02478nas a2200289   4500000000100000008004100001653001300042653000900055653002200064653002900086653000900115100001600124700001500140700002300155700001300178700001400191700001500205700001600220700001400236700002300250245019300273856026000466300000700726490000600733520143500739022001402174       2017                            d10aZoonosis10aWASH10aFreshwater snails10aEnvironmental Monitoring10aeDNA1 aStothard RJ1 aCampbell S1 aOsei-Atweneboana M1 aDurant T1 aStanton M1 aBiritwum N1 aRollinson D1 aOmbede DE1 aTchuem-Tchuenté L00aTowards interruption of schistosomiasis transmission in sub-Saharan Africa: developing an appropriate environmental surveillance framework to guide and to support 'end game' interventions.  uhttp://download.springer.com/static/pdf/607/art%253A10.1186%252Fs40249-016-0215-9.pdf?originUrl=http%3A%2F%2Fidpjournal.biomedcentral.com%2Farticle%2F10.1186%2Fs40249-016-0215-9&token2=exp=1484924541~acl=%2Fstatic%2Fpdf%2F607%2Fart%25253A10.1186%25252Fs40  a100 v63 a<p>Schistosomiasis is a waterborne parasitic disease in sub-Saharan Africa, particularly common in rural populations living in impoverished conditions. With the scale-up of preventive chemotherapy, national campaigns will transition from morbidity- to transmission-focused interventions thus formal investigation of actual or expected declines in environmental transmission is needed as 'end game' scenarios arise. Surprisingly, there are no international or national guidelines to do so in sub-Saharan Africa. Our article therefore provides an introduction to key practicalities and pitfalls in the development of an appropriate environmental surveillance framework. In this context, we discuss how strategies need to be adapted and tailored to the local level to better guide and support future interventions through this transition. As detection of egg-patent infection in people becomes rare, careful sampling of schistosome larvae in freshwater and in aquatic snails with robust species-specific DNA assays will be required. Appropriate metrics, derived from observed prevalence(s) as compared with predetermined thresholds, could each provide a clearer insight into contamination- and exposure-related dynamics. Application could be twofold, first to certify areas currently free from schistosomiasis transmission or second to red-flag recalcitrant locations where extra effort or alternative interventions are needed.</p>
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