02648nas a2200253   4500000000100000008004100001653001800042653001500060653001100075100001300086700001500099700001300114700001400127700001100141700002100152700001400173700001500187245009900202856006400301300000800365490000600373520200100379022001402380       2015                            d10aTransmissions10aParameters10aAdults1 aTurner H1 aTruscott J1 aBettis A1 aShuford K1 aDunn J1 aHollingsworth DT1 aBrooker S1 aAnderson R00aAn economic evaluation of expanding hookworm control strategies to target the whole community.  uhttp://link.springer.com/article/10.1186/s13071-015-1187-5   a5700 v83 a<p><strong>Editor's introduction:</strong></p>

<p><strong>BACKGROUND: </strong>The WHO treatment guidelines for the soil-transmitted helminths (STH) focus on targeting children for the control of morbidity induced by heavy infections. However, unlike the other STHs, the majority of hookworm infections are harboured by adults. This untreated burden may have important implications for controlling both hookworm's morbidity and transmission. This is particularly significant in the context of the increased interest in investigating STH elimination strategies.</p>

<p><strong>METHODS: </strong>We used a deterministic STH transmission model and parameter estimates derived from field epidemiological studies to evaluate the impact of child-targeted (2-14 year olds) versus community-wide treatment against hookworm in terms of preventing morbidity and the timeframe for breaking transmission. Furthermore, we investigated how mass treatment may influence the long-term programmatic costs of preventive chemotherapy for hookworm.</p>

<p><strong>RESULTS: </strong>The model projected that a large proportion of the overall morbidity due to hookworm was unaffected by the current child-targeted strategy. Furthermore, driving worm burdens to levels low enough to potentially break transmission was only possible when using community-wide treatment. Due to these projected reductions in programme duration, it was possible for community-wide treatment to generate cost savings - even if it notably increases the annual distribution costs.</p>

<p><strong>CONCLUSIONS: </strong>Community-wide treatment is notably more cost-effective for controlling hookworm's morbidity and transmission than the current child-targeted strategies and could even be cost-saving in many settings in the longer term. These calculations suggest that it is not optimum to treat using the same treatment strategies as other STH. Hookworm morbidity and transmission control require community-wide treatment.</p>
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