02112nas a2200301   4500000000100000008004100001260001600042653002100058100001500079700001500094700001500109700001400124700001600138700001200154700001200166700001400178700001800192700001400210700001500224700001600239700001300255245014000268856007500408300001600483490000700499520129000506022001401796       2022                            d  bElsevier BV10aGeneral Medicine1 aWiegand RE1 aFleming FM1 ade Vlas SJ1 aOdiere MR1 aKinung'hi S1 aKing CH1 aEvans D1 aFrench MD1 aMontgomery SP1 aStraily A1 aUtzinger J1 aVounatsou P1 aSecor WE00aDefining elimination as a public health problem for schistosomiasis control programmes: beyond prevalence of heavy-intensity infections  uhttps://www.thelancet.com/action/showPdf?pii=S2214-109X%2822%2900287-X  ae1355-e13590 v103 a<p>WHO's 2021-30 road map for neglected tropical diseases (NTDs) outlines disease-specific and cross-cutting targets for the control, elimination, and eradication of NTDs in affected countries. For schistosomiasis, the criterion for elimination as a public health problem (EPHP) is defined as less than 1% prevalence of heavy-intensity infections (ie, ≥50 Schistosoma haematobium eggs per 10 mL of urine or ≥400 Schistosoma mansoni eggs per g of stool). However, we believe the evidence supporting this definition of EPHP is inadequate and the shifting distribution of schistosomiasis morbidity towards more subtle, rather than severe, morbidity in the face of large-scale control programmes requires guidelines to be adapted. In this Viewpoint, we outline the need for more accurate measures to develop a robust evidence-based monitoring and evaluation framework for schistosomiasis. Such a framework is crucial for achieving the goal of widespread EPHP of schistosomiasis and to meet the WHO road map targets. We encourage use of overall prevalence of schistosome infection (instead of the prevalence of heavy-intensity infections), development of species-dependent and age-dependent morbidity markers, and construction of a standardised monitoring and evaluation protocol.</p>
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