Skip to main content Accessibility help

The influence of transmission season on parasitological cure rates and intensity of infection after praziquantel treatment of Schistosoma haematobium-infected schoolchildren in Mozambique

  • G. AUGUSTO (a1), P. MAGNUSSEN (a2), T. K. KRISTENSEN (a2), C. C. APPLETON (a3) and B. J. VENNERVALD (a2)...


Schistosoma haematobium is refractory to praziquantel (PZQ) during the prepatent period of infection. A hypothesis based on this observation is that in areas where S. haematobium transmission is seasonal, the outcome of chemotherapy depends on the timing of the treatment relative to the annual transmission pattern. To examine this hypothesis, a study was carried out in southern Mozambique. Following demonstration of seasonal transmission, PZQ was administered separately to two cohorts of S. haematobium-infected schoolchildren in (1) the high and (2) the low transmission seasons and followed up after two months when levels of infection and intensities were measured. The prevalence of infection decreased from 54·2% and 51·7% in cohorts 1 and 2 to 30·3% and 1·8%, respectively. The geometric mean intensity of infection decreased from 23·3 eggs/10 ml of urine at baseline to 15·6 eggs/10 ml of urine in cohort 1 (treated during high transmission season), and from 23·5 eggs/10 ml urine to 7·3 eggs/10 ml of urine in cohort 2 (treated during low transmission season). The observed cure rates in cohorts 1 and 2 were 69·7% and 98·2%, respectively. Differences in infection between the cohorts in terms of cure rate and level of infection two months post-treatment were statistically significant and indicate that in areas with a seasonal transmission pattern, the effect of PZQ can be enhanced if treatment takes place during the low transmission season. We conclude that appropriately timed PZQ administration will increase the impact of schistosomiasis control programmes.


Corresponding author

*Corresponding author: Gerito Augusto, Instituto Nacional de Saúde (INS) Ministério da Saúde, Av. Eduardo MondlaneNo. 1008 Caixa Postal 264, Maputo, Moçambique. Tel.: +258 21431103, Fax: +258 21431103. E-mail:


Hide All
Abu-Elyazeed, R. R., Mansour, N. S., Youssef, F. G., Boghdadi, A. M., el Khoby, T. A., Hassanein, Y. A. and el Gamal, R. R. (1998). Seasonality as a determinant of the efficacy of praziquantel in population-based chemotherapy. Lessons from the practice. Journal of the Egyptian Society of Parasitology 28, 17.
Aragon, A. D., Imani, R. A., Blackburn, V. R., Cupit, P. M., Melman, S. D., Goronga, T., Webb, T., Loker, E. S. and Cunningham, C. (2008). Towards an understanding of the mechanism of action of praziquantel. Molecular and Biochemical Parasitology 164, 5765.
Augusto, G. (2007) Effect of transmission season on the outcome of treatment of urinary schistosomiasis in schoolchildren in Matola and Maputo, Mozambique. PhD thesis, School of Biological and Conservation Sciences, University of KwaZulu-Natal, Durban, South Africa, 5067.
Borrmann, S., Szlezak, N., Faucher, J. F., Matsiegui, P. B., Neubauer, R., Binder, R. K., Lell, B. and Kremsner, P. G. (2001). Artesunate and praziquantel for the treatment of Schistosoma haematobium infections: a double-blind, randomized, placebo controlled study. Journal of Infectious Diseases 184, 13631366.
Botros, S., Sayed, H., Amer, N., El-Ghannam, M., Bennett, J. L. and Day, T. A. (2005). Current status of sensitivity to praziquantel in a focus of potential drug resistance in Egypt. International Journal for Parasitology 35, 787791.
Brown, D. S. and Kristensen, T. K. (1989). A Field Guide to African Freshwater Snails and Southern African Species. Danish Bilharziasis Laboratory, Copenhagen.
Campagne, G., Garba, A., Barkire, H., Vera, C., Sidiki, A. and Chippaux, J. P. (2001). Continued ultrasonic follow-up of children infected with Schistosoma haematobium after treatment with praziquantel. Tropical Medicine and International Health 6, 2430.
Christensen, N. O., Gotsche, G. and Frandsen, F. (1984). Parasitological Techniques for Use in Routine Laboratory Maintenance of Schistosomes and for Use in Studies on the Epidemiology of Human and Bovine Schistosomiasis. Danish Bilharziasis Laboratory, Copenhagen.
Cioli, D. (1998). Chemotherapy of schistosomiasis: an update. Parasitology Today 14, 418422.
Danso-Appiah, A., Utzinger, J., Liu, J. and Olliaro, P. (2008). Drugs for treating urinary schistosomiasis. Cochrane Database Systematic Review 3, CD000053.
da Silva, I. M., Pereira Filho, E., Thiengo, R., Ribeiro, P. C., Conceicao, M. J., Panasco, M. and Lenzi, H. L. (2008). Schistosomiasis (Schistosoma haematobium): histopathological course determined by cystoscopy in a patient in whom praziquantel treatment failed. Revista do Instituto de Medicina Tropical de Sao Paulo 50, 343346.
Doenhoff, M. J., Modha, J., Lambertucci, J. R. and McLaren, D. J. (1991). The immune dependence of chemotherapy. Parasitology Today 7, 1618.
Doumenge, J. P., Mott, K. E., Cheung, C., Villenave, D., Chapuis, O., Perrin, M. F. and Reaud-Thomas, G. (1987). Atlas of the Global Distribution of Schistosomiasis. Press Universitaires de Bordeaux, Bordeaux.
Frandsen, F. and Christensen, N. O. (1984). An introductory guide to the identification of cercariae from African freshwater snails with special reference to cercariae of trematode species of medical and veterinary importance. Acta Tropica 41, 181202.
Ghandour, A. M. (1978). The development of Schistosoma haematobium in the hamster. Annals of Tropical Medicine and Parasitology, 72, 219225.
Gryseels, B., Stelma, F. F, Talla, I., van Dam, G. J, Polman, K., Sow, S, Diaw, M., Sturrock, R. F., Doehring-Schwerdtfeger, E., Kardorff, R., Decam, C., Niang, M. and Deelder, A. M. (1994). Epidemiology, immunology and chemotherapy of Schistosoma mansoni infections in a recently exposed community in Senegal. Tropical and Geographical Medicine 56, 209219.
Hatz, C., Mayombana, C., de Savigny, D., Macpherson, C. N. L., Koella, J. C., Degrémont, A. and Tanner, M. (1990). Ultrasound scanning for detecting morbidity due to Schistosoma haematobium and its resolution following treatment with different doses of praziquantel. Transactions of the Royal Society of Tropical Medicine and Hygiene 84, 8488.
Hatz, C. F., Vennervald, B. J., Nkulila, T., Vounatsou, P., Kombe, Y., Mayombana, C., Mshinda, H. and Tanner, M. (1998). Evolution of Schistosoma haematobium-related pathology over 24 months after treatment among school children in southeastern Tanzania. American Journal of Tropical Medicine and Hygiene 59, 775781.
Herwaldt, B. L., Tao, L. F., van Pelt, W., Tsang, V. C. and Bruce, J. I. (1995). Persistence of Schistosoma haematobium infection despite multiple courses of therapy with praziquantel. Clinical Infectious Diseases 20, 309315.
Inyang-Etoh, P. C., Ejezie, G. C., Useh, M. F. and Inyang-Etoh, E. C. (2004). Efficacy on artesunate in the treatment of urinary schistosomiasis, in an endemic community in Nigeria. Annals of Tropical Medicine and Parasitology 98, 491499.
Kahama, A. I., Odek, A. E., Kihara, R. W., Vennervald, B. J., Kombe, Y., Nkulila, T., Hatz, C. F., Ouma, J. H. and Deelder, A. M. (1999 a). Urine circulating soluble egg antigen in relation to egg counts, haematuria, and urinary tract pathology before and after treatment in children infected with Schistosoma haematobium in Kenya. American Journal and Tropical Medicine and Hygiene 61, 215219.
Kahama, A. I., Vennervald, B. J., Kombe, Y., Kihara, R. W., Ndzovu, M., Mungai, P. and Ouma, J. H. (1999 b). Parameters associated with Schistosoma haematobium infection before and after chemotherapy in school children from two villages in the Coast Province of Kenya. Tropical Medicine and International Health 4, 335340.
King, C. H., Wiper, D. W. 3rd, De Stigter, K. V., Peters, P. A., Koech, D., Ouma, J. H., Arap Siongok, T. K. and Mahmoud, A. A. (1989). Dose-finding study for praziquantel therapy of Schistosoma haematobium in Coast Province, Kenya. American Journal and Tropical Medicine and Hygiene 40, 507513.
Kumar, V. and Gryseels, B. (1994). Use of praziquantel against schistosomiasis: a review of current status. International Journal of Antimicrobial Agents 4, 313320.
Muchiri, E. M., Ouma, J. H. and King, C. H. (1996). Dynamics and control of Schistosoma haematobium transmission in Kenya: an overview of the Msambweni project. American Journal of Tropical Medicine and Hygiene 55, 127134.
Mutapi, F., Hagan, P., Ndhlovu, P. and Woolhouse, M. E. J. (1997). Comparison of humoral responses to Schistosoma haematobium in areas with high and low levels of infection. Parasite Immunology 19, 255263.
National Institute of Meteorology of Mozambique 2004 and 2005.
N'Goran, E. K., Gnaka, H. N., Tanner, M. and Utzinger, J. (2003). Efficacy and side-effects of two praziquantel treatments against Schistosoma haematobium infection, among schoolchildren from Côte d'Ivoire. Annals of Tropical Medicine and Parasitology 97, 3751.
N'Goran, E. K., Utzinger, J., N'Guessan, A. N., Müller, I., Zamble, K., Lohourignon, K. L., Traoré, M., Sosthene, B. A., Lengeler, C. and Tanner, M. (2001). Reinfection with Schistosoma haematobium following school-based chemotherapy with praziquantel in four highly endemic villages in Côte d'Ivoire. Tropical Medicine and International Health 6, 817825.
Raso, G., N'Goran, E. K., Toty, A., Luginbühl, A., Adjoua, C. A., Tian-Bi, N. T., Bogoch, I. I., Vounatsou, P., Tanner, M. and Utzinger, J. (2004). Efficacy and side effects of praziquantel against Schistosoma mansoni in a community of western Côte d'Ivoire. Transactions of the Royal Society of Tropical Medicine and Hygiene 98, 1827.
Saathoff, E., Olsen, A., Magnussen, P., Kvalsvig, J. D., Becker, W. and Appleton, C. C. (2004). Patterns of Schistosoma heamatobium infection, impact of praziquantel treatment and re-infection after treatment in a cohort of schoolchildren from rural Kwa-Zulu Natal/South Africa. BMC Infectious Diseases 4, 40.
Sabah, A. A., Fletcher, C., Jebe, G. and Doenhoff, M. J. (1986). Schistosoma mansoni: chemotherapy of infections of different ages. Experimental Parasitology 61, 294303.
Stelma, F. F., Sall, S., Daff, B., Sow, S., Niang, M. and Gryseels, B. (1997). Oxamniquine cures Schistosoma mansoni infection in a focus in which cure rates with praziquantel are unusually low. Journal of Infectious Diseases 176, 304307.
Tchuem-Tchuenté, L. A., Shaw, D. J., Polla, L., Cioli, D. and Vercruysse, J. (2004). Efficacy of praziquantel against Schistosoma haematobium infection in children. American Journal of Tropical Medicine and Hygiene 71, 778782.
Touré, S., Zhang, Y., Bosqué-Oliva, E., Ky, C., Ouedraogo, A., Koukounari, A., Gabrielli, A. F., Sellin, B., Webster, J. P. and Fenwick, A. (2008). Two-year impact of single praziquantel treatment on infection in the national control programme on schistosomiasis in Burkina Faso. Bulletin of the World Health Organization 86, 780787.
UAAC (2004). Levantamento realizado nos bairros em 2003. Unidade de Apoio a Autoridade Comunitária, cidades da Matola e Maputo.
WHO (2002). Prevention and Control of Schistosomiasis and Soil-transmitted Helminthiasis. Report of a WHO expert committee. WHO Technical Report Series 912, Geneva.
WHO (2007). Report on Schistosomiasis. Report of a WHO scientific working group, Geneva 2007, TDR/SWG/07.
Utzinger, J., N'Goran, E. K, N'Dri, A., Lengeler, C. and Tanner, M. (2000). Efficacy of praziquantel against Schistosoma mansoni with particular consideration for intensity of infection. Tropical Medicine and International Health 5, 771778.
Utzinger, J., Keiser, J., Xiao, S. H., Tanner, M. and Singer, B. H. (2003). Combination chemotherapy of schistosomiasis in laboratory studies and clinical trials. Antimicrobial Agents and Chemotherapy 47, 14871495.


The influence of transmission season on parasitological cure rates and intensity of infection after praziquantel treatment of Schistosoma haematobium-infected schoolchildren in Mozambique

  • G. AUGUSTO (a1), P. MAGNUSSEN (a2), T. K. KRISTENSEN (a2), C. C. APPLETON (a3) and B. J. VENNERVALD (a2)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed