  36. Closing the Treatment Gap – Young Children

  37. Closing the Treatment Gap – Young Children Age-groups targeted for treatment School-aged Children Adults

  38. Closing the Treatment Gap – Young Children Age-groups targeted for treatment School-aged Children Adults

  39. Closing the Treatment Gap – Young Children Age-groups targeted for treatment Under 6s School-aged Children Adults

  40. Closing the Treatment Gap – Young Children • Understanding the role that young children play in transmission. • Carried out by Arminder Deol and Judy Fernandes in our team • Full age-intensity profiles in Liberia and Uganda • Combined with modelling work being carried out by the NTD Modelling Consortium

  41. Closing the Treatment Gap – Young Children

  42. Summary and way forward All stages towards elimination suggest there is a need for complementary interventions: • Need an evidence base for which are the most appropriate interventions in different settings and species • Meaningful collaboration with other sectors – how is this best achieved? • Doing the basics well (and better)

  43. Thank you www.imperial.ac.uk/sci @sci_ntds michael.french@imperial.ac.uk

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