04373nas a2200673   4500000000100000008004100001260001200042653001100054653002400065653002800089653003200117653002000149100001400169700001600183700001400199700001600213700001600229700001400245700001200259700001400271700001900285700001400304700001400318700001800332700001200350700001500362700001400377700001500391700001800406700001200424700001300436700001300449700001100462700001300473700001100486700001400497700001000511700001600521700001100537700001500548700001600563700001200579700001100591700001800602700001400620700001200634700002200646700001200668700001500680700002300695700001200718700001500730245013500745856008300880300001200963490000700975520270300982022001403685       2023                            d  c01/202310aBrazil10aSchistosoma mansoni10acontrol and elimination10aNeglected Tropical Diseases10aschistosomiasis1 aMenezes C1 aMontresor L1 aJangola S1 ade Mattos A1 aDomingues A1 aJúnior A1 aSilva C1 aBarbosa C1 ade Mendonça C1 aMassara C1 aFonseca C1 ade Oliveira E1 aGomes E1 ada Silva E1 aBezerra F1 aSilva-Jr F1 ade Siqueira I1 aSilva J1 aHeller L1 aFarias L1 aBeck L1 aSantos M1 aLima M1 aMourão M1 aEnk M1 aFernandez M1 aKatz N1 aCarvalho O1 aParreiras P1 aNeves R1 aGava S1 ade Oliveira S1 aThiengo S1 aFavre T1 aGraeff-Teixeira C1 aPieri O1 aCaldeira R1 ada Silva-Pereira R1 aRocha R1 aOliveira R00aFioSchisto's expert perspective on implementing WHO guidelines for schistosomiasis control and transmission elimination in Brazil.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10739458/pdf/fimmu-14-1268998.pdf  a12689980 v143 a<p>The World Health Organization (WHO) recognizes schistosomiasis as one of the Neglected Tropical Diseases targeted for global elimination in the 2030 Agenda of the Sustainable Development Goals. In Brazil, schistosomiasis mansoni is considered a public health problem, particularly prevalent among vulnerable populations living in areas with poor environmental and sanitary conditions. In 2022, the WHO published a Guideline encompassing recommendations to assist national programs in endemic countries in achieving morbidity control, eliminating schistosomiasis as a public health problem, and advancing towards interrupting transmission. The perspectives presented here, collectively prepared by members of the Oswaldo Cruz Foundation's (Fiocruz) Schistosomiasis Translational Program (FioSchisto), along with invited experts, examine the feasibility of the WHO recommendations for the Brazilian settings, providing appropriate recommendations for public health policies applicable to the epidemiological reality of Brazil, and suggests future research to address relevant issues. In Brazil, the provision of safe water and sanitation should be the key action to achieve schistosomiasis elimination goals. The agencies involved in measures implementation should act together with the Primary Care teams for planning, executing, monitoring, and evaluating actions in priority municipalities based on their epidemiological indicators. Host snails control should prioritize judicious ecological interventions at breeding sites. The Information, Education, and Communication (IEC) strategy should be associated with water and sanitation and other control actions, actively involving school community. To identify infected carriers, FioSchisto recommends a two-stage approach of immunological and molecular tests to verify transmission interruption during the intervention and beyond. Praziquantel administration should be done under medical supervision at the Primary Care level. MDA should be considered in exceptional settings, as a measure of initial attack strategy in locations presenting high endemicity, always integrated with water and sanitation, IEC, and snail control. To assist decision-making, as well as the monitoring and evaluation of strategic actions, there is a need for an Information System. FioSchisto considers this systematization essential to make investments in strategic research to support the improvement of schistosomiasis control actions. Efforts toward schistosomiasis elimination in Brazil will succeed with a paradigm shift from the vertical prescriptive framework to a community-centered approach involving intersectoral and interdisciplinary collaboration.</p>
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