Correspondence

highest sensitivity so far, is currently techniques, such as the Baermann Johnson and GSK, outside the submitted work.
widely avail­able and used.3 PCR, too, stool concentration or Koga agar PMJ is a consultant at the Department of
Maternal, Newborn, Child and Adolescent Health at
despite some concerns about its plate culture, are often needed to WHO. PHLL was a consultant on WHO’s 2016
sensitivity, has been increasingly used confirm diagnosis. We agree that schistosomiasis and soil-transmitted helminths
as a routine diagnostic tool. However, more sensitive tests for S stercoralis, strategy. All other authors declare no competing
interests.
the method has been validated on including serologic assays and PCR,
stool and it has been tested only should be used when available. Peter M Jourdan, *Poppy H L Lamberton,
occasionally on other body fluids.3,4 However, it is also our understanding Alan Fenwick, David G Addiss
Stool examination is not a sufficiently that despite the increasing use of such poppy.lamberton@glasgow.ac.uk
accurate tool for follow-up either, and tests, they are still not widely used as Schistosomiasis Control Initiative (PMJ, AF) and
Department of Infectious Disease Epidemiology
at the least the Baermann method routine diagnostic tools in most STH-
(PHLL), Imperial College London, St Mary’s Campus,
and Koga agar plate culture should be endemic areas. As an overview for London, UK; DEWORM3, Natural History Museum,
used to confirm response to treatment, clinicians and public health scientists, London, UK (PMJ); Norwegian Centre for Imported
when serology is not available.3 Finally, in both low-income and high-income and Tropical Diseases, Department of Infectious
Diseases, Oslo University Hospital, Ullevål, Oslo,
it must be stressed that albendazole has settings, our Seminar aimed to Norway (PMJ); Institute of Biodiversity, Animal
poor (if any) effectiveness;5 hence, it is balance state-of-the-art diagnostic Health and Comparative Medicine, and Wellcome
not a valid alternative, although it is and treatment options with the often Centre for Molecular Parasitology, University of
Glasgow, Glasgow G12 8QQ, UK (PHLL); The Task
frequently suggested as such. poor availability OF and accessibility Force for Global Health, Decatur, GA, USA (DGA);
We declare no competing interests. to health services in endemic areas. and Eck Institute for Global Health, University of
We further agree with Buonfrate Notre Dame, Notre Dame, IN, USA (DGA)
*Dora Buonfrate, Federico Gobbi,
Andrea Angheben, Zeno Bisoffi and colleagues that ivermectin 1 Jourdan PM, Lamberton PHL, Fenwick A,
Addiss DG. Soil-transmitted helminth
dora.buonfrate@sacrocuore.it is the first choice of treatment infections. Lancet 2018; 391: 252–65.
for strongyloidiasis. However, in 2 Henriquez-Camacho C, Gotuzzo E, Echevarria J,
Centre for Tropical Diseases, Sacro Cuore et al. Ivermectin versus albendazole or
Don Calabria Hospital, Negrar, Verona 37024, Italy endemic settings where ivermectin
thiabendazole for Strongyloides stercoralis
1 Jourdan PM, Lamberton PHL, Fenwick A,
and thiabendazole are sometimes infection. Cochrane Database Syst Rev 2016;
Addis DG. Soil-transmitted helminth infections. not available, evidence suggests 1: CD007745.
Lancet 2017; 391: 252–65. 3 WHO. Guideline—alternative mass drug
that treatment with albendazole is administration regimens to eliminate
2 Albonico M, Becker SL, Odermatt P, et al.
StrongNet: an International network to superior to no treatment.2 lymphatic filariasis. Geneva: World Health
improve diagnostics and access to treatment The authors rightly underscore the Organization, 2017.
for strongyloidiasis control. PLoS Negl Trop Dis 4 Mectizan Donation Program. Mectizan
2016; 10: e0004898.
clinical and public health import­ Donation Program expanded to reach
3 Requena-Mendez A, Chiodini P, Bisoffi Z, ance of strongyloidiasis, the need additional 100 million people annually for
lymphatic filariasis in support of new,
Buonfrate D, Gotuzzo E, Munoz J. for sensitive diagnostic tests, and evidence-based WHO guidelines. Dec 19, 2017.
The laboratory diagnosis and follow up of
strongyloidiasis: a systematic review. the superior treat­m ent efficacy of https://www.mectizan.org/news/mectizan-
PLoS Negl Trop Dis 2013; 7: e2002. ivermectin. In this regard, we applaud donation-program-expanded-to-reach-
4 Nadir E, Grossman T, Ciobotaro P, et al. additional-100-million-people-annually-for
the recent WHO recommend­ (accessed April 30, 2018).
Real-time PCR for Strongyloides
stercoralis-associated meningitis. ation to include ivermectin in a
Diagn Microbiol Infect Dis 2016; 84: 197–99. triple-drug regimen for prevent­
5 Henriquez-Camacho C, Gotuzzo E, Echevarria J,
et al. Ivermectin versus albendazole or
ive chemotherapy for lymphatic Transparency in
filariasis, 3 and the subsequent ex­
thiabendazole for Strongyloides stercoralis
infection. Cochrane Database Syst Rev 2016; pansion by Merck of its Mectizan
continuing medical
18: CD007745.
Donation Program to support this education
recommendation. 4 In addition
Authors’ reply to hastening the elimination of In their Comment,1 Ladan Golestaneh
We thank Dora Buonfrate and lymphatic filariasis, the collateral and Ethan Cowan (Nov 11, p 2128)
noipornpan/iStock

colleagues for their interest in benefits of this regimen against question the integrity of continuing
our Seminar on soil-transmitted strongyloidiasis are likely to be medical education (CME) courses
helminth (STH) infections. 1 We substantial. However, control of that are accredited by CME providers.
appreciate their highlighting the strongyloidiasis worldwide will We believe their Comment conveys
importance of strongyloidiasis, which require an adequate supply of inaccuracies about joint providership,
is often overlooked because of the effective drugs as well as improved which we discuss below.
poor sensitivity of standard stool mapping of endemic areas to guide Joint providership, which has
examinations to detect Strongyloides their administration. been an established process for
stercoralis. For this reason, we noted DGA reports personal fees from Janssen, and more than 25 years, gives accredited
in the Seminar that more sensitive previous organisational support from Johnson & organisations the opportunity to

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