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: Results From the LaVIISWA Cluster-randomized Trial
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Clinical infectious diseases
Abstract
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.
Description
Keywords
Helminths, Schistosoma mansoni, Mass drug administration, Allergy-related disease, Africa
Citation
Sanya, R. E., Nkurunungi, G., Hoek Spaans, R., Nampijja, M., O’Hara, G., Kizindo, R., ... & Elliott, A. M. (2019). 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: results from the LaVIISWA cluster-randomized trial. Clinical infectious diseases, 68(10), 1665-1674. DOI: 10.1093/cid/ciy761