Skip to main content
  • Loading metrics

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

  • Sören L. Becker ,

    Contributed equally to this work with: Sören L. Becker, Harvy Joy Liwanag, Jedidiah S. Snyder

    Affiliations Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany

  • Harvy Joy Liwanag ,

    Contributed equally to this work with: Sören L. Becker, Harvy Joy Liwanag, Jedidiah S. Snyder

    Affiliations Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland, Ateneo School of Medicine and Public Health, Ateneo de Manila University, Metro Manila, the Philippines

  • Jedidiah S. Snyder ,

    Contributed equally to this work with: Sören L. Becker, Harvy Joy Liwanag, Jedidiah S. Snyder

    Affiliations Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America

  • Oladele Akogun,

    Affiliations Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America, Modibbo Adama University of Technology, Yola, Nigeria

  • Vicente Belizario. Jr,

    Affiliations Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America, College of Public Health, University of the Philippines, Manila, the Philippines

  • Matthew C. Freeman,

    Affiliations Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America, Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America

  • Theresa W. Gyorkos,

    Affiliations Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada

  • Rubina Imtiaz,

    Affiliations Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America, Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America

  • Jennifer Keiser,

    Affiliations Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland

  • Alejandro Krolewiecki,

    Affiliations Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America, Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta, Oran, Argentina

  • Bruno Levecke,

    Affiliation Department of Virology, Parasitology, and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium

  • Charles Mwandawiro,

    Affiliations Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America, Kenya Medical Research Institute, Nairobi, Kenya

  • Rachel L. Pullan,

    Affiliations Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America, London School of Hygiene and Tropical Medicine, London, United Kingdom

  • David G. Addiss , (DGA); (JU)

    Affiliations Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America, Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America

  • Jürg Utzinger (DGA); (JU)

    Affiliations Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Basel, Switzerland, Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America


On May 22, 2001, a resolution passed during the 54th World Health Assembly (WHA 54.19) took an historic step toward reducing the morbidity and mortality associated with the world’s most common parasitic worm (helminth) infections [1]. Indeed, an estimated 1.45 billion individuals are infected with soil-transmitted helminths worldwide [2]. The soil-transmitted helminths primarily comprise hookworm (Ancylostoma duodenale and Necator americanus), roundworm (Ascaris lumbricoides), and whipworm (Trichuris trichiura). Taken together, soil-transmitted helminthiasis accounts for a global burden of over 3.3 million disability-adjusted life years [3] and is associated with anemia [4], malnutrition [5], and impaired physical and cognitive development [69]. As the primary recommendation to eliminate soil-transmitted helminthiasis as a public health problem, WHA 54.19 called for improved water and sanitation to reduce transmission and urged that 3 high-risk groups receive regular treatment with anthelmintic drugs: preschool-aged children (PSAC), school-aged children (SAC), and women of reproductive age (WRA) [1].

During the decade 2001–2010, however, soil-transmitted helminthiasis control focused almost exclusively on preventive chemotherapy targeting SAC through the education sector, with a target of achieving at least 75% drug coverage in this population group by 2010 (Table 1). While this target was not reached [10], global efforts to address soil-transmitted helminthiasis were renewed in 2011, when several high-level meetings took place and their reports published in subsequent years. The “Roadmap on Neglected Tropical Diseases” was published first, reiterating the 75% preventive chemotherapy coverage target for PSAC and SAC [11]. This roadmap inspired 22 partners from public and private sectors to endorse the London Declaration on Neglected Tropical Diseases [12] and called on all partners to sustain and expand programs to achieve the 2020 goals outlined in the roadmap. Subsequently, a specific strategic plan for soil-transmitted helminthiasis was published, also in 2012, in which, on top of the 75% target for coverage, the additional target of reducing moderate- and heavy-intensity infections (defined as the number of helminth eggs excreted by an individual exceeding a preset, species-specific threshold, used as a proxy for worm burden) to less than 1% among SAC was affirmed [13]. With 2020 on the horizon, we are well into the second decade post-WHA 54.19. Major challenges remain. Among others, these include (1) the need to maximize the impact of pharmaceutic donations of anthelmintic drugs, (2) the need to clarify targets to guide monitoring efforts moving forward, and (3) the need to take into account recent successes of the Global Program to Eliminate Lymphatic Filariasis (GPELF). The latter challenge results in the consequent scaling down of community-based control interventions, thus reducing the ancillary benefits of this strategy on soil-transmitted helminthiasis [14]. A complete transition from a lymphatic filariasis elimination program to a soil-transmitted helminthiasis control program will have important consequences so that efforts to ensure that all risk groups for soil-transmitted helminthiasis will be adequately covered need to be planned well in advance of the actual transition.

Table 1. Overview of the evolution of documents published by WHO pertaining to the control of soil-transmitted helminthiasis since 2001.

If the goal of eliminating soil-transmitted helminthiasis as a public health problem is to be achieved, it is important to proactively review and address gaps in disease control programs. The Soil-Transmitted Helminthiasis Advisory Committee (subsequently termed “the Committee,” established in 2012, as the successor of the Mebendazole Advisory Committee that was launched in 2006) is an independent group of experts that holds an annual meeting to assess challenges and review progress made in soil-transmitted helminthiasis control, including operational research, monitoring, and evaluation, and to deliberate on next steps. The Committee makes recommendations to address technical and scientific challenges and provides advice to members of the Soil-Transmitted Helminthiasis Coalition and the World Health Organization (WHO) Strategic and Technical Advisory Group (STAG). On October 18–19, 2016, the Committee convened for 2 days in Basel, Switzerland, to review and discuss advances in operational research, anthelmintic treatment options, and diagnostic tools and strategies. Furthermore, programmatic and strategic challenges in global control efforts were debated. Here, we present the recommendations arising from this meeting and highlight challenges and potential solutions on the road toward the 2020 goal of soil-transmitted helminthiasis control and elimination and beyond.

Controlling soil-transmitted helminthiasis morbidity

Progress and challenges

The Soil-Transmitted Helminthiasis Strategic Plan 2011–2020 [13] has outlined 4 primary milestones for global control of soil-transmitted helminthiasis: (1) 100% of countries requiring preventive chemotherapy for soil-transmitted helminthiasis have achieved 75% national coverage of PSAC and SAC, (2) these countries regularly assess intensity of soil-transmitted helminth infections in sentinel sites, (3) less than 1% of countries requiring preventive chemotherapy for soil-transmitted helminthiasis have infection of moderate or high or intensity by 2020, and (4) 75%–100% of PSAC and SAC needing preventive chemotherapy worldwide have been treated.

In 2016, the Weekly Epidemiological Record (WER) reported the global progress toward milestones 1 and 4, indicating that <30% of countries requiring preventive chemotherapy for soil-transmitted helminthiasis had achieved the 75% national coverage target for PSAC and SAC and that 48% of PSAC and 65% of SAC needing preventive chemotherapy worldwide had received treatment [15]. It was not possible to report on either milestone 2 or 3 because there were no publicly available data to review whether sentinel surveillance or parasitologic monitoring was being implemented in the endemic countries. Based on current progress toward milestones 1 and 4, it is anticipated that these may potentially be achieved by 2020 (at least for SAC), whereas milestones 2 and 3 are less likely to be reached by 2020. Using the London Declaration Scorecard (, the Committee noted that milestones for country reporting on coverage and parasitologic monitoring were lagging.

In order to bring progress toward milestones 2 and 3 on track, the Committee suggests that barriers to program implementation be acknowledged and that technical support be provided to countries struggling to reach the 75% national coverage targets. As the year 2020 nears, there is a pressing need for the global community to consider a serious recommitment to milestones 2 and 3 and to work together to improve parasitologic assessment in affected countries. The London Declaration Scorecard remains a useful tool in monitoring progress toward these milestones, but the Committee recommends that the Scorecard be updated to include water, sanitation, and hygiene (WASH) indicators to be aligned with the United Nations Sustainable Development Goals (SDGs; and that treatment be expanded to include other at-risk groups, most importantly WRA. Beyond being explicitly called for in WHA 54.19, these additional measures will likely be needed to accelerate elimination of soil-transmitted helminthiasis as a public health problem in children [1620]. In this context, a robust, integrated, and regularly updated global surveillance platform is needed. Ideally, this platform could also be used for schistosomiasis and other neglected tropical diseases [21,22].

The Committee also recognizes the unique contribution of GPELF to concurrently control soil-transmitted helminthiasis–related morbidity. Launched in 2002 by WHO, GPELF has successfully treated an estimated 36 million PSAC and 139 million SAC in 2015 with combination preventive chemotherapy that included albendazole [23], one of the two donated anthelmintic drugs widely used against soil-transmitted helminthiasis [24]. The GPELF community-based delivery platform reaches at-risk groups outside of the school setting and through the coadministration of 2 drugs with a different mechanism of action (e.g., albendazole and ivermectin) that, as shown for animal helminthiasis, are likely to reduce the risk of resistance [25,26]. It follows that GPELF has enhanced the coverage and effectiveness of soil-transmitted helminthiasis control activities in many countries. However, there is an immediate risk of losing this delivery infrastructure as the GPELF achieves its goal and as national governments and donors scale down or discontinue their support for the program. Hence, without a strategic transition plan in place, communities that used to benefit from lymphatic filariasis control activities run the risk of undermining the gains already made for soil-transmitted helminthiasis control once GPELF is discontinued. The Committee therefore proposes that (1) a parasitologic assessment be first conducted in areas where termination of lymphatic filariasis control activities is being contemplated and that (2) WHO convenes a technical working group to develop a decision algorithm for countries on when and how to implement a lymphatic filariasis–soil-transmitted helminthiasis transition. Such an algorithm will be especially important in areas where there are no clear alternatives for continuing preventive chemotherapy for soil-transmitted helminthiasis among SAC and other at-risk groups [27,28].

Clearly, eliminating soil-transmitted helminthiasis as a public health problem has to go beyond preventive chemotherapy for SAC alone, as other groups at risk also serve as a reservoir of infection, e.g., hookworm infections frequently predominate in adult populations [29]. Coverage of preventive chemotherapy for PSAC continues to lag behind the coverage for SAC; to date, there is no regular preventive chemotherapy program against soil-transmitted helminthiasis for WRA (although, some countries have developed such programs specifically for pregnant women). To address these gaps, we recommend that specific guidelines for the treatment of PSAC and WRA be developed and validated under the lead of WHO, including a regular reporting mechanism for the treatment coverage in these groups. Taken together, there is a need for a robust, integrated, and regularly updated global neglected tropical disease surveillance platform to include interactive preventive chemotherapy data ( and georeferenced survey and intervention data ( [22,30].

Treatment options and new developments

In comparison to other classes of anti-infective drugs such as antibiotics, the number of anthelmintics that are used in human medicine is limited, and there have been far fewer innovations or new compounds developed to broaden the pharmacologic armamentarium [24,3134]. In this context, several important challenges for soil-transmitted helminthiasis control need to be highlighted, i.e., (1) the development of a new and rapidly disintegrating, chewable formulation of mebendazole for PSAC; (2) the introduction of combination treatment approaches for soil-transmitted helminthiasis; (3) the limited understanding of resistance development to anthelmintic drugs in human soil-transmitted helminthiasis; and (4) careful considerations pertaining to the continuing role of pharmaceutic drug donations in the post-2020 agenda.

Albendazole and mebendazole, both benzimidazole drugs, are widely used in preventive chemotherapy programs targeting soil-transmitted helminthiasis worldwide. Their anthelmintic properties differ slightly, with albendazole being more active against hookworm [31,35]. Of note, the efficacy of both compounds against T. trichiura is unsatisfactory, and low cure rates of single-dose administration have also been reported for hookworm infection, in particular if mebendazole is used. Other factors, such as suboptimal dissolution of the tablets, may further decrease their therapeutic effects [36]. In addition, PSAC, especially those less than 3 years of age, have difficulty chewing and swallowing the relatively large tablets [37], and several deaths have been caused by aspiration and choking [38]. Hence, the Committee welcomes the recent approval of a new, rapidly disintegrating chewable formulation of mebendazole. The drug’s efficacy and tolerability have been shown in a study conducted in Ethiopia and Rwanda [37], and the drug received approval by the United States Food and Drug Administration (FDA) on October 19, 2016. We now advocate that access to this new formulation be provided in endemic areas, particularly for preventive chemotherapy targeting PSAC.

It has been suggested that widespread use of monotherapy might facilitate the development of anthelmintic drug resistance [3944]. Hence, as for other chronic infections (e.g., tuberculosis, human immune deficiency virus [HIV], and malaria), combination therapy against soil-transmitted helminthiasis might decrease this risk and could enhance efficacy [25]. Moreover, the need for combination therapy is further supported by coendemicity of multiple helminth infections. Indeed, in many endemic settings, infections due to A. lumbricoides, hookworm, and T. trichiura co-occur. Recent studies reported an improved drug efficacy if a combination of albendazole plus either ivermectin or oxantel pamoate was administered [4547]. An overview of currently used anthelmintics and promising drug combinations is presented in Table 2. Logistically, it would be desirable to develop coformulations of drug combinations that could be distributed as a single tablet (such combinations are readily available for other conditions, e.g., arterial hypertension, HIV/AIDS, and tuberculosis), but pharmacologic challenges need to be resolved before this approach becomes feasible in daily practice. While combination therapy may temporarily lower the resistance pressure, there is also a clear need for new anthelmintic drugs to ensure access to efficacious treatment options in the future. Additionally, ongoing research on developing anthelmintic vaccines can also provide important additional control tools, which may be integrated into future control strategies. The Committee urges that further studies be conducted to identify the most promising drug combinations for preventive chemotherapy against soil-transmitted helminthiasis. It applauds new funding granted by the Bill & Melinda Gates Foundation that addresses some of these issues, which has already resulted in the addition of the albendazole plus ivermectin combination to the WHO Model List of Essential Medicines [48]. Additionally, we welcome ongoing research projects that will strengthen the monitoring and surveillance of drug efficacy and anthelmintic resistance in soil-transmitted helminthiasis control programs (e.g., the Bill & Melinda Gates Foundation-funded STARWORMS [Stop Anthelminthic Resistant WORMS] project;

Table 2. Efficacy of anthelmintic drugs used for the treatment of soil-transmitted helminthiasis and recent evidence from clinical trials pertaining to 3 drug combinations.

Experience and lessons from preventive chemotherapy programs targeting millions of mainly SAC were only possible through drug donations by the manufacturing pharmaceutic industry. However, it is important to note that a long-lasting, durable strategy for soil-transmitted helminthiasis control or even elimination cannot solely rely on such drug donation programs. As generic deworming drugs will become increasingly important in the future, particularly in the post-2020 agenda, the Committee urges WHO to encourage prequalification of the manufacturers of these drugs.

Parasitologic monitoring

Progress and challenges

Survey methods currently endorsed by WHO to assess the prevalence of any soil-transmitted helminth infection are not designed to determine whether or not the goal of eliminating soil-transmitted helminthiasis as a public health problem in children has been achieved. Hence, there is a need to develop a new survey design that (1) is sufficiently powered to assess if the prevalence of moderate- or heavy-intensity infections falls below 1% and (2) is feasible and affordable, considering the limited resources and capacity of national soil-transmitted helminthiasis control programs. Any new methodology being proposed should enable the measurement of prevalence of soil-transmitted helminth infection in SAC, PSAC, WRA, and other risk groups, providing a more complete picture of the burden of soil-transmitted helminthiasis in the entire community [49]. The Committee urges WHO to spearhead discussions with stakeholders to refine this survey methodology and, after successful field validation, to support and endorse its use so that it can be adopted by countries before 2020. At the same time, areas where the prevalence of soil-transmitted helminth infection continues to be high despite several years of preventive chemotherapy would warrant further investigation as these serve as potential indicators of previously unrecognized programmatic challenges.

Diagnostic methods and new developments

Accurate diagnostic techniques for soil-transmitted helminth infection are of paramount importance in settings where the overall prevalence is low and, even more importantly, where the majority of infections are of light intensity. Indeed, different diagnostic techniques are required at different stages of helminthiasis control programs, e.g., to prove elimination as a public health problem or to document an interruption of transmission. The detection limit of most diagnostic techniques decreases considerably in such areas, and techniques with a higher sensitivity are required for an accurate assessment of remaining foci of endemicity [50]. It has recently been argued that the development of new and more sensitive diagnostic techniques has been slowed down by the strong focus on drug coverage rather than parasitologic monitoring in most soil-transmitted helminthiasis control programs [51]. The development of several new techniques, many of which are not based on stool microscopy, are encouraging. Their different features and characteristics are summarized in Table 3.

Table 3. Brief characterization of the Kato–Katz technique and selected other diagnostic developments for detection of soil-transmitted helminths, which might potentially be used in soil-transmitted helminthiasis control programs and epidemiologic surveys.

As soil-transmitted helminthiasis control efforts evolve, diagnostic techniques must also be further developed to ensure that their application is feasible and that the reported results are accurate. In areas where preventive chemotherapy has been employed for many years, conventional techniques based on stool microscopy alone might fail to demonstrate the persistence of light-intensity infections [50,52]. In such instances, more sensitive molecular methods such as stool-based polymerase chain reaction (PCR) assays may depict the “true” situation more accurately. In settings of a very low prevalence of soil-transmitted helminth infection, pooling of stool specimens and subsequent PCR examination might be a promising method to detect and monitor areas of ongoing transmission, although costs and required logistic infrastructure require elaboration [53,54].

Additionally, a transition away from stool specimen analysis to, for example, blood- or urine-based tests for antigen or antibody detection might further enhance the accurate diagnosis of soil-transmitted helminthiasis [55,56]. For the aforementioned methods, in particular the molecular techniques, adequate specimen preservation, simplified nucleic acid extraction, and quality assurance systems are crucial [57]. This is important as many laboratories use a wide variety of in-house PCR techniques for detection of helminths, but target genes and techniques used differ considerably. Following 2 expert meetings held in Ghent, Belgium and Annecy, France in mid-2016, recommendations were made to develop target product profiles for different use-cases and to prepare field sites for large-scale validation studies of helminth PCR techniques. The Committee encourages rigorous, multicenter evaluations and strategic developments for large-scale application and setups for external quality assurance systems of such PCR techniques in the field.

Evolution of soil-transmitted helminthiasis control: Clarifying the goals.

When reviewing the different documents pertaining to the global strategy against soil-transmitted helminthiasis (Table 1), the roadmap in particular fails to mention previous targets with respect to coverage and morbidity reduction. The Committee therefore urges WHO to ensure that all relevant future documentation reaffirm both morbidity control and parasitologic monitoring targets in order to allay any confusion or programmatic concerns. While the 2020 target of 75% drug coverage may be in reach for SAC—and perhaps PSAC [15]—in certain countries, it is likely that elimination of soil-transmitted helminthiasis as a public health problem will remain a challenge. In our view, rigorous parasitologic monitoring is required. The current strategy and the strong emphasis on drug coverage targets offer only indirect endpoints for national soil-transmitted helminthiasis control programs. A comparative assessment of the different strategies for soil-transmitted helminthiasis control and its arising implications for national control programs is presented in Table 4. The Committee supports a recent call [58] and stresses the importance for clarifying the goals of soil-transmitted helminthiasis control strategies.

Table 4. Key characteristics of 3 different strategies pertaining to future soil-transmitted helminthiasis control efforts.

Several specific aspects underscore the importance of the choice of one common strategy for soil-transmitted helminthiasis control. For example, it is generally acknowledged that soil-transmitted helminth infection negatively impacts health, especially when infection intensity is high; that safe and effective anthelmintic drugs are available to reduce morbidity; and that preventive chemotherapy is an effective way to reach those at risk. However, a recent Cochrane review [59] and a systematic review with network meta-analysis [60], while criticized for their methodologic limitations and other concerns [61,62], challenged some of the portrayed beneficial effects. The Committee advocates for rigorous parasitologic monitoring after several rounds of preventive chemotherapy to assess the reduced burden of moderate- and high-intensity infections associated with morbidity, enabling a more accurate quantification of the likely health benefits of deworming. Indeed, a return from a treatment coverage target to the original goal of eliminating soil-transmitted helminthiasis as a public health problem, and the prioritization of parasitologic monitoring would offer a measurable and direct endpoint for national programs (i.e., less than 1% moderate or heavy infection intensity prevalence in all risk groups). At present, it remains unclear whether this goal can be reached through preventive chemotherapy alone. It is also important to note that sustaining the gains against soil-transmitted helminthiasis made possible by community-based GPELF programs will not be feasible without taking the goal of eliminating soil-transmitted helminthiasis as a public health problem seriously, as monitoring is needed to guide the planning of a transition from lymphatic filariasis elimination to soil-transmitted helminthiasis control. At present, drug coverage in the 3 identified high-risk groups alone is too often the main focus. It may be that other at-risk groups (e.g., adolescents and adults) constitute an important reservoir of transmission, which may need specific control efforts. Accounting for these populations will more accurately reflect the success of a control program [63].

The interruption of soil-transmitted helminthiasis transmission is a topic of growing interest [64,65]. History shows that sustained control efforts, coupled with economic development, can lead to transmission interruption in different parts of the world [6668]. However, the attributable preventive fraction of different control strategies for successful transmission interruption is difficult to assess, and many experts emphasized that urbanization, economic development, and improved hygiene are more important factors than repeated anthelmintic treatment because rapid reinfection occurs frequently in highly endemic areas. As it is unlikely that such rapid and sustained economic developments will occur anytime soon in many of the most affected low-income countries, this underscores the importance of additional tools for control efforts. Yet, mathematical modeling also suggests that interruption of transmission is feasible in soil-transmitted helminthiasis–endemic settings that are characterized by low-infection intensities [65]. The burden of soil-transmitted helminthiasis varies across settings. A multifaceted, intersectoral approach along with appropriate delivery platforms is needed to achieve the ambitious goal of interrupting soil-transmitted helminthiasis transmission at a local level. WHA 54.19 originally called for improved access to WASH through intersectoral collaboration. Growing evidence supports that call [69] and further pleas for WASH integration into neglected tropical disease control programs have been re-emphasized [70]. While WHO has begun to integrate WASH into its global neglected tropical disease control strategy [71], guidelines are needed for the implementation of specific WASH interventions into soil-transmitted helminthiasis control strategies, similar to that of the “SAFE” strategy targeting trachoma [7274].

Vast resources have been contributed to sustain and expand programs for the 10 neglected tropical diseases highlighted in the London Declaration to be eradicated, eliminated, or controlled by 2020. While many programs registered success due to this collaborative effort [75,76], guidelines for the evaluation of soil-transmitted helminthiasis control programs need to be strengthened. The Committee advocates that parasitologic surveys need to be performed after several years of preventive chemotherapy to document whether or not the goals set by WHO (i.e., those pertaining to infection intensity) have been achieved. Suitable approaches (e.g., adequately powered surveys) need to be included in a revised WHO strategic plan. The key recommendations put forth by the Committee are summarized in Box 1.

Box 1. Key items, related challenges, and recommendations to all stakeholders put forth by the Soil-Transmitted Helminthiasis Advisory Committee (“the Committee”) at the 2016 annual meeting with regard to global control efforts for soil-transmitted helminthiasis

Key item 1: Elimination of soil-transmitted helminthiasis as a public health problem

Challenge: While elimination as a public health problem is clearly defined (<1% prevalence of moderate- or heavy-intensity infections for any soil-transmitted helminth species in a distinct geographic area), there is disagreement on the tools needed to achieve and to assess elimination.

Recommendation: The Committee supports this definition of soil-transmitted helminthiasis elimination and urges all stakeholders to develop a common strategy on how to achieve this goal.

Key item 2: Parasitologic monitoring of control efforts

Challenge: Accurate parasitologic studies are not carried out on a regular basis in many endemic areas. There is no agreement on a sampling design to determine if set targets have been reached.

Recommendation: Parasitologic monitoring in endemic countries is essential for assessing progress toward the elimination goal. WHO should develop and support a sampling design that is powered enough to determine if the goal of <1% prevalence of moderate- or heavy-intensity infection has been reached and affordable and relatively easy to implement given the limited resources available to, and capacity of, national control programs. The reporting of age- and sex-disaggregated data should be emphasized.

Key item 3: Anthelmintic treatment coverage of at-risk groups

Challenge: Anthelmintic treatment rates for preschool-aged children (PSAC) lag behind coverage rates reported for school-aged children (SAC), while most women of reproductive age (WRA) remain untreated amid scale-up efforts in high-burden countries.

Recommendation: Conduct operational research to identify challenges for coverage of PSAC and WRA and use findings for developing new guidelines for these risk groups.

Key item 4: Reporting on treatment coverage and data sharing on subnational level

Challenge: WRA are among the at-risk groups for whom deworming is recommended, but treatment coverage data are not reported. For all groups receiving treatment, it would be more informative to have regional- and/or district-specific coverage rates in addition to national estimates.

Recommendation: WHO should improve reporting of treatment coverage rates by inclusion of WRA in the regular updates on soil-transmitted helminthiasis published in the Weekly Epidemiological Record (WER). Additionally, WHO can provide a platform where subnational-level data on drug coverage in soil-transmitted helminthiasis–endemic districts should be shared whenever available. It is further suggested that WHO report the proportion of soil-transmitted helminthiasis–endemic districts (globally and by country) that have reached at least 75% coverage.

Key item 5: Water, sanitation, and hygiene (WASH)

Challenge: WASH is essential for soil-transmitted helminthiasis elimination as a public health problem and more investment is needed to include this important component into control efforts.

Recommendation: Long-term investments for soil-transmitted helminthiasis–specific WASH are needed, and WASH indicators should be included in the London Declaration Scorecard that align with the 2030 Sustainable Development Goal (SDG) 6, that is to “ensure availability and sustainable management of water and sanitation for all”.

Key item 6: Transition from lymphatic filariasis elimination to soil-transmitted helminthiasis control

Challenge: Many ancillary benefits of the Global Program for Eliminating Lymphatic Filariasis (GPELF) with regard to soil-transmitted helminthiasis might be lost if GPELF is scaled down.

Recommendation: Design an effective transition strategy and conduct operational research to identify and promote the policy frameworks, capacity building, planning, and intersectoral collaboration needed to sustain the contributions of the lymphatic filariasis program to progress made in soil-transmitted helminthiasis control.

Key item 7: Clinical morbidity due to soil-transmitted helminthiasis

Challenge: Soil-transmitted helminths cause primarily chronic, subtle morbidity, which is difficult to assess. For an accurate estimation of the attributable disease burden, clinical studies are needed.

Recommendation: Gather scientific evidence pertaining to clinical morbidity due to soil-transmitted helminthiasis and address how soil-transmitted helminthiasis control activities may lead to a measurable decrease of morbidity in endemic areas.

Key item 8: Laboratory diagnosis of soil-transmitted helminthiasis

Challenge: 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 helminthiasis

Challenge: 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 programs

Challenge: 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 transmission

Challenge: 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.


  1. 1. WHO (2002) Prevention and control of schistosomiasis and soil-transmitted helminthiasis: report of a WHO expert committee. WHO Tech Rep Ser 912: 1–57.
  2. 2. Pullan RL, Smith JL, Jasrasaria R, Brooker SJ (2014) Global numbers of infection and disease burden of soil transmitted helminth infections in 2010. Parasit Vectors 7: 37. pmid:24447578
  3. 3. GBD 2016 DALYs and HALE Collaborators (2017) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390: 1260–1344. pmid:28919118
  4. 4. Gulani A, Nagpal J, Osmond C, Sachdev HP (2007) Effect of administration of intestinal anthelmintic drugs on haemoglobin: systematic review of randomised controlled trials. BMJ 334: 1095. pmid:17434954
  5. 5. de Gier B, Campos Ponce M, van de Bor M, Doak CM, Polman K (2014) Helminth infections and micronutrients in school-age children: a systematic review and meta-analysis. Am J Clin Nutr 99: 1499–1509. pmid:24740209
  6. 6. Watkins WE, Pollitt E (1997) "Stupidity or worms": do intestinal worms impair mental performance? Psychol Bull 121: 171–191. pmid:9100486
  7. 7. Sur D, Saha DR, Manna B, Rajendran K, Bhattacharya SK (2005) Periodic deworming with albendazole and its impact on growth status and diarrhoeal incidence among children in an urban slum of India. Trans R Soc Trop Med Hyg 99: 261–267. pmid:15708385
  8. 8. Shang Y, Tang LH, Zhou SS, Chen YD, Yang YC, et al. (2010) Stunting and soil-transmitted-helminth infections among school-age pupils in rural areas of southern China. Parasit Vectors 3: 97. pmid:20942948
  9. 9. Gall S, Müller I, Walter C, Seelig H, Steenkamp L, et al. (2017) Associations between selective attention and soil-transmitted helminth infections, socioeconomic status, and physical fitness in disadvantaged children in Port Elizabeth, South Africa: an observational study. PLoS Negl Trop Dis 11: e0005573. pmid:28481890
  10. 10. WHO (2012) Soil-transmitted helminthiases: number of children treated in 2010. Wkly Epidemiol Rec 87: 225–232. pmid:24340403
  11. 11. WHO (2012). World Health Organization's 2020 roadmap on NTDs. Available at: (last accessed: 8 June 2018).
  12. 12. London Declaration on Neglected Tropical Diseases (2012). Available at: (last accessed: 15 January 2018).
  13. 13. WHO (2012) Eliminating soil-transmitted helminthiases as public health problem in children: progress report 2001–2010 and strategic plan 2011–2020. Available at: (last accessed: 8 June 2018).
  14. 14. Mupfasoni D, Montresor A, Mikhailov A, King J (2016) The impact of lymphatic filariasis mass drug administration scaling down on soil-transmitted helminth control in school-age children. Present situation and expected impact from 2016 to 2020. PLoS Negl Trop Dis 10: e0005202. pmid:27992424
  15. 15. WHO (2016) Schistosomiasis and soil-transmitted helminthiases: number of people treated in 2015. Wkly Epidemiol Rec 91: 585–595. pmid:27934297
  16. 16. Anderson R, Truscott J, Hollingsworth TD (2014) The coverage and frequency of mass drug administration required to eliminate persistent transmission of soil-transmitted helminths. Philos Trans R Soc Lond B Biol Sci 369: 20130435. pmid:24821921
  17. 17. Lo NC, Bogoch II, Blackburn BG, Raso G, N'Goran EK, et al. (2015) Comparison of community-wide, integrated mass drug administration strategies for schistosomiasis and soil-transmitted helminthiasis: a cost-effectiveness modelling study. Lancet Glob Health 3: e629–638. pmid:26385302
  18. 18. Araujo Navas AL, Hamm NA, Soares Magalhães RJ, Stein A (2016) Mapping soil-transmitted helminths and schistosomiasis under uncertainty: a systematic review and critical appraisal of evidence. PLoS Negl Trop Dis 10: e0005208. pmid:28005901
  19. 19. Truscott JE, Turner HC, Farrell SH, Anderson RM (2016) Soil-transmitted helminths: mathematical models of transmission, the impact of mass drug administration and transmission elimination criteria. Adv Parasitol 94: 133–198. pmid:27756454
  20. 20. Clarke NE, Clements ACA, Doi SA, Wang D, Campbell SJ, et al. (2017) Differential effect of mass deworming and targeted deworming for soil-transmitted helminth control in children: a systematic review and meta-analysis. Lancet 389: 287–297. pmid:27979381
  21. 21. Lockwood DN, Suneetha S (2005) Leprosy: too complex a disease for a simple elimination paradigm. Bull World Health Organ 83: 230–235. pmid:15798849
  22. 22. Hürlimann E, Schur N, Boutsika K, Stensgaard AS, Laserna de Himpsl M, et al. (2011) Toward an open-access global database for mapping, control, and surveillance of neglected tropical diseases. PLoS Negl Trop Dis 5: e1404. pmid:22180793
  23. 23. WHO (2016) Global programme to eliminate lymphatic filariasis: progress report, 2015. Wkly Epidemiol Rec 91: 441–455. pmid:27758091
  24. 24. Keiser J, Utzinger J (2010) The drugs we have and the drugs we need against major helminth infections. Adv Parasitol 73: 197–230. pmid:20627144
  25. 25. Geary TG, Hosking BC, Skuce PJ, von Samson-Himmelstjerna G, Maeder S, et al. (2012) World Association for the Advancement of Veterinary Parasitology (W.A.A.V.P.) guideline: anthelmintic combination products targeting nematode infections of ruminants and horses. Vet Parasitol 190: 306–316.
  26. 26. Leathwick DM, Waghorn TS, Miller CM, Candy PM, Oliver AM (2012) Managing anthelmintic resistance–use of a combination anthelmintic and leaving some lambs untreated to slow the development of resistance to ivermectin. Vet Parasitol 187: 285–294. pmid:22244532
  27. 27. Padmasiri EA, Montresor A, Biswas G, de Silva NR (2006) Controlling lymphatic filariasis and soil-transmitted helminthiasis together in South Asia: opportunities and challenges. Trans R Soc Trop Med Hyg 100: 807–810. pmid:16546228
  28. 28. Montresor A, Gabrielli AF, Chitsulo L, Ichimori K, Mariotti S, et al. (2012) Preventive chemotherapy and the fight against neglected tropical diseases. Expert Rev Anti Infect Ther 10: 237–242. pmid:22339196
  29. 29. Turner HC, Truscott JE, Bettis AA, Shuford KV, Dunn JC, et al. (2015) An economic evaluation of expanding hookworm control strategies to target the whole community. Parasit Vectors 8: 570. pmid:26542226
  30. 30. Flueckiger RM, Nikolay B, Gelderblom HC, Smith JL, Haddad D, et al. (2015) Integrating data and resources on neglected tropical diseases for better planning: the NTD mapping tool ( PLoS Negl Trop Dis 9: e0003400. pmid:25654670
  31. 31. Keiser J, Utzinger J (2008) Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. JAMA 299: 1937–1948. pmid:18430913
  32. 32. Pedrique B, Strub-Wourgaft N, Some C, Olliaro P, Trouiller P, et al. (2013) The drug and vaccine landscape for neglected diseases (2000–11): a systematic assessment. Lancet Glob Health 1: e371–379. pmid:25104602
  33. 33. Panic G, Duthaler U, Speich B, Keiser J (2014) Repurposing drugs for the treatment and control of helminth infections. Int J Parasitol Drugs Drug Resist 4: 185–200. pmid:25516827
  34. 34. Moser W, Schindler C, Keiser J (2017) Efficacy of recommended drugs against soil transmitted helminths: systematic review and network meta-analysis. BMJ 358: j4307. pmid:28947636
  35. 35. Sacko M, De Clercq D, Behnke JM, Gilbert FS, Dorny P, et al. (1999) Comparison of the efficacy of mebendazole, albendazole and pyrantel in treatment of human hookworm infections in the southern region of Mali, West Africa. Trans R Soc Trop Med Hyg 93: 195–203. pmid:10450449
  36. 36. Belew S, Getachew M, Suleman S, Mohammed T, Deti H, et al. (2015) Assessment of efficacy and quality of two albendazole brands commonly used against soil-transmitted helminth infections in school children in Jimma Town, Ethiopia. PLoS Negl Trop Dis 9: e0004057. pmid:26406600
  37. 37. Silber SA, Diro E, Workneh N, Mekonnen Z, Levecke B, et al. (2017) Efficacy and safety of a single-dose mebendazole 500 mg chewable, rapidly-disintegrating tablet for Ascaris lumbricoides and Trichuris trichiura infection treatment in pediatric patients: a double-blind, randomized, placebo-controlled, phase 3 study. Am J Trop Med Hyg 97: 1851–1856. pmid:29016336
  38. 38. WHO (2004). How to add deworming to vitamin A distribution. Available at: (last accessed: 8 June 2018).
  39. 39. Geerts S, Gryseels B (2000) Drug resistance in human helminths: current situation and lessons from livestock. Clin Microbiol Rev 13: 207–222. pmid:10755998
  40. 40. Geerts S, Gryseels B (2001) Anthelmintic resistance in human helminths: a review. Trop Med Int Health 6: 915–921. pmid:11703846
  41. 41. Albonico M, Wright V, Ramsan M, Haji HJ, Taylor M, et al. (2005) Development of the egg hatch assay for detection of anthelminthic resistance in human hookworms. Int J Parasitol 35: 803–811. pmid:15885696
  42. 42. Vercruysse J, Albonico M, Behnke JM, Kotze AC, Prichard RK, et al. (2011) Is anthelmintic resistance a concern for the control of human soil-transmitted helminths? Int J Parasitol Drugs Drug Resist 1: 14–27. pmid:24533260
  43. 43. Humphries D, Simms BT, Davey D, Otchere J, Quagraine J, et al. (2013) Hookworm infection among school age children in Kintampo north municipality, Ghana: nutritional risk factors and response to albendazole treatment. Am J Trop Med Hyg 89: 540–548. pmid:23836564
  44. 44. Humphries D, Nguyen S, Kumar S, Quagraine JE, Otchere J, et al. (2017) Effectiveness of albendazole for hookworm varies widely by community and correlates with nutritional factors: a cross-sectional study of school-age children in Ghana. Am J Trop Med Hyg 96: 347–354. pmid:27895280
  45. 45. Speich B, Ame SM, Ali SM, Alles R, Huwyler J, et al. (2014) Oxantel pamoate-albendazole for Trichuris trichiura infection. N Engl J Med 370: 610–620. pmid:24521107
  46. 46. Palmeirim MS, Hürlimann E, Knopp S, Speich B, Belizario V Jr, et al. (2018) Efficacy and safety of co-administered ivermectin plus albendazole for treating soil-transmitted helminths: a systematic review, meta-analysis and individual patient data analysis. PLoS Negl Trop Dis 12: e0006458. pmid:29702653
  47. 47. Speich B, Moser W, Ali SM, Ame SM, Albonico M, et al. (2016) Efficacy and reinfection with soil-transmitted helminths 18-weeks post-treatment with albendazole-ivermectin, albendazole-mebendazole, albendazole-oxantel pamoate and mebendazole. Parasit Vectors 9: 123. pmid:26935065
  48. 48. WHO (2017). WHO Model List of Essential Medicines. 20th List (March 2017). Available at: (last accessed: 8 June 2018).
  49. 49. Dana D, Mekonnen Z, Emana D, Ayana M, Getachew M, et al. (2015) Prevalence and intensity of soil-transmitted helminth infections among pre-school age children in 12 kindergartens in Jimma Town, southwest Ethiopia. Trans R Soc Trop Med Hyg 109: 225–227. pmid:25371496
  50. 50. Medley GF, Turner HC, Baggaley RF, Holland C, Hollingsworth TD (2016) The role of more sensitive helminth diagnostics in mass drug administration campaigns: elimination and health impacts. Adv Parasitol 94: 343–392. pmid:27756457
  51. 51. Hawkins KR, Cantera JL, Storey HL, Leader BT, de los Santos T (2016) Diagnostic tests to support late-stage control programs for schistosomiasis and soil-transmitted helminthiases. PLoS Negl Trop Dis 10: e0004985. pmid:28005900
  52. 52. Nikolay B, Brooker SJ, Pullan RL (2014) Sensitivity of diagnostic tests for human soil-transmitted helminth infections: a meta-analysis in the absence of a true gold standard. Int J Parasitol 44: 765–774. pmid:24992655
  53. 53. Mekonnen Z, Meka S, Ayana M, Bogers J, Vercruysse J, et al. (2013) Comparison of individual and pooled stool samples for the assessment of soil-transmitted helminth infection intensity and drug efficacy. PLoS Negl Trop Dis 7: e2189. pmid:23696905
  54. 54. Kure A, Mekonnen Z, Dana D, Bajiro M, Ayana M, et al. (2015) Comparison of individual and pooled stool samples for the assessment of intensity of Schistosoma mansoni and soil-transmitted helminth infections using the Kato-Katz technique. Parasit Vectors 8: 489. pmid:26400064
  55. 55. Vlaminck J, Levecke B, Vercruysse J, Geldhof P (2014) Advances in the diagnosis of Ascaris suum infections in pigs and their possible applications in humans. Parasitology 141: 1904–1911. pmid:24775944
  56. 56. Vlaminck J, Supali T, Geldhof P, Hokke CH, Fischer PU, et al. (2016) Community rates of IgG4 antibodies to Ascaris haemoglobin reflect changes in community egg loads following mass drug administration. PLoS Negl Trop Dis 10: e0004532. pmid:26991326
  57. 57. Papaiakovou M, Pilotte N, Baumer B, Grant J, Asbjornsdottir K, et al. (2018) A comparative analysis of preservation techniques for the optimal molecular detection of hookworm DNA in a human fecal specimen. PLoS Negl Trop Dis 12: e0006130. pmid:29346412
  58. 58. Lo NC, Addiss DG, Hotez PJ, King CH, Stothard JR, et al. (2017) A call to strengthen the global strategy against schistosomiasis and soil-transmitted helminthiasis: the time is now. Lancet Infect Dis 17: e64–e69. pmid:27914852
  59. 59. Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P (2015) Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance. Cochrane Database Syst Rev: CD000371. pmid:26202783
  60. 60. Welch VA, Ghogomu E, Hossain A, Awasthi S, Bhutta ZA, et al. (2017) Mass deworming to improve developmental health and wellbeing of children in low-income and middle-income countries: a systematic review and network meta-analysis. Lancet Glob Health 5: e40–e50. pmid:27955788
  61. 61. de Silva N, Ahmed BN, Casapia M, de Silva HJ, Gyapong J, et al. (2015) Cochrane reviews on deworming and the right to a healthy, worm-free life. PLoS Negl Trop Dis 9: e0004203. pmid:26492484
  62. 62. Montresor A, Addiss D, Albonico M, Ali SM, Ault SK, et al. (2015) Methodological bias can lead the Cochrane collaboration to irrelevance in public health decision-making. PLoS Negl Trop Dis 9: e0004165. pmid:26492178
  63. 63. Anderson RM, Turner HC, Truscott JE, Hollingsworth TD, Brooker SJ (2015) Should the goal for the treatment of soil-transmitted helminth (STH) infections be changed from morbidity control in children to community-wide transmission elimination? PLoS Negl Trop Dis 9: e0003897. pmid:26291538
  64. 64. Knopp S, Stothard JR, Rollinson D, Mohammed KA, Khamis IS, et al. (2013) From morbidity control to transmission control: time to change tactics against helminths on Unguja Island, Zanzibar. Acta Trop 128: 412–422. pmid:21586268
  65. 65. Brooker SJ, Mwandawiro CS, Halliday KE, Njenga SM, McHaro C, et al. (2015) Interrupting transmission of soil-transmitted helminths: a study protocol for cluster randomised trials evaluating alternative treatment strategies and delivery systems in Kenya. BMJ Open 5: e008950. pmid:26482774
  66. 66. Hong ST, Chai JY, Choi MH, Huh S, Rim HJ, et al. (2006) A successful experience of soil-transmitted helminth control in the Republic of Korea. Korean J Parasitol 44: 177–185. pmid:16969055
  67. 67. Bleakley H (2007) Disease and development: evidence from hookworm eradication in the American South. Q J Econ 122: 73–117. pmid:24146438
  68. 68. Bundy DAP, Walson JL, Watkins KL (2013) Worms, wisdom, and wealth: why deworming can make economic sense. Trends Parasitol 29: 142–148. pmid:23332661
  69. 69. Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, et al. (2014) Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS Med 11: e1001620. pmid:24667810
  70. 70. Freeman MC, Ogden S, Jacobson J, Abbott D, Addiss DG, et al. (2013) Integration of water, sanitation, and hygiene for the prevention and control of neglected tropical diseases: a rationale for inter-sectoral collaboration. PLoS Negl Trop Dis 7: e2439. pmid:24086781
  71. 71. WHO (2015). Water, sanitation and hygiene for accelerating and sustaining progress on neglected tropical diseases. A global strategy 2015–2020. Available at: (last accessed: 8 June 2018).
  72. 72. Emerson P, Kollmann M, MacArthur C, Bush S, Haddad D (2012) SAFE strategy for blinding trachoma addresses sanitation, the other half of MDG7. Lancet 380: 27–28.
  73. 73. King JD, Endeshaw T, Escher E, Alemtaye G, Melaku S, et al. (2013) Intestinal parasite prevalence in an area of Ethiopia after implementing the SAFE strategy, enhanced outreach services, and health extension program. PLoS Negl Trop Dis 7: e2223. pmid:23755308
  74. 74. Echazú A, Bonanno D, Juarez M, Cajal SP, Heredia V, et al. (2015) Effect of poor access to water and sanitation as risk factors for soil-transmitted helminth infection: selectiveness by the infective route. PLoS Negl Trop Dis 9: e0004111. pmid:26421865
  75. 75. Gustavsen K, Hopkins A, Sauerbrey M (2011) Onchocerciasis in the Americas: from arrival to (near) elimination. Parasit Vectors 4: 205. pmid:22024050
  76. 76. Ichimori K, King JD, Engels D, Yajima A, Mikhailov A, et al. (2014) Global programme to eliminate lymphatic filariasis: the processes underlying programme success. PLoS Negl Trop Dis 8: e3328. pmid:25502758
  77. 77. WHO (2012) Helminth control in school-age children: a guide for managers of control programmes. Available at: (last accessed: 8 June 2018).
  78. 78. Levecke B, Montresor A, Albonico M, Ame SM, Behnke JM, et al. (2014) Assessment of anthelmintic efficacy of mebendazole in school children in six countries where soil-transmitted helminths are endemic. PLoS Negl Trop Dis 8: e3204. pmid:25299391
  79. 79. Echazú A, Juarez M, Vargas PA, Cajal SP, Cimino RO, et al. (2017) Albendazole and ivermectin for the control of soil-transmitted helminths in an area with high prevalence of Strongyloides stercoralis and hookworm in northwestern Argentina: a community-based pragmatic study. PLoS Negl Trop Dis 11: e0006003. pmid:28991899
  80. 80. Moser W, Coulibaly JT, Ali SM, Ame SM, Amour AK, et al. (2017) Efficacy and safety of tribendimidine, tribendimidine plus ivermectin, tribendimidine plus oxantel pamoate, and albendazole plus oxantel pamoate against hookworm and concomitant soil-transmitted helminth infections in Tanzania and Côte d'Ivoire: a randomised, controlled, single-blinded, non-inferiority trial. Lancet Infect Dis 17: 1162–1171. pmid:28864027
  81. 81. Katz N, Chaves A, Pellegrino J (1972) A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop São Paulo 14: 397–400. pmid:4675644
  82. 82. Utzinger J, Becker SL, van Lieshout L, van Dam GJ, Knopp S (2015) New diagnostic tools in schistosomiasis. Clin Microbiol Infect 21: 529–542. pmid:25843503
  83. 83. Coulibaly JT, Ouattara M, Becker SL, Lo NC, Keiser J, et al. (2016) Comparison of sensitivity and faecal egg counts of Mini-FLOTAC using fixed stool samples and Kato-Katz technique for the diagnosis of Schistosoma mansoni and soil-transmitted helminths. Acta Trop 164: 107–116. pmid:27591137
  84. 84. Godber OF, Phythian CJ, Bosco A, Ianniello D, Coles G, et al. (2015) A comparison of the FECPAK and Mini-FLOTAC faecal egg counting techniques. Vet Parasitol 207: 342–345. pmid:25579397
  85. 85. Hoekendijk DJ, Hill PC, Sowerby SJ (2016) Rationale for quality assurance in fecal egg monitoring of soil-transmitted helminthiasis. Am J Trop Med Hyg 95: 502–504. pmid:27352875
  86. 86. Cringoli G, Maurelli MP, Levecke B, Bosco A, Vercruysse J, et al. (2017) The Mini-FLOTAC technique for the diagnosis of helminth and protozoan infections in humans and animals. Nat Protoc 12: 1723–1732. pmid:28771238
  87. 87. Bosco A, Rinaldi L, Maurelli MP, Musella V, Coles GC, et al. (2014) The comparison of FLOTAC, FECPAK and McMaster techniques for nematode egg counts in cattle. Acta Parasitol 59: 625–628. pmid:25236271
  88. 88. Cooke IR, Laing CJ, White LV, Wakes SJ, Sowerby SJ (2015) Analysis of menisci formed on cones for single field of view parasite egg microscopy. J Microsc 257: 133–141. pmid:25384843
  89. 89. Moser W, Bärenbold O, Mirams GJ, Cools P, Vlaminck J, et al. (2018) Diagnostic comparison between FECPAKG2 and the Kato-Katz method for analyzing soil-transmitted helminth eggs in stool. PLoS Negl Trop Dis. 12: e0006562. pmid:29864132
  90. 90. George S, Geldhof P, Albonico M, Ame SM, Bethony JM, et al. (2016) The molecular speciation of soil-transmitted helminth eggs collected from school children across six endemic countries. Trans R Soc Trop Med Hyg 110: 657–663. pmid:28100811
  91. 91. Crannell ZA, Cabada MM, Castellanos-Gonzalez A, Irani A, White AC, et al. (2015) Recombinase polymerase amplification-based assay to diagnose Giardia in stool samples. Am J Trop Med Hyg 92: 583–587. pmid:25510713
  92. 92. Cabada MM, Malaga JL, Castellanos-Gonzalez A, Bagwell KA, Naeger PA, et al. (2017) Recombinase polymerase amplification compared to real-time polymerase chain reaction test for the detection of Fasciola hepatica in human stool. Am J Trop Med Hyg 96: 341–346. pmid:27821691
  93. 93. Mugambi RM, Agola EL, Mwangi IN, Kinyua J, Shiraho EA, et al. (2015) Development and evaluation of a loop-mediated isothermal amplification (LAMP) technique for the detection of hookworm (Necator americanus) infection in fecal samples. Parasit Vectors 8: 574. pmid:26546069
  94. 94. Rashwan N, Diawara A, Scott ME, Prichard RK (2017) Isothermal diagnostic assays for the detection of soil-transmitted helminths based on the SmartAmp2 method. Parasit Vectors 10: 496. pmid:29047387