Sustaining Control of Schistosomiasis Mansoni in Western Côte d'Ivoire: Results from a SCORE Study, One Year after Initial Praziquantel Administration.
Sustaining Control of Schistosomiasis Mansoni in Western Côte d'Ivoire: Results from a SCORE Study, One Year after Initial Praziquantel Administration.
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DOI：
10.1371/journal.pntd.0004329
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发表时间：
2016-01
影响因子：
3.8
通讯作者：
N'Goran EK
中科院分区：
文献类型：
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作者：
Assaré RK;Tian-Bi YN;Yao PK;N'Guessan NA;Ouattara M;Yapi A;Coulibaly JT;Meïté A;Hürlimann E;Knopp S;Utzinger J;N'Goran EK
血吸虫病业务研究和评价联盟（SCORE）已经启动了几项大规模试验，以确定获得和维持血吸虫病控制并向消灭过渡的最佳战略。在Côte科特迪瓦，正在75所学校实施一项为期5年的集群随机试验，以维持对曼氏血吸虫病的控制。我们报告了在吡喹酮初始校本治疗（SBT）一年后儿童的曼氏血吸虫感染水平，并与基线结果进行比较，以确定干预的效果。基线横断面调查于2011年底/ 2012年初进行，第一次随访于2013年5月进行。从75所学校的9至12岁儿童中连续收集了三份粪便样本，这些儿童在基线时和在随访时分别来自50所学校。粪便样本进行重复加藤-卡茨厚涂片。评估SBT的直接观察治疗（DOT）覆盖率，并比较基线和随访期间曼氏链球菌感染的患病率和强度。基线时，75所学校的曼氏梭菌患病率为22.1%（95%可信区间（CI）： 19.5-24.4%）。DOT覆盖率为84.2%。在基线和治疗后一年接受调查的50所学校中，mansoni感染的总体患病率从19.7% （95% CI: 18.5-20.8%）显著下降到12.8% (95% CI: 11.9-13.8%)，而感染儿童中每克粪便（EPG）的算术平均值从92.2 EPG （95% CI: 79.2-105.3 EPG）略有增加到109.3 EPG （95% CI: 82.7-135.9 EPG）。在50所学校中的两所，患病率显著上升，尽管DOT覆盖率为75%。在最初的SBT一年后，曼氏血吸虫的流行率下降了。尽管这是一个积极的趋势，但在一些学校还是出现了增长。此外，与基线情况相比，1年随访时感染曼氏梭菌儿童的感染强度略高。我们的研究结果强调了传播动力学的异质性，并为这项多年SCORE干预研究的未来年度随访调查提供了基准。血吸虫病是一种在撒哈拉以南非洲广泛传播的寄生虫病。为了更好地了解如何在不同的流行病学环境中获得和维持对血吸虫病的控制，以及如何消除这种疾病，血吸虫病业务研究和评价联盟（SCORE）发起了几项多年期研究，目前正在东非和西非实施。本文重点介绍了Côte科特迪瓦西部5-15岁儿童在最初使用抗虫药物吡喹酮治疗一年后，曼氏血吸虫感染水平的变化情况。学校一级的感染和治疗数据来自50所学校的4600多名儿童。在80%以上的儿童接受治疗一年后，曼森氏杆菌的总体流行率从19.7%下降到12.8%，而曼森氏杆菌阳性儿童的感染强度略有增加。在一些学校，曼森氏球菌的强度，特别是患病率，出乎意料地增加。我们的研究结果表明，血吸虫病的传播动态因村而异。随着SCORE研究的展开，在更长的时间内监测变化将是一件有趣的事情。
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has launched several large-scale trials to determine the best strategies for gaining and sustaining control of schistosomiasis and transitioning toward elimination. In Côte d’Ivoire, a 5-year cluster-randomized trial is being implemented in 75 schools to sustain the control of schistosomiasis mansoni. We report Schistosoma mansoni infection levels in children one year after the initial school-based treatment (SBT) with praziquantel and compare with baseline results to determine the effect of the intervention. The baseline cross-sectional survey was conducted in late 2011/early 2012 and the first follow-up in May 2013. Three consecutive stool samples were collected from 9- to 12-year-old children in 75 schools at baseline and 50 schools at follow-up. Stool samples were subjected to duplicate Kato-Katz thick smears. Directly observed treatment (DOT) coverage of the SBT was assessed and the prevalence and intensity of S. mansoni infection compared between baseline and follow-up. The S. mansoni prevalence in the 75 schools surveyed at baseline was 22.1% (95% confidence interval (CI): 19.5–24.4%). The DOT coverage was 84.2%. In the 50 schools surveyed at baseline and one year after treatment, the overall prevalence of S. mansoni infection decreased significantly from 19.7% (95% CI: 18.5–20.8%) to 12.8% (95% CI: 11.9–13.8%), while the arithmetic mean S. mansoni eggs per gram of stool (EPG) among infected children slightly increased from 92.2 EPG (95% CI: 79.2–105.3 EPG) to 109.3 EPG (95% CI: 82.7–135.9 EPG). In two of the 50 schools, the prevalence increased significantly, despite a DOT coverage of >75%. One year after the initial SBT, the S. mansoni prevalence had decreased. Despite this positive trend, an increase was observed in some schools. Moreover, the infection intensity among S. mansoni-infected children was slightly higher at the 1-year follow-up compared to the baseline situation. Our results emphasize the heterogeneity of transmission dynamics and provide a benchmark for the future yearly follow-up surveys of this multi-year SCORE intervention study. Schistosomiasis is a parasitic worm disease that is widespread in sub-Saharan Africa. To better understand how to gain and sustain the control of schistosomiasis and how to eliminate this disease in different epidemiologic settings, the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has launched several multi-year studies that are being implemented in East and West Africa. This article highlights how the Schistosoma mansoni infection levels changed one year after an initial treatment with the anti-worm drug praziquantel given to children aged 5–15 years in western Côte d’Ivoire. Infection and treatment data at school level were available from more than 4,600 children in 50 schools. One year after the treatment that had been received by more than 80% of the children, the overall S. mansoni prevalence decreased from 19.7% to 12.8%, while the intensity of infection among S. mansoni-positive children slightly increased. In several schools, the S. mansoni intensity and, particularly the prevalence, increased unexpectedly. Our findings show that the dynamics of schistosomiasis transmission varies from one village to another. It will be interesting to monitor changes over longer time periods as this SCORE study unfolds.