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Schistosoma mansoni reinfection: Analysis of risk factors by classification and regression tree (CART) modeling

Author

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  • Andréa Gazzinelli
  • Roberta Oliveira-Prado
  • Leonardo Ferreira Matoso
  • Bráulio M Veloso
  • Gisele Andrade
  • Helmut Kloos
  • Jeffrey M Bethony
  • Renato M Assunção
  • Rodrigo Correa-Oliveira

Abstract

Praziquantel (PZQ) is an effective chemotherapy for schistosomiasis mansoni and a mainstay for its control and potential elimination. However, it does not prevent against reinfection, which can occur rapidly in areas with active transmission. A guide to ranking the risk factors for Schistosoma mansoni reinfection would greatly contribute to prioritizing resources and focusing prevention and control measures to prevent rapid reinfection. The objective of the current study was to explore the relationship among the socioeconomic, demographic, and epidemiological factors that can influence reinfection by S. mansoni one year after successful treatment with PZQ in school-aged children in Northeastern Minas Gerais state Brazil. Parasitological, socioeconomic, demographic, and water contact information were surveyed in 506 S. mansoni-infected individuals, aged 6 to 15 years, resident in these endemic areas. Eligible individuals were treated with PZQ until they were determined to be negative by the absence of S. mansoni eggs in the feces on two consecutive days of Kato-Katz fecal thick smear. These individuals were surveyed again 12 months from the date of successful treatment with PZQ. A classification and regression tree modeling (CART) was then used to explore the relationship between socioeconomic, demographic, and epidemiological variables and their reinfection status. The most important risk factor identified for S. mansoni reinfection was their “heavy” infection at baseline. Additional analyses, excluding heavy infection status, showed that lower socioeconomic status and a lower level of education of the household head were also most important risk factors for S. mansoni reinfection. Our results provide an important contribution toward the control and possible elimination of schistosomiasis by identifying three major risk factors that can be used for targeted treatment and monitoring of reinfection. We suggest that control measures that target heavily infected children in the most economically disadvantaged households would be most beneficial to maintain the success of mass chemotherapy campaigns.

Suggested Citation

  • Andréa Gazzinelli & Roberta Oliveira-Prado & Leonardo Ferreira Matoso & Bráulio M Veloso & Gisele Andrade & Helmut Kloos & Jeffrey M Bethony & Renato M Assunção & Rodrigo Correa-Oliveira, 2017. "Schistosoma mansoni reinfection: Analysis of risk factors by classification and regression tree (CART) modeling," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-16, August.
    • Handle: RePEc:plo:pone00:0182197
    DOI: 10.1371/journal.pone.0182197
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    References listed on IDEAS

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    1. Sara Lustigman & Roger K Prichard & Andrea Gazzinelli & Warwick N Grant & Boakye A Boatin & James S McCarthy & María-Gloria Basáñez, 2012. "A Research Agenda for Helminth Diseases of Humans: The Problem of Helminthiases," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 6(4), pages 1-13, April.
    2. Evaristus Chibunna Mbanefo & Nguyen Tien Huy & Anita Akpeedje Wadagni & Christine Ifeoma Eneanya & Obioma Nwaorgu & Kenji Hirayama, 2014. "Host Determinants of Reinfection with Schistosomes in Humans: A Systematic Review and Meta-analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 8(9), pages 1-15, September.
    3. Jack E T Grimes & David Croll & Wendy E Harrison & Jürg Utzinger & Matthew C Freeman & Michael R Templeton, 2014. "The Relationship between Water, Sanitation and Schistosomiasis: A Systematic Review and Meta-analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 8(12), pages 1-12, December.
    4. Andrea Gazzinelli & Rodrigo Correa-Oliveira & Guo-Jing Yang & Boakye A Boatin & Helmut Kloos, 2012. "A Research Agenda for Helminth Diseases of Humans: Social Ecology, Environmental Determinants, and Health Systems," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 6(4), pages 1-11, April.
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    3. Abdallah Zacharia & Vivian Mushi & Twilumba Makene, 2020. "A systematic review and meta-analysis on the rate of human schistosomiasis reinfection," PLOS ONE, Public Library of Science, vol. 15(12), pages 1-17, December.

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