Review of the WHO guideline on preventive chemotherapy for public health control of strongyloidiasis.

Strongyloidiasis is a soil-transmitted helminthiasis that is estimated to affect 300-600 million people across Asia, Africa, South and central America, and the Pacific. This neglected parasitic disease is most known for its ability to persist as a lifelong infection due to autoinfection and its risk of hyperinfection and disseminated disease during immunosuppression, which has a more than 60% case fatality. Despite the large global burden of strongyloidiasis, there have been no large-scale public health programmes or WHO guidelines directed towards its control and elimination. However, over the past decade, key scientific and policy changes along with requests from endemic countries have led to WHO incorporating strongyloidiasis into its 2021-30 roadmap and public health targets for control and elimination of neglected tropical diseases. In 2024, WHO published its first guideline on public health control of strongyloidiasis with a single recommendation: in endemic settings with a Strongyloides stercoralis infection prevalence of 5% or higher (measured either with Baermann or agar plate culture from stool specimens), WHO conditionally recommends mass drug administration with single-dose ivermectin (200 μg/kg; oral therapy) in all age groups from 5 years and older to reduce strongyloidiasis. This Review, written by the 2023-24 strongyloidiasis guidelines development group along with WHO colleagues and international experts, presents a summary of the recently published WHO guideline recommendation for strongyloidiasis, and the supporting evidence, considerations for public health implementation, and future research needs.

Informations de copyright

© 2024 World Health Organization. Published by Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.

Déclaration de conflit d'intérêts

Declaration of interests The authors of this Review participated in the WHO guideline development for strongyloidiasis, which, in some cases, included compensation for time, travel, expertise, and research products related to development of the guidelines. LM and DM are currently employed by WHO. AM was formally employed by WHO. RSB reports research grants and a patent related to strongyloidiasis diagnostics, which are outside the scope of this Review and their role as Vice President of Strongyloides Australia. AK reports an affiliation as an independent consultant with Liconsa Labs, which is a producer of a WHO-prequalified generic ivermectin. FM reports being Vice Board Chair of the organisation Uniting to Combat NTDs. JB declares employment with the Public Health Agency of Canada; however, this Review was not undertaken under the auspices of the Public Health Agency of Canada as part of JB's employment responsibilities. NCL is supported by the National Institutes of Health (National Institute of Allergy and Infectious Diseases) under award R01AI179771. The content of this Review is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors declare no competing interests. This Review was funded by WHO. The funder had no role in the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.