Large-scale deworming interventions, using anthelminthic drugs, are recommended in areas where the prevalence of soil-transmitted helminth infection is high. Anthelminthic safety has been established ...primarily in school-age children. Our objective was to provide evidence on adverse events from anthelminthic use in early childhood. A randomized multi-arm, placebo-controlled trial of mebendazole, administered at different times and frequencies, was conducted in children 12 months of age living in Iquitos, Peru. Children were followed up to 24 months of age. The association between mebendazole administration and the occurrence of a serious or minor adverse event was determined using logistic regression. There was a total of 1,686 administrations of mebendazole and 1,676 administrations of placebo to 1,760 children. Eighteen serious adverse events (i.e., 11 deaths and seven hospitalizations) and 31 minor adverse events were reported. There was no association between mebendazole and the occurrence of a serious adverse event (odds ratio OR = 1.21; 95% confidence interval CI = 0.47, 3.09) or a minor adverse event (OR = 0.84; 95% CI = 0.41, 1.72). Results from our trial support evidence of safety in administering mebendazole during early childhood. These results support World Health Organization deworming policy and the scaling up of interventions to reach children as of 12 months of age in endemic areas.
There is a low incidence of malaria in Iquitos, Peru, suburbs detected by passive case-detection. This low incidence might be attributable to infections clustered in some households/regions and/or ...undetected asymptomatic infections.
Passive case-detection (PCD) during the malaria season (February-July) and an active case-detection (ACD) community-wide survey (March) surveyed 1,907 persons. Each month, April-July, 100-metre at-risk zones were defined by location of Plasmodium falciparum infections in the previous month. Longitudinal ACD and PCD (ACP+PCD) occurred within at-risk zones, where 137 houses (573 persons) were randomly selected as sentinels, each with one month of weekly active sampling. Entomological captures were conducted in the sentinel houses.
The PCD incidence was 0.03 P. falciparum and 0.22 Plasmodium vivax infections/person/malaria-season. However, the ACD+PCD prevalence was 0.13 and 0.39, respectively. One explanation for this 4.33 and 1.77-fold increase, respectively, was infection clustering within at-risk zones and contiguous households. Clustering makes PCD, generalized to the entire population, artificially low. Another attributable-factor was that only 41% and 24% of the P. falciparum and P. vivax infections were associated with fever and 80% of the asymptomatic infections had low-density or absent parasitaemias the following week. After accounting for asymptomatic infections, a 2.6-fold increase in ACD+PCD versus PCD was attributable to clustered transmission in at-risk zones.
Even in low transmission, there are frequent highly-clustered asymptomatic infections, making PCD an inadequate measure of incidence. These findings support a strategy of concentrating ACD and insecticide campaigns in houses adjacent to houses were malaria was detected one month prior.
•Human T-lymphotropic viruses 1 (HTLV-1) infection is endemic in many regions of South America and the Caribbean.•Meta-analysis of HTLV1/2 infection in South American and Caribbean pregnant women was ...done.•The prevalence of HTLV1/2 infection among pregnant women is 1.3% (most HTLV-1).•This rate is greater than for other microbial agents checked in antenatal screening.•HTLV1/2 antenatal testing should be recommended in South America and Caribbean pregnant women.
Human T-lymphotropic viruses (HTLV)-1 infection is endemic in many countries of Central and South America and Caribbean (CSA&C). Neither screening nor surveillance programs exist for HTLV-1/2 infection among pregnant women in this region. Neither in Western nations with large migrant flows from HTLV-1/2 endemic regions.
Systematic review and meta-analysis of the prevalence of HTLV-1/2 infection among CSA&C pregnant women. We included studies searching EMBASE, PubMed/MEDLINE, Scopus, and Web of Science from inception to February 15, 2023. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.
We identified a total of 620 studies. Only 41 were finally included in the meta-analysis. Most studies (61.0%) were from Brazil and Peru (14.6%). The total number of participants was 343,707. The pooled prevalence of HTLV-1/2 infection among CSA&C pregnant women was 1.30% (95% CI: 0.96-1.69) using anti-HTLV-1/2 antibody screening tests. There was a high heterogeneity (I2 = 98.6%). Confirmatory tests gave an HTLV-1 infection rate of 1.02% (95% CI: 0.75-1.33).
The prevalence of HTLV-1/2 infection among CSA&C pregnant women is 1.3%, most cases being HTLV-1. This rate is greater than for other microbial agents regularly checked as part of antenatal screening (such as HIV, hepatitis B, or syphilis). Thus, HTLV-1/2 antenatal testing should be mandatory among CSA&C pregnant women everywhere.
Soil-transmitted helminth (STH) infections are a leading cause of disability and disease burden in school-age children of worm-endemic regions. Their effect on school absenteeism, however, remains ...unclear. The World Health Organization currently recommends delivering mass deworming and health hygiene education through school-based programs, in an effort to control STH-related morbidity. In this cluster-RCT, the impact of a health hygiene education intervention on absenteeism was measured. From April to June 2010, all Grade 5 students at 18 schools in a worm-endemic region of the Peruvian Amazon were dewormed. Immediately following deworming, nine schools were randomly assigned to the intervention arm of the trial using a matched-pair design. The Grade 5 students attending intervention schools (N = 517) received four months of health hygiene education aimed at increasing knowledge of STH prevention. Grade 5 students from the other nine schools (N = 571) served as controls. Absenteeism was measured daily through teachers' attendance logs. After four months of follow-up, overall absenteeism rates at intervention and control schools were not statistically significantly different. However, post-trial non-randomized analyses have shown that students with moderate-to-heavy Ascaris infections and light hookworm infections four months after deworming had, respectively, missed 2.4% (95% CI: 0.1%, 4.7%) and 4.6% (95% CI: 1.9%, 7.4%) more schooldays during the follow-up period than their uninfected counterparts. These results provide empirical evidence of a direct effect of STH infections on absenteeism in school-age children.
Summary
Objective To assess the following associations between the second and third trimesters of pregnancy: (i) the intensity of soil‐transmitted helminth (STH) infection and haemoglobin/anaemia, ...(ii) the effect of mebendazole treatment on the occurrence of STH infection, and (iii) the effect of mebendazole treatment on haemoglobin/anaemia.
Methods Data originated from a trial of 1042 pregnant women recruited in their second trimester and followed to delivery. Baseline assessments included socio‐demographic/health information from questionnaires, haemoglobin/anaemia from HemoCue ascertainment of fingerprick blood, and the presence and intensity of STH (Ascaris lumbricoides, hookworms and Trichuris trichiura) infections from Kato–Katz examination. All women were given iron supplements; half were randomly allocated to receive single dose 500 mg mebendazole, and half, placebo. Haemoglobin/anaemia and STH infection status were determined again in the third trimester of pregnancy.
Results Complete information was available from 935 (89.7%) women. Mebendazole significantly reduced the prevalence and intensity of all three STH infections. Higher intensities of hookworm and Trichuris infections in the second trimester were associated with a higher risk of anaemia in the third trimester. Overall, women with moderate/heavy Trichuris infection were found to be at a higher risk of anaemia; the highest risk was observed among those with moderate/heavy hookworm co‐infection (adjusted OR = 2.77; 95% CI: 1.26, 6.11). Mebendazole treatment did not reduce the risk of anaemia.
Conclusion Higher intensities of both Trichuris and hookworm infections are associated with anaemia in pregnancy. The importance of Trichuris infections during pregnancy requires renewed attention.
Infections au second trimestre par Trichuris et l’ankylostome, associées à l’anémie au troisième trimestre dans une population de femmes enceintes péruviennes
Objectifs: Evaluer les associations suivantes au cours du deuxième et du troisième trimestre de la grossesse: 1) l’intensité de l’infection par les helminthes transmis par le sol (HTS) et l’hémoglobine/l’anémie, 2) l’effet du traitement au mébendazole sur la présence d’infection par les HTS et 3) l’effet du traitement au mébendazole sur l’hémoglobine/l’anémie.
Méthodes: Les données proviennent d’un essai portant sur 1042 femmes enceintes recrutées au cours de leur deuxième trimestre et suivies jusqu’à l’accouchement. Les évaluations de base comprenaient des informations sociodémographiques/santéà partir de questionnaires, l’hémoglobine/l’anémie à partir du test HemoCue sur goute de sang digital et la présence et l’intensité d’infections par des HTS (Ascaris lumbricoides, Trichuris trichiura et ankylostomes) à partir de l’examen de Kato‐Katz. Toutes les femmes ont reçu des suppléments de fer; la moitié d’entre elles ont été réparties aléatoirement pour recevoir d’une part, une dose unique de 500 mg de mébendazole et d’autre part, un placebo. Les statuts d’hémoglobine/anémie et d’infection par des HTS ont été déterminés à nouveau au cours du troisième trimestre de la grossesse.
Résultats: Une information complète était disponible pour 935 (89,7%) femmes. Le mébendazole a considérablement réduit la prévalence et l’intensité des infections par les trois HTS. Des intensités plus élevées d’infections par l’ankylostome et Trichuris au deuxième trimestre étaient associées à un risque plus élevé d’anémie au troisième trimestre. Globalement, les femmes avec une infection modérée/forte àTrichuris ont été trouvées avec un risque plus élevé d’anémie, le risque le plus élevéétant observé chez celles avec une coinfection modérée/forte avec l’ankylostome (OR ajusté = 2,77; IC95%: 1,26‐6,11). Le traitement au mébendazole n’a pas réduit le risque d’anémie.
Conclusions: Des intensités d’infections plus élevées par Trichuris et ankylostomes sont associées à l’anémie pendant la grossesse. L’importance des infections àTrichuris pendant la grossesse nécessite une attention renouvelée.
Asociación entre las infecciones por Trichuris y anquilostoma durante el segundo semestre y la anemia en el tercer trimestre, en mujeres peruanas embarazadas
Objetivos: Evaluar las siguientes asociaciones entre el segundo y tercer trimestre de embarazo: 1) la intensidad de la infección por helmintos transmitidos por el suelo (HTS) y hemoglobina/anemia; 2) el efecto del mebendazol en la incidencia de infecciones por HTS; y 3) el efecto del tratamiento con mebendazol sobre la hemoglobina/anemia.
Métodos: Los datos se originaron en un ensayo de 1042 mujeres embarazadas, reclutadas en su segundo trimestre y seguidas hasta dar a luz. Las evaluaciones de base incluían información socio‐demográfica/salud de cuestionarios, hemoglobina/anemia constatado por HemoCue en sangre obtenida por punción en el dedo, y la presencia e intensidad de infecciones por HTS (Ascaris lumbricoides, anquilostoma y Trichuris trichiura) mediante la técnica de Kato‐Katz. Todas las mujeres recibieron suplementos de hierro; la mitad fueron asignadas de forma aleatoria para recibir una dosis única de 500 mg de mebendazol, y la mitad, placebo. Hemoglobina/anemia, y el estatus de infección por HTS se determinaron de nuevo durante el tercer trimestre de embarazo.
Resultados: La información completa estaba disponible para 935 (89.7%) mujeres. El mebendazol redujo significativamente la prevalencia e intensidad de todas las tres infecciones por HTS. Una mayor intensidad de infección por anquilostoma y Trichuris durante el segundo trimestre estaba asociada a un mayor riesgo de anemia en el tercer trimestre. En general, las mujeres con una infección moderada/alta por Trichuris estaban en mayor riesgo de anemia; el mayor riesgo se observó entre aquellas con una co‐infección moderada/alta por anquilostoma (OR ajustado = 2.77; 95% IC: 1.26, 6.11). El tratamiento con mebendazol no redujo el riesgo de anemia.
Conclusiones: Una alta intensidad de infecciones por Trichuris y anquilostoma estaba asociada con anemia durante el embarazo. La importancia de infecciones por Trichuris durante el embarazo requiere una atención renovada.
In the development of HIV vaccines, improving immunogenicity while maintaining safety is critical. Route of administration can be an important factor.
This multicenter, open-label, randomized trial, ...HVTN 069, compared routes of administration on safety and immunogenicity of a DNA vaccine prime given intramuscularly at 0, 1 and 2 months and a recombinant replication-defective adenovirus type 5 (rAd5) vaccine boost given at 6 months by intramuscular (IM), intradermal (ID), or subcutaneous (SC) route. Randomization was computer-generated by a central data management center; participants and staff were not blinded to group assignment. The outcomes were vaccine reactogenicity and humoral and cellular immunogenicity. Ninety healthy, HIV-1 uninfected adults in the US and Peru, aged 18-50 were enrolled and randomized. Due to the results of the Step Study, injections with rAd5 vaccine were halted; thus 61 received the booster dose of rAd5 vaccine (IM: 20; ID:21; SC:20). After the rAd5 boost, significant differences by study arm were found in severity of headache, pain and erythema/induration. Immune responses (binding and neutralizing antibodies, IFN-γ ELISpot HIV-specific responses and CD4+ and CD8+ T-cell responses by ICS) at four weeks after the rAd5 booster were not significantly different by administration route of the rAd5 vaccine boost (Binding antibody responses: IM: 66.7%; ID: 70.0%; SC: 77.8%; neutralizing antibody responses: IM: 11.1%; ID: 0.0%; SC 16.7%; ELISpot responses: IM: 46.7%; ID: 35.3%; SC: 44.4%; CD4+ T-cell responses: IM: 29.4%; ID: 20.0%; SC: 35.3%; CD8+ T-cell responses: IM: 29.4%; ID: 16.7%; SC: 50.0%.)
This study was limited by the reduced sample size. The higher frequency of local reactions after ID and SC administration and the lack of sufficient evidence to show that there were any differences in immunogenicity by route of administration do not support changing route of administration for the rAd5 boost.
ClinicalTrials.gov NCT00384787.
The intensity categories, or thresholds, currently used for Trichuris trichiura (ie. epg intensities of 1-999 (light); 1,000-9,999 epg (moderate), and ≥ 10,000 epg (heavy)) were developed in the ...1980s, when there were little epidemiological data available on dose-response relationships. This study was undertaken to determine a threshold for T. trichiura-associated anemia in pregnant women and to describe the implications of this threshold in terms of the need for primary prevention and chemotherapeutic interventions.
In Iquitos, Peru, 935 pregnant women were tested for T. trichiura infection in their second trimester of pregnancy; were given daily iron supplements throughout their pregnancy; and had their blood hemoglobin levels measured in their third trimester of pregnancy. Women in the highest two T. trichiura intensity quintiles (601-1632 epg and ≥ 1633 epg) had significantly lower mean hemoglobin concentrations than the lowest quintile (0-24 epg). They also had a statistically significantly higher risk of anemia, with adjusted odds ratios of 1.67 (95% CI: 1.02, 2.62) and 1.73 (95% CI: 1.09, 2.74), respectively.
This analysis provides support for categorizing a T. trichiura infection ≥ 1,000 epg as 'moderate', as currently defined by the World Health Organization. Because this 'moderate' level of T. trichiura infection was found to be a significant risk factor for anemia in pregnant women, the intensity of Trichuris infection deemed to cause or aggravate anemia should no longer be restricted to the 'heavy' intensity category. It should now include both 'heavy' and 'moderate' intensities of Trichuris infection. Evidence-based deworming strategies targeting pregnant women or populations where anemia is of concern should be updated accordingly.
Strongyloidiasis is a soil-transmitted helminthiasis with a high global prevalence.
We aimed to evaluate the prevalence of
infection and assess strongyloidiasis serology as a screening technique in ...the Peruvian Amazon.
We performed a cross-sectional study of strongyloidiasis in 300 pregnant women in Iquitos (Peru) from 1 May 2019 to 15 June 2019. Women were tested using serology (Strongyloides IgG IVD-ELISA kit) as an index test and the modified Baermann technique and/or charcoal fecal culture as the parasitological reference standard.
The reference tests showed
in the stool of 30 women (prevalence: 10%; 95% confidence interval CI 7.1% to 13.9%), while 101 women tested positive on the blood test (prevalence: 33.7%; 95% CI 28.6% to 39.4%). Fourteen of the 15 women (93.3%) with positive results according to the modified Baermann technique, and 14 of the 23 women (56.5%) with positive charcoal cultures also had positive serological results. Serology showed a sensitivity of 63.3% and a negative predictive value of 94.4%.
In Iquitos, pregnant women have a high prevalence of
.
ELISA could be an excellent tool for population-based screening, as it has a high negative predictive value that can help to rule out the presence of active infection.
The World Health Organization recommends deworming of children aged 12–24 months in highly endemic areas. Our research objectives were to: 1) examine prevalence patterns of helminth infection in ...early childhood; 2) assess the association between helminth infection and socio-demographic characteristics; and 3) examine the effect of the intensity of helminth infection on stunting and anemia. A survey of children (7–9 and 12–14 months) living in Belén (Peru) was undertaken between July 2007 and February 2008. A questionnaire was administered to obtain socio-demographic characteristics, blood and stool samples were collected, and length-for-age Z scores were calculated. The Kato-Katz method was used to determine the prevalence and intensity of
Ascaris,
Trichuris, and hookworm infections. Of 370 participating children, 349 had parasitological results. Infections first appeared in children at 8 months of age. The prevalence of any helminth infection increased linearly to approximately 37.0% (95%CI: 24.3–51.3%) by 14 months of age. Multivariate analysis showed that age, female sex, and residing in the floodplain were significant determinants of helminth infection. Among infected children, moderate-to-heavy infection of any helminth was associated with stunting (β
adjusted
=
−0.84; 95%CI: −1.48, −0.20). These results support the implementation of deworming programs aimed at young children in highly endemic areas.
Objective:Oral preexposure prophylaxis (PrEP) with antiretrovirals (ARVs) is at the forefront of biomedical HIV prevention research, and ARVs are also being tested for rectal administration to target ...people practicing unprotected receptive anal intercourse (URAI) and at risk of HIV infection. This study assessed the acceptability of daily oral PrEP and rectal PrEP during URAI among men who have sex with men (MSM) and transgender women (TGW) in Peru.
Methods:During the 2008 HIV sentinel surveillance survey conducted in 3 Peruvian cities (Lima, Iquitos, and Pucallpa), MSM and TGW reported being “versatile,” “most of the time receptive,” and “exclusively receptive” during anal sex behavior where surveyed on their acceptability of oral and rectal PrEP.
Results:Among 532 individuals, high acceptance of either oral (96.2%) or rectal (91.7%) PrEP products was reported. If both products were efficacious/available, 28.6% would prefer a pill, 57.3% a rectal lubricant, and 14.1% either. A trend toward higher acceptance was observed as receptive anal sex behavior exclusivity rose (P = .013). Being receptive most of the time (adjusted odds ratio aOR: 9.1, P = .01) and exclusively receptive (aOR: 7.5, P = .01), compared to being versatile, were independently associated with oral PrEP acceptability. A similar association was found with the acceptability of rectal formulations (aOR: 2.3, P = .07; and aOR: 2.5, P = .02; respectively).
Conclusions:Oral and rectal PrEP were highly acceptable among Peruvian MSM and TGW, particularly among those at the highest HIV infection risk. These data can guide the implementation of PrEP programs in Peru and similar settings and populations.
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