在莫桑比克莫皮亚设计用于治疗头虱疟疾的伊维菌素大规模给药的附带效益:一项聚类随机对照试验。

IF 5.5 1区 医学
Joanna Furnival-Adams, Amelia Houana, Patricia Nicolas, Julia Montaña, Samuel Martinho, Aina Casellas, Hansel Mundaca, Jenisse Mbanze, Arlindo Soares, Saimado Imputiua, Paula Ruiz-Castillo, Marta Ribes, Almudena Sanz, Mussa Mamudo Salé, Antonio Macucha, Eldo Elobolobo, Vegovito Vegove, Victor Mutepa, Humberto Munguambe, Aida Xerinda, Felisbela Materula, Regina Rabinovich, Francisco Saute, Carlos Chaccour
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引用次数: 0

摘要

背景:头虱在世界范围内普遍存在,在农村和中低收入地区负担更重。它们会引起强烈的瘙痒、不适和继发性细菌感染,并可能带来严重的后果。伊维菌素对头虱有效,作为疟疾病媒控制工具也正在进行评估。在本研究中,我们探讨了头虱的危险因素,并评估了设计用于疟疾的伊维菌素大规模药物给药(MDA)对头虱的疗效。方法:我们在莫桑比克莫佩亚进行了一项开放标签、评估盲、集群随机对照试验。在雨季,连续3个月,按月给予符合条件的人或人畜单剂伊维菌素(人:400 μg/kg,牲畜:1%可注射200 μg/kg)。对照组给予阿苯达唑(仅限人类)。随机选择39个组(每组13个)进行头虱患病率的巢式评估。1341名接受治疗的参与者在第一轮MDA治疗后的3个月和6个月至少随访一次、1个月、2个月和3个月,382名未接受治疗(不合格)的参与者在第一轮MDA治疗后的3个月和6个月随访。头虱诊断通过头皮检查确定。采用Logistic回归在基线时确定头虱的危险因素,并估计每个时间点的治疗效果。结果:评估伊维菌素MDA疗效的主分析共纳入1309人,风险因素分析共纳入1332人。头虱的基线患病率为11%。危险因素包括与患有头痒的家庭成员一起生活[调整优势比(aOR) = 48.63, 95%可信区间(CI): 28.7-82.3, p值]结论:在高度流行的环境中,大量使用伊维菌素的患者连续三个月服用该药物可显著降低头虱的发病率。在未经治疗的不符合条件的儿童中缺乏效果意味着需要额外的干预措施来中断当地传播。试验注册:本研究已在ClinicalTrials.gov注册(NCT04966702)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Collateral benefits of ivermectin mass drug administration designed for malaria against headlice in Mopeia, Mozambique: a cluster randomised controlled trial.

Collateral benefits of ivermectin mass drug administration designed for malaria against headlice in Mopeia, Mozambique: a cluster randomised controlled trial.

Collateral benefits of ivermectin mass drug administration designed for malaria against headlice in Mopeia, Mozambique: a cluster randomised controlled trial.

Background: Headlice are prevalent worldwide, with a higher burden in rural, lower-middle income settings. They can cause intense itchiness, discomfort, and secondary bacterial infections with potentially serious consequences. Ivermectin is efficacious against headlice, and is also being evaluated as a malaria vector control tool. In this study, we explored risk factors for headlice, and assessed the efficacy of ivermectin mass drug administration (MDA) designed for malaria against headlice.

Methods: We conducted an open-label, assessor-blind, cluster-randomized controlled trial in Mopeia, Mozambique. A single dose of ivermectin was given monthly to eligible humans or humans and livestock (humans: 400 μg/kg, livestock: 1% injectable 200 μg/kg) in 3 consecutive months during the rainy season. The control group received albendazole (humans only). Thirty-nine clusters (13 per arm) were randomly selected for the nested assessment of headlice prevalence. 1341 treated participants were followed up at least once, 1, 2 and 3 months and 382 untreated (ineligible) participants at 3 and 6 months after the first MDA round. Headlice diagnosis was determined by scalp examination. Logistic regression was used to identify risk factors for headlice at baseline, and to estimate the treatment effect at each time point.

Results: A total of 1309 participants were included in the main analysis assessing ivermectin MDA efficacy, and 1332 in the risk factor analysis. The baseline headlice prevalence was 11%. Risk factors included living with a household member with head itch [adjusted odds ratio (aOR) = 48.63, 95% confidence interval (CI): 28.7-82.3, P-value < 0.0001], being female (aOR = 2.25, 95% CI: 1.33-3.80, P-value < 0.01), and using surface water as the main water (aOR = 2.37, 95% CI: 1.12-5.33, P-value = 0.04). The treated population receiving ivermectin had significantly lower odds of having headlice at 3 months compared to those receiving albendazole (aOR = 0.19, 95% CI: 0.04-0.91, P-value = 0.04). There was no indirect effect on headlice among children ineligible for treatment.

Conclusions: In a highly endemic setting, mass drug administration with ivermectin significantly reduces headlice infestation prevalence among those who receive the drug for three sequential months. The lack of effect among untreated, ineligible children implies that additional interventions would be needed to interrupt local transmission.

Trial registration: This study is registered with ClinicalTrials.gov (NCT04966702).

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来源期刊
Infectious Diseases of Poverty
Infectious Diseases of Poverty INFECTIOUS DISEASES-
自引率
1.20%
发文量
368
期刊介绍: Infectious Diseases of Poverty is an open access, peer-reviewed journal that focuses on addressing essential public health questions related to infectious diseases of poverty. The journal covers a wide range of topics including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. It also considers the transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology. The journal aims to identify and assess research and information gaps that hinder progress towards new interventions for public health problems in the developing world. Additionally, it provides a platform for discussing these issues to advance research and evidence building for improved public health interventions in poor settings.
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