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University of Basel

Worm infections in developing countries: veterinary drugs improve the health of school children

A new study by the Swiss Tropical and Public Health Institute, published in the New England Journal of Medicine, reveals that the health of millions of children with worm infections could be improved thanks to a veterinary drug. The study represents a vital contribution in the fight against worm infections – still largely neglected – in developing countries.

13 February 2014

Field research in East Africa:

School children are investigated for worm infection on the island of Pemba, Tanzania.

Around one third of the children were free from worm infections after a combined treatment with a standard substance and a drug used in veterinary medicine. (Top center: Jennifer Keiser, head of the study. Images: Swiss TPH)

Hookworms and whipworms are detrimental to health. Children in many developing countries in particular are prone to regular infection via contaminated soil due to a lack of latrines and clean water. Whipworm eggs enter the body via the gastrointestinal tract and evolve over several development stages. To contain the health risks of worm infections, the World Health Organization (WHO) recommends annual deworm treatment for children and at-risk groups (such as field hands and miners). However, the recommended standard treatment appears to have little effect against the widespread whipworm

(Trichuris trichiura).

“We remembered that there was an effective deworming drug used in veterinary medicine,” says head of the study Jennifer Keiser, from the Swiss Tropical and Public Health Institute, which is associated with the University of Basel. Following a preliminary study in the laboratory, her group tested the veterinary treatment ‘Oxantel Pamoate’ in combination with the standard treatment, Albendazole. The randomised double-blind trial with school children with worm infections took place on the East African island of Pemba (Tanzania). After one treatment with this combination therapy, 31% of the children were free of worm infections. The number of worm eggs in the children’s stools decreased by 96% after one treatment.

Veterinary medicine for neglected worm infections

Oxantel Pamoate was developed in the 1970s to combat whipworm. Today, it is widely used in veterinary deworming drugs in combination with other substances. Studies in the 1970s showed that Oxantel Pamoate is also a safe and effective way of tackling whipworm infections in humans. Yet, the drug was soon forgotten about and was never widely used for humans.

“Health experts in the field of worm infections have been discussing its use for some years now,” says Jennifer Keiser: “The problem was the availability of the active ingredient as a single substance.” The veterinary medicine manufacturers did not want to release the drug for human clinical trials and the drug is not commercially available.

Successful collaboration with pharmacists at the University of Basel

The solution was found during a collaboration with pharmacists at the University of Basel. Jörg Huwyler’s laboratory in the Centre for Pharmaceutical Sciences succeeded in producing a tablet whose taste and color were attractive to children. Thanks to this expertise, it was possible to develop the substance entirely independently of the pharmaceutical industry.

Drug doses and delivery are currently being improved in further clinical trials. On the strength of the study, the WHO could extend its recommendation to include this substance in future. This would improve the health of millions of children worldwide.

The study was financed by the Swiss National Science Foundation and the Medicor Foundation.

Original Article

Benjamin Speich, M.Sc., Shaali M. Ame, M.Sc., Said M. Ali, M.Sc., Rainer Alles, Ph.D., Jörg Huwyler, Ph.D., Jan Hattendorf, Ph.D., Jürg Utzinger, Ph.D., Marco Albonico, M.D., Ph.D., and Jennifer Keiser, Ph.D.

Oxantel Pamoate–Albendazole for Trichuris trichiura Infection

N Engl J Med 2014; 370:610-620 | February 13, 2014 | doi: 10.1056/NEJMoa1301956

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