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A Combined Strategy to Improve the Control of Schistosoma mansoni in Areas of Low Prevalence in Brazil

Results of stool examinations for infections with Schistosoma mansoni among schoolchildren, living in a village of Minas Gerais State, Brazil, were used as an indicator to identify schistosomiasis-positive individuals within the entire population. This new approach is based on dividing the community into schoolchildren, members of households of schistosomiasis-positive and -negative schoolchildren, and members of households without schoolchildren. Each subgroup was evaluated comparing different sampling efforts with the predetermined "gold standard" to find the best relationship between detection rate and sampling effort. Consequently these results were combined, and a proposal for a new strategy, valid for an entire community, was elaborated. This alternative approach during the screening process permits to treat a similar proportion of positives as detected with 6 Kato–Katz slides of 3 stool samples, with 3-fold reduced sampling effort, enhancing the efficiency of schistosomiasis control programs in low-endemic areas.

Received March 23, 2007. Accepted for publication September 24, 2007.

Acknowledgments: The authors thank Aureo Almeida de Oliveira, senior technician of the Laboratory of Schistosomiasis, for his valuable contribution in carrying out field work and examining stool samples. We are grateful for the excellent cooperation of the technical team of the Secretary of Health in the State of Minas Gerais, Section Governador Valadares.

Financial support: This work obtained financial support from the Fundação de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG), Brazil, Conselho National de Pesquisa (CNPq), and Sistema Único de Saúde (SUS).

^* Address correspondence to Martin Enk, Hospital Santa Casa de Misericordia de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil. E-mail: marenk{at}cpqrr.fiocruz.br

Authors’ addresses: Martin Johannes Enk and Paulo Marcos Zech Coelho, Laboratory of Schistosomiasis, René Rachou Research Center/Oswaldo Cruz Foundation, Av. Augusto de Lima 1715, Belo Horizonte, Minas Gerais, Brazil, Telephone: +55–31–33497700, Fax: +55–31–32953115, E-mail: marenk{at}cpqrr.fiocruz.br, coelhopm{at}cpqrr.fiocruz.br. Anna Carolina Lustosa Lima, Department of Scientific Support, Unit for Biostatistics, René Rachou Research Center/Oswaldo Cruz Foundation, Av. Augusto de Lima 1715, Belo Horizonte, Minas Gerais, Brazil, E-mail: anna{at}cpqrr.fiocruz.br. Cristiano Lara Massara, Laboratory of Helminthiasis, René Rachou Research Center/Oswaldo Cruz Foundation, Av. Augusto de Lima 1715, Belo Horizonte, Minas Gerais, Brazil, E-mail: massara{at}cpqrr.fiocruz.br. Virginia Torres Schall, Laboratory of Health Education, René Rachou Research Center/Oswaldo Cruz Foundation, Av. Augusto de Lima 1715, Belo Horizonte, Minas Gerais, Brazil, E-mail: vtschall{at}cpqrr.fiocruz.br.