Comment on: Evaluating the efficacy of the praziquantel dose pole for schistosomiasis treatment: A multi-country systematic review
Antonio Montresor1 and Amadou Garba2
1- Ivo de Carneri Foundation
2- Department of Malaria and neglected Tropical Diseases,World Health Organization
We read with interest the article by Berry and Gazzinelli-Guimarães1 published in the October issue of PLOS Neglected Tropical Diseases. The authors evaluated nine data sets from 20 African and non-African countries, comprising approximately 46,000 individuals who received praziquantel during Mass Drug Administration (MDA). The aim was to compare the number of praziquantel tablets indicated by the dose pole with the number administered according to body weight (the gold standard). The authors conclude that the current dose-pole format does not perform adequately among overweight or obese adults and highlight the need to update the WHO dose pole to avoid administering subtherapeutic praziquantel doses to adults.
The study is well conducted, clearly described, and its conclusions are consistent with the paper published by Montresor et al. in 20222, which proposed adjustments to the dose pole to account for overweight and obesity among those receiving MDA. In our view, the adjustment is straightforward: add one praziquantel tablet for individuals classified as overweight or obese during visual screening. According with our study, applying this adjustment would ensure that overweight or obese adults receive an appropriate dose of praziquantel.
At present, a new version of the WHO Manual for Preventive Chemotherapy is nearing finalization, and the proposed adjustment to the dose pole will be incorporated. We would like to invite Berry and Gazzinelli-Guimarães to re-evaluate the dataset they identified and to assess the efficacy of the WHO adjustment; such an evaluation would be a significant contribution to global schistosomiasis control.

1- Berry P, Gazzinelli-Guimaraes PH. Evaluating the efficacy of the praziquantel dose pole for schistosomiasis treatment: A multi-country systematic review. PLoS Negl Trop Dis. 2025 Oct 10;19(10):e0013587

2- Montresor A, Mwinzi P, Garba A. Adjustments in case of overweight and obesity to the WHO tablet pole for praziquantel administration. Trans R Soc Trop Med Hyg. 2023 Apr 3;117(4):255-259.