Impact of preventive chemotherapy on Strongyloides stercoralis: A systematic review and meta-analysis.
Journal
PLoS neglected tropical diseases
ISSN: 1935-2735
Titre abrégé: PLoS Negl Trop Dis
Pays: United States
ID NLM: 101291488
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
received:
01
03
2023
accepted:
23
06
2023
revised:
20
07
2023
medline:
23
10
2023
pubmed:
10
7
2023
entrez:
10
7
2023
Statut:
epublish
Résumé
Strongyloides stercoralis is a neglected soil-transmitted helminth (STH) that leads to significant morbidity in endemic populations. Infection with this helminth has recently been recognised by the World Health Organization (WHO) as a major global health problem to be addressed with ivermectin preventive chemotherapy, and therefore, there is now, the need to develop guidelines for strongyloidiasis control that can be implemented by endemic countries. This study aimed to evaluate the impact of ivermectin preventive chemotherapy (PC) on S. stercoralis prevalence in endemic areas to generate evidence that can inform global health policy. This study was a systematic review and meta-analysis. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and LILACS for literature published between 1990 and 2022 and reporting prevalence of S. stercoralis before and after PC with ivermectin, administered either at school or at community level. The search strategy identified 933 records, eight of which were included in the meta-analysis. Data extraction and quality assessment were carried out by two authors. Meta-analysis of studies based on fecal testing demonstrated a significant reduction of S. stercoralis prevalence after PC: prevalence Risk Ratio (RR) 0.18 (95% CI 0.14-0.23), I2 = 0. A similar trend was observed in studies that used serology for diagnosis: RR 0.35 (95% CI 0.26-0.48), I2 = 4.25%. A sensitivity analysis was carried out for fecal tests where low quality studies were removed, confirming a post-intervention reduction in prevalence. The impact of PC could not be evaluated at different time points or comparing annual vs biannual administration due to insufficient data. Our findings demonstrate a significant decrease of S. stercoralis prevalence in areas where ivermectin PC has taken place, supporting the use of ivermectin PC in endemic areas.
Sections du résumé
BACKGROUND
Strongyloides stercoralis is a neglected soil-transmitted helminth (STH) that leads to significant morbidity in endemic populations. Infection with this helminth has recently been recognised by the World Health Organization (WHO) as a major global health problem to be addressed with ivermectin preventive chemotherapy, and therefore, there is now, the need to develop guidelines for strongyloidiasis control that can be implemented by endemic countries. This study aimed to evaluate the impact of ivermectin preventive chemotherapy (PC) on S. stercoralis prevalence in endemic areas to generate evidence that can inform global health policy.
METHODOLOGY/PRINCIPAL FINDINGS
This study was a systematic review and meta-analysis. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and LILACS for literature published between 1990 and 2022 and reporting prevalence of S. stercoralis before and after PC with ivermectin, administered either at school or at community level. The search strategy identified 933 records, eight of which were included in the meta-analysis. Data extraction and quality assessment were carried out by two authors. Meta-analysis of studies based on fecal testing demonstrated a significant reduction of S. stercoralis prevalence after PC: prevalence Risk Ratio (RR) 0.18 (95% CI 0.14-0.23), I2 = 0. A similar trend was observed in studies that used serology for diagnosis: RR 0.35 (95% CI 0.26-0.48), I2 = 4.25%. A sensitivity analysis was carried out for fecal tests where low quality studies were removed, confirming a post-intervention reduction in prevalence. The impact of PC could not be evaluated at different time points or comparing annual vs biannual administration due to insufficient data.
CONCLUSIONS/SIGNIFICANCE
Our findings demonstrate a significant decrease of S. stercoralis prevalence in areas where ivermectin PC has taken place, supporting the use of ivermectin PC in endemic areas.
Identifiants
pubmed: 37428815
doi: 10.1371/journal.pntd.0011473
pii: PNTD-D-23-00284
pmc: PMC10358935
doi:
Substances chimiques
Ivermectin
70288-86-7
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0011473Informations de copyright
Copyright: © 2023 Stroffolini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Pathogens. 2020 Jun 13;9(6):
pubmed: 32545787
Bull World Health Organ. 2004 Aug;82(8):563-71
pubmed: 15375445
Lancet Glob Health. 2023 Jun;11(6):e924-e932
pubmed: 37202027
Am J Trop Med Hyg. 2009 Dec;81(6):1071-8
pubmed: 19996439
Infect Dis Poverty. 2021 May 17;10(1):70
pubmed: 34001286
Am J Trop Med Hyg. 2017 Sep;97(3):681-683
pubmed: 28722622
PLoS Negl Trop Dis. 2017 Oct 9;11(10):e0006003
pubmed: 28991899
Cochrane Database Syst Rev. 2016 Jan 18;(1):CD007745
pubmed: 26778150
Am J Trop Med Hyg. 2019 Jun;100(6):1305-1311
pubmed: 30963990
Adv Parasitol. 2022;118:1-84
pubmed: 36088083
PLoS Negl Trop Dis. 2021 Mar 17;15(3):e0009144
pubmed: 33730099
PLoS Negl Trop Dis. 2020 Aug 10;14(8):e0008505
pubmed: 32776942
N Engl J Med. 2015 Dec 10;373(24):2305-13
pubmed: 26650152
PLoS Negl Trop Dis. 2017 May 15;11(5):e0005607
pubmed: 28505198
Clin Infect Dis. 2020 Dec 15;71(12):3226-3228
pubmed: 32421762
PLoS Negl Trop Dis. 2015 Nov 05;9(11):e0004150
pubmed: 26540412
Parasit Vectors. 2022 May 28;15(1):181
pubmed: 35643508