Table 1.

Summary of SCORE’s six key findings and related key messages

	Key findings of SCORE	Key messages of SCORE
1	Four years of school-based treatment and/or community-wide treatment MDA with PZQ—biannually, annually, or biennially—is effective in reducing average Schistosoma prevalence and the intensity of infection.	Biennial MDA through school and/or communities is sufficient to reach a programmatic goal of moderate prevalence of infection.
		Biennial MDA is insufficient to reach low prevalence of infection.
2	No SCORE MDA regimens eliminated Schistosoma transmission within 5–6 years.	MDA alone will not achieve a programmatic goal of elimination of transmission in most settings.
3	All MDA regimens in the SCORE gaining control and sustaining control studies left at least 30% of the study villages in all study arms as persistent hotspots. (PHSs) these PHS villages, by definition, failed to decrease as expected in prevalence and intensity following multiple years of MDA.	A programmatic goal to gain and sustain control of schistosomiasis in all villages receiving MDA should identify persistent hotspots following 2 years of annual MDA through an epidemiologic assessment.
	Monitoring outcomes to assess if villages are likely to be PHS versus responder villages is feasible as soon as a year after 2 years of annual MDAs.	On identification of PHSs, interventions should be adjusted, for example, more intensive MDA and/or complementary interventions to drive down the prevalence and intensity of the PHS. Continued research is needed to evaluate these options. Efforts can be maintained, adapted, or possibly decreased in responder villages.
4	If a village starts with ≥ 25% prevalence, then over 4 years, annual MDA is (i) more effective at reducing prevalence and intensity than 2 years of MDA (biennial) and (ii) leaves fewer PHSs than biennial MDA.	A program will be most effective at reducing prevalence and intensity of infection and lowering the number of PHS villages with annual MDA.
5	Both control of morbidity and elimination as a public health problem goal28 based on the percent prevalence of heavy infection are achieved through MDA.	Current WHO definitions of control of morbidity and elimination as a public health problem based on intensities of infection are inappropriate for determining success related to changes in infection.
	Often, in areas with established moderate-to-high prevalence, these goals defined by the prevalence of heavy intensity are fulfilled even before any MDA, and, thus, need to be redefined.	For programs to determine success of their efforts to control and/or eliminate schistosomiasis, new targets, which are evidence-based, urgently need to be defined.
6	Use of the point-of-care circulating cathodic antigen (POC-CCA) urine assay for S. mansoni finds more low-intensity infections in low-to-moderate prevalence areas than the standard parasitologic methods.	The POC-CCA urine assay for S. mansoni is an appropriate tool for epidemiologic assessments (i.e., mapping and impact assessment) in areas of low-to-moderate prevalence (5–40% by Kato–Katz) to prevent undertreatment.
	The POC-CCA yields some false positives, especially in areas where prevalence is extremely low (i.e., < 5%).	POC-CCA cannot be used as a diagnostic tool to determine interruption of transmission (elimination).

MDA = mass drug administration; PHS = persistent hotspot; POC-CCAs = point-of-care circulating cathodic antigen assays; PZQ = praziquantel; SCORE = Schistosomiasis Consortium for Operational Research and Evaluation.