伊维菌素对盘尾丝虫病传播的影响:评估反复伊维菌素大规模治疗可能导致西非消灭/根除盘尾丝虫病的经验证据

Gerard JJM Borsboom, Boakye A Boatin, Nico JD Nagelkerke, Hyacinthe Agoua, Komlan LB Akpoboua, E William Soumbey Alley, Yeriba Bissan, Alfons Renz, Laurent Yameogo, Jan HF Remme, J Dik F Habbema
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引用次数: 117

摘要

背景:西非盘尾丝虫病控制规划(OCP)已于2002年底结束。随后的所有控制将移交给参与国,并几乎完全以伊维菌素定期大规模治疗为基础。这就产生了一个问题,即利用这一至关重要的战略能否消除感染或根除盘尾丝虫病。本研究旨在探讨这一问题。方法:采用实证方法,对十多年来伊维菌素治疗对盘尾丝虫病感染和传播影响的现有数据进行全面分析。回顾了东部太平洋地区14个流域和喀麦隆一个流域的相关昆虫学和流行病学数据。根据治疗频率(6个月或每年)、流行程度和媒介控制等额外控制措施来区分地区。根据流行病学和昆虫学参数对结果进行评估,并使用治疗率和地理覆盖率作为投入的衡量标准。结果:在所研究的所有流域中,伊维菌素治疗显著降低了感染率和感染强度。然而,在伊维菌素治疗10-12年后,在一些流域仍在发生重大传播。在其他盆地,传播可能已经中断,但这需要通过深入评价加以证实。在一个中流行盆地,经过20轮4个月的治疗,感染流行率降至2-3%,但在中断治疗后的几年内,感染明显复发。结论:伊维菌素治疗在消除盘尾丝虫病这一公共卫生问题方面非常成功。然而,本文提出的结果几乎可以肯定,反复的伊维菌素大规模治疗不会导致消除西非盘尾丝虫病的传播。6个月治疗的数据不足以得出明确的结论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Impact of ivermectin on onchocerciasis transmission: assessing the empirical evidence that repeated ivermectin mass treatments may lead to elimination/eradication in West-Africa.

Impact of ivermectin on onchocerciasis transmission: assessing the empirical evidence that repeated ivermectin mass treatments may lead to elimination/eradication in West-Africa.

Impact of ivermectin on onchocerciasis transmission: assessing the empirical evidence that repeated ivermectin mass treatments may lead to elimination/eradication in West-Africa.

Impact of ivermectin on onchocerciasis transmission: assessing the empirical evidence that repeated ivermectin mass treatments may lead to elimination/eradication in West-Africa.

BACKGROUND: The Onchocerciasis Control Program (OCP) in West Africa has been closed down at the end of 2002. All subsequent control will be transferred to the participating countries and will almost entirely be based on periodic mass treatment with ivermectin. This makes the question whether elimination of infection or eradication of onchocerciasis can be achieved using this strategy of critical importance. This study was undertaken to explore this issue. METHODS: An empirical approach was adopted in which a comprehensive analysis was undertaken of available data on the impact of more than a decade of ivermectin treatment on onchocerciasis infection and transmission. Relevant entomological and epidemiological data from 14 river basins in the OCP and one basin in Cameroon were reviewed. Areas were distinguished by frequency of treatment (6-monthly or annually), endemicity level and additional control measures such as vector control. Assessment of results were in terms of epidemiological and entomological parameters, and as a measure of inputs, therapeutic and geographical coverage rates were used. RESULTS: In all of the river basins studied, ivermectin treatment sharply reduced prevalence and intensity of infection. Significant transmission, however, is still ongoing in some basins after 10-12 years of ivermectin treatment. In other basins, transmission may have been interrupted, but this needs to be confirmed by in-depth evaluations. In one mesoendemic basin, where 20 rounds of four-monthly treatment reduced prevalence of infection to levels as low as 2-3%, there was significant recrudescence of infection within a few years after interruption of treatment. CONCLUSIONS: Ivermectin treatment has been very successful in eliminating onchocerciasis as a public health problem. However, the results presented in this paper make it almost certain that repeated ivermectin mass treatment will not lead to the elimination of transmission of onchocerciasis from West Africa. Data on 6-monthly treatments are not sufficient to draw definitive conclusions.

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