A Framework for Decision-Making for Mass Distribution of Mectizan(R) in Areas Endemic for Loa loa.
A Framework for Decision-Making for Mass Distribution of Mectizan(R) in Areas Endemic for Loa loa.
复制标题
DOI：
10.1186/1475-2883-2-s1-s9
复制
发表时间：
2003-10-24
期刊：
影响因子：
--
通讯作者：
Richards, Frank O
中科院分区：
文献类型：
--
作者：
Addiss, David G;Rheingans, Richard;Richards, Frank O
背景：大量使用甲硝唑(R)治疗盘尾丝虫病后出现的Loa Loa脑病对中部非洲的盘尾丝虫病控制工作产生了不利影响。微丝核血症者患脑病的风险增加，但对这些人在中非的地理分布知之甚少。RAPLOA是一种新技术，它将报告有眼虫史的社区成员的比例与该社区高强度Lloa微丝虫病的流行率联系起来，可能有助于快速评估存在治疗相关L.Loa脑病潜在风险的地区。RAPLOA的验证正在进行中。目前尚不清楚RAPLOA相对于目前逐村快速流行病学评估(REA)技术的可操作性和降低风险的优势。方法：我们开发了一个决策模型，用来比较在盘尾丝虫病和血吸虫病共同流行的地区使用甲环磷酰胺(R)大规模治疗后将LOA脑病的后遗症降至最低的四种策略：REA；RAPLOA眼虫患病率分别为40%和20%的RAPLOA(分别为RAPLOA-40和RAPLOA-20)；以及REA/RAPLOA-40的组合。结果：在模型中，所有四种策略都显著降低了Lloa脑病的死亡风险和神经并发症，但RAPLOA-20和REA导致的此类病例数量是RAPLOA-40或REA/RAPLOA-40组合的一半。结论：RAPLOA很可能是一种程序性有效的药物，可用于降低大量使用Mectian(R)治疗后的L.Loa脑病的风险。这也可能节省成本。在全面实施之前，还需要关于高密度微丝核血症者的地理聚集以及RAPLOA的可靠性和成本的更多数据。
BACKGROUND: The occurrence of Loa loa encephalopathy following mass treatment of onchocerciasis with Mectizan(R) has adversely affected onchocerciasis control efforts in central Africa. Persons with very high densities of L. loa microfilaremia are at increased risk of encephalopathy, but little is known about the geographic distribution of these persons within central Africa. RAPLOA, a new technique that correlates the proportion of community members reporting a history of eyeworm with the prevalence of high-intensity L. loa microfilaremia in that community, may be useful for rapid assessment of areas at potential risk of treatment-related L. loa encephalopathy. Validation of RAPLOA is ongoing. The operational and risk-reduction advantages of RAPLOA over the current technique of village-by-village rapid epidemiologic assessment for onchocerciasis (REA) are unknown. METHODS: We developed a decision model to compare four strategies for minimizing sequelae of L. loa encephalopathy following mass treatment with Mectizan(R) in areas co-endemic for onchocerciasis and loiasis: REA; RAPLOA with threshold eyeworm prevalences of 40% and 20% (RAPLOA-40 and RAPLOA-20, respectively); and combined REA/RAPLOA-40. RESULTS: In the model, all four strategies significantly reduced risk of death and neurologic complications from L. loa encephalopathy, but RAPLOA-20 and REA resulted in half as many such cases as did RAPLOA-40 or combined REA/RAPLOA-40. CONCLUSION: RAPLOA is likely to be useful programmatically in reducing risk of L. loa encephalopathy following mass treatment with Mectizan(R). It also may be cost-saving. Before full-scale implementation, additional data are needed on geographic clustering of high-density L. loa microfilaremia and on RAPLOA's reliability and cost.