Toward the 2020 goal of soil-transmitted helminthiasis control and elimination

Laboratory diagnosis of soil-transmitted helminthiasisChallenge: The global implementation of standard diagnostic tools based on microscopy (i.e., Kato-Katz technique) allowed comparison between countries, but these are not sensitive enough to be used in settings where elimination of soil-transmitted helminthiasis seems feasible and where infection intensities are low.Recommendation: Continue the development and validation of recent advances in PCR-based diagnostics for soil-transmitted helminthiasis and conduct rigorous, multisite evaluations, and strategic developments for larger-scale application in the field. Key item 9: Combination therapy for soil-transmitted helminthiasisChallenge: Preventive chemotherapy programs have increased considerably worldwide.Yet no single drug is equally effective in achieving satisfactory cure rates for the major soil-transmitted helminths, and drug resistance is expected to arise and further decrease the efficacy of available treatment options.Recommendation: The Committee appreciates both the efforts and challenges to developing coformulations of anthelmintic drugs and supports research initiatives that assess the safety and efficacy of various combination therapies in order to identify which combination is best suited for scaling up to achieve a maximum impact. Key item 10: Ownership of soil-transmitted helminthiasis control programsChallenge: Drug donation is the cornerstone of current soil-transmitted helminthiasis control efforts in many areas, but this is not a sustainable solution without a long-term perspective.Recommendation: Country ownership of soil-transmitted helminthiasis prevention and control programs is paramount, and future efforts should not rely on drug donation alone.Generic deworming drugs will become increasingly important post-2020, and WHO should encourage the prequalification of the manufacturers of these drugs. Key item 11: Foci of continued soil-transmitted helminthiasis transmissionChallenge: Guidance is required on how to deal with foci of ongoing transmission in areas where a regular preventive chemotherapy program is no longer being implemented.Recommendation: WHO should develop or endorse decision-making guidelines for program managers to identify and respond to foci of "unexpectedly high" soil-transmitted helminthiasis transmission post-preventive chemotherapy program.