Questionable benefit of single-dose anthelmintic treatment during pregnancy

January 01, 0001

Questionable benefit of single-dose anthelmintic treatment during pregnancy

Helminth infections affect the human immune response. The researchers from Uganda and the UK investigated whether prenatal exposure to and treatment of maternal helminth infections affects development of an infant's immune response to immunisations and unrelated infections. In this randomised, double-blind, placebo-controlled trial, they enrolled 2507 women in the second or third trimester of pregnancy who were planning to deliver in Entebbe General Hospital, Entebbe, Uganda. They randomly assigned patients to 440 mg albendazole and 40 mg/kg praziquantel (n=628), 440 mg albendazole and a praziquantel-matching placebo (n=625), 40 mg/kg praziquantel and an albendazole-matching placebo (n=626), or an albendazole-matching placebo and praziquantel- matching placebo (n=628). All participants and hospital staff were masked to allocation. Data were available at delivery for 2356 women, with 2345 livebirths; 2115 (90%) of liveborn infants remained in follow-up at 1 year of age.

Neither albendazole nor praziquantel treatments affected infant response to BCG, tetanus, or measles immunisation. However, in infants of mothers with hookworm infection, albendazole treatment reduced interleukin-5 (geometric mean ratio 0·50) and interleukin-13 (0·52, both significant) response to tetanus toxoid. The rate per 100 person- years of malaria was 40·9, of diarrhoea was 134·1 and of pneumonia was 22·3. They noted no effect on infectious disease incidence for albendazole treatment (malaria hazard ratio 0·95, diarrhoea 1·06, pneumonia 1·11) or praziquantel treatment (malaria 1·00, diarrhoea 1·07, pneumonia 1·00). In HIV- exposed infants, 39 (18%) were infected at 6 weeks; vertical transmission was not associated with albendazole (odds ratio 0·70) or praziquantel (0·60) treatment.

The researchers concluded: "These results do not accord with the recently advocated policy of routine antenatal anthelmintic treatment, and the value of such a policy may need to be reviewed."

An interesting example of EBM differing from public health policy … let’s see what is done with it.

For the full abstract, click here.

The Lancet 1 January 2011 377(9759):52-62
© 2011 Elsevier Limited
Effect of single-dose anthelmintic treatment during pregnancy on an infant's response to immunisation and on susceptibility to infectious diseases in infancy: a randomised, double-blind, placebo-controlled trial. Emily L Webb, Patrice A Mawa, Juliet Ndibazza et al. Correspondence to Emily Webb: [email protected]

Category: Keywords: antihelmintic treatment, pregnancy, immunization, response, infectious diseases, susceptibility, infancy, randomised, double-blind, placebo-controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 21 January 2011

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