Prospects for elimination of soil-transmitted helminths.
Prospects for elimination of soil-transmitted helminths.
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DOI：
10.1097/qco.0000000000000395
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发表时间：
2017-10
影响因子：
3.9
通讯作者：
Walson JL
中科院分区：
文献类型：
--
作者：
Ásbjörnsdóttir KH;Means AR;Werkman M;Walson JL
土壤传播蠕虫（STH）在120个国家流行，并与大量的发病率和经济生产力的损失。尽管世卫组织目前的指导方针侧重于通过大规模药物管理（MDA）控制发病率，但全球关注的是，在某些情况下，以消除疾病为目标的战略是否可行。本文综述了从控制转向消除策略的前景。STH控制工作降低了目标人群的感染强度，从而降低了发病率。然而，成人并不经常成为目标，仍然是接受治疗的儿童再次感染的重要宿主。最近的模型表明，传输中断可能是通过扩大社区范围内的MDA，其可行性已被证明其他程序的交付。然而，这些模式表明，必须实现高水平的覆盖率和合规性。潜在的挑战包括过早取消STH计划的风险和抗蠕虫药耐药性的潜在增加风险。消除性病可能提供一个机会，以消除大量性病相关的发病率，同时减少被忽视的热带病项目的资源需求。需要从大型社区试验中获得证据，以确定在某些地理环境中阻断STH传播的可行性。
Soil-transmitted helminths (STH) are endemic in 120 countries and are associated with substantial morbidity and loss of economic productivity. Although current WHO guidelines focus on morbidity control through mass drug administration (MDA), there is global interest in whether a strategy targeting disease elimination might be feasible in some settings. This review summarizes the prospects for switching from control to an elimination strategy. STH control efforts have reduced the intensity of infections in targeted populations with associated reductions in morbidity. However, adults are not frequently targeted and remain important reservoirs for reinfection of treated children. Recent modeling suggests that transmission interruption may be possible through expanded community-wide delivery of MDA, the feasibility of which has been demonstrated by other programs. However, these models suggest that high levels of coverage and compliance must be achieved. Potential challenges include the risk of prematurely dismantling STH programs and the potential increased risk of antihelminthic resistance. Elimination of STH may offer an opportunity to eliminate substantial STH-related morbidity while reducing resource needs of neglected tropical disease programs. Evidence from large community trials is needed to determine the feasibility of interrupting the transmission of STH in some geographic settings.