Longitudinal changes in the prevalence and intensity of soil-transmitted helminth infection following expanded community-wide mass drug administration in the delta region of Myanmar

Abstract: Mass drug administration (MDA), targeted at school-aged children is the method recommended by the World Health Organization for the control of morbidity induced by soil-transmitted helminth (STH) infection in endemic countries. However, MDA does not prevent reinfection between treatment rounds. In countries with endemic infection, such as Myanmar, the MDA coverage, who is targeted, and rates of reinfection in given environmental and social settings will determine how effective mass drug treatment is in suppressing transmission in the long-term. In this paper, data from an epidemiology study on STH, conducted between June 2015 and June 2016 in the delta region of Myanmar, are analysed to determine the risks of STH infection in the whole community over a year which included two MDA rounds. Risk ratios (RRs) for the four-month reinfection period were below one, whereas RRs for the six-month reinfection period were above one, indicating that more people were infected after six months of exposure post-MDA. Evidence of predisposition, as measured by the Kendall Tau-b statistic, was found for all STH species and across all age groups. This study demonstrates that a six-month gap between MDA in these communities is enough time for STH infection to return to pre-MDA levels and that the same individuals are being consistently infected between MDA rounds. Author summary Mass drug administration (MDA), treating either whole communities or targeted groups without a prior diagnosis, is used as a control strategy for many neglected tropical diseases, including soil-transmitted helminth (STH) infection. MDA takes place at set intervals, aiming to reduce morbidity caused by the target disease and potentially interrupt transmission. In this study we measure STH infection in two villages in the delta region of Myanmar over the course of a year, both before and after MDA rounds, to quantify the effect of treatment on infection and to identify groups with persistent infections. We found that whilst overall prevalence of STH infection decreased over the year, intensity of infection, measured by eggs per gram of faeces, did not significantly decrease. We also found evidence to suggest that particular people are predisposed to STH infection. This is possibly due to non-compliance to MDA, or behavioural and social factors. The findings presented here will provide evidence to support continuing Myanmar’s MDA programme for STH control and using accurate diagnostics to identify and target “predisposed” people for sustained treatment.