WHO guidelines for schistosomiasis

Reaching these targets requires the following actions:

• The integration and mainstreaming of cross-sector approaches into national healthcare systems
• The development of integrated platforms for the delivery of interventions to improve the cost-effectiveness, coverage & geographical reach of NTD programs
• Equitable access to appropriate treatment and care for all populations at risk

For schistosomiasis, the main goal is to reach elimination of the disease as a public health problem (defined as less than 1% prevalence of heavy intensity infections measured by Kato-Katz or urine filtration) in 100% of endemic countries by 2030.

To achieve this, the following actions are required:

• Define indicators for measuring morbidity towards elimination as a public health problem
• Implement effective interventions including expanding Mass Drug Administration (MDA) to all populations in need and ensure access to necessary medicines; implement targeted snail control using updated guidelines; continue micro-mapping and targeting
• Develop the necessary diagnostic tests including a standardized point-of-care diagnostic tool and develop new interventions including alternatives to praziquantel and methods of snail control
• Create effective cross-sectoral governance mechanisms to coordinate with WASH (Water, Sanitation and Hygiene), and other key sectors including vector control, animal health, and environmental management
• Ensure sufficient resources, including domestic financing, for access to interventions (including MDA for children and adults as well as snail control), development of new tools and strengthening of health care capacity

Updated WHO guidelines

In February 2022, the WHO launched new guidelines on the control and elimination of human schistosomiasis. The new guidelines specifically state the need to move beyond school-aged children as the primary focus for preventive chemotherapy, to a more inclusive targeting of preschool-aged children. Additionally, the guidelines indicate the implementation path to address this age group:

• In endemic communities with prevalence of schistosoma infection of more than 10%, annual preventive chemotherapy should take place with a single dose of praziquantel with more than 75% treatment coverage in all age groups from 2 years old. This is needed to control schistosomiasis morbidity and advance towards eliminating the disease as a public health problem
• Health facilities need to provide access to treatment with praziquantel to control morbidity due to schistosomiasis in all infected individuals regardless of age, including infected pregnant and lactating women (excluding the first trimester) and preschool-age children. The decision to administer treatment in children under 2 years of age should be based on testing and clinical judgement