Document Detail


Impact of anthelminthic treatment in pregnancy and childhood on immunisations, infections and eczema in childhood: a randomised controlled trial.
MedLine Citation:
PMID:  23236367     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Helminth infections may modulate immune responses to unrelated pathogens and allergens; these effects may commence prenatally. We addressed the hypothesis that anthelminthic treatment in pregnancy and early childhood would improve responses to immunisation and modulate disease incidence in early childhood with both beneficial and detrimental effects.
METHODS AND FINDINGS: A randomised, double-blind, placebo-controlled trial was conducted in Entebbe, Uganda [ISRCTN32849447]. In three independent randomisations, 2507 pregnant women were allocated to receive single-dose albendazole or placebo, and praziquantel or placebo; 2016 of their offspring were randomised to receive quarterly single-dose albendazole or placebo from age 15 months to 5 years. Primary outcomes were post-immunisation recall responses to BCG and tetanus antigens, and incidence of malaria, diarrhoea, and pneumonia; incidence of eczema was an important secondary outcome. Analysis was by intention-to-treat. Of 2345 live births, 1622 (69%) children remained in follow-up at age 5 years. 68% of mothers at enrolment, and 11% of five-year-olds, had helminth infections. Maternal hookworm and Schistosoma mansoni were effectively treated by albendazole and praziquantel, respectively; and childhood hookworm and Ascaris by quarterly albendazole. Incidence rates of malaria, diarrhoea, pneumonia, and eczema were 34, 65, 10 and 5 per 100 py, respectively. Albendazole during pregnancy caused an increased rate of eczema in the children (HR 1.58 (95% CI 1.15-2.17), p = 0.005). Quarterly albendazole during childhood was associated with reduced incidence of clinical malaria (HR 0.85 (95% CI 0.73-0.98), p = 0.03). There were no consistent effects of the interventions on any other outcome.
CONCLUSIONS: Routine use of albendazole in pregnancy may not always be beneficial, even in tropical developing countries. By contrast, regular albendazole treatment in preschool children may have an additional benefit for malaria control where helminths and malaria are co-endemic. Given the low helminth prevalence in our children, the effect of albendazole on malaria is likely to be direct.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN32849447.
Authors:
Juliet Ndibazza; Harriet Mpairwe; Emily L Webb; Patrice A Mawa; Margaret Nampijja; Lawrence Muhangi; Macklyn Kihembo; Swaib A Lule; Diana Rutebarika; Barbara Apule; Florence Akello; Hellen Akurut; Gloria Oduru; Peter Naniima; Dennison Kizito; Moses Kizza; Robert Kizindo; Robert Tweyongere; Katherine J Alcock; Moses Muwanga; Alison M Elliott
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-12-07
Journal Detail:
Title:  PloS one     Volume:  7     ISSN:  1932-6203     ISO Abbreviation:  PLoS ONE     Publication Date:  2012  
Date Detail:
Created Date:  2012-12-13     Completed Date:  2013-05-24     Revised Date:  2014-02-24    
Medline Journal Info:
Nlm Unique ID:  101285081     Medline TA:  PLoS One     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e50325     Citation Subset:  IM    
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN32849447
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MeSH Terms
Descriptor/Qualifier:
Adult
Albendazole / therapeutic use*
Anthelmintics / adverse effects*
Child, Preschool
Double-Blind Method
Eczema / epidemiology,  immunology
Female
Helminthiasis / drug therapy*,  epidemiology,  immunology
Humans
Incidence
Infant
Male
Pregnancy
Pregnancy Complications, Parasitic / drug therapy*,  immunology
Treatment Outcome
Uganda
Vaccination
Grant Support
ID/Acronym/Agency:
064693//Wellcome Trust; 074791//Wellcome Trust; 079110//Wellcome Trust; 095778//Wellcome Trust; G0700837//Medical Research Council; N0I-AI-25147/AI/NIAID NIH HHS; WT084289MA//Wellcome Trust; //Medical Research Council
Chemical
Reg. No./Substance:
0/Anthelmintics; F4216019LN/Albendazole
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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