Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children.
Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children.
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DOI：
10.1017/s0031182011001235
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发表时间：
2011-10
期刊：
影响因子：
2.4
通讯作者：
Montresor, Antonio
中科院分区：
文献类型：
--
作者：
Stothard, J. Russell;Sousa-Figueiredo, Jose C.;Betson, Martha;Green, Helen K.;Seto, Edmund Y. W.;Garba, Amadou;Sacko, Moussa;Mutapi, Francisca;Nery, Susana Vaz;Amin, Mutamad A.;Mutumba-Nakalembe, Margaret;Navaratnam, Annalan;Fenwick, Alan;Kabatereine, Narcis B.;Gabrielli, Albis F.;Montresor, Antonio
关键词：
如果年幼的儿童接触含有血吸虫尾蚴的水，就会发生感染，并可能发现血吸虫病。在高传播环境中，母亲每天用环境中的自来水给孩子洗澡，许多婴儿和学龄前儿童患有血吸虫病。这一“新”负担包括与血吸虫和曼氏血吸虫的混合感染，目前正在正式探索，因为在目前的预防性化疗活动中，受感染的儿童目前不能接受吡喹酮(PZQ)治疗。因此，存在着一个重要的PZQ治疗缺口，受感染的儿童可能要等上4-5年才能在学校接受第一次治疗。在国家治疗平台内制定的国际治疗指南目前正在修改，以便更早地获得药物治疗(S)。虽然需要进行详细的药代动力学研究，以促进现场的实际剂量，但已经设计了一个延长的“剂量极”，流行病学监测表明，在这一较年轻的年龄段，以粉碎片剂或液体混悬剂的形式给予PZQ(40 mg/kg)既安全又有效；然而，在重复几轮治疗后，对曼氏葡萄球菌的药物疗效似乎有所减弱。因此，使用PZQ应与适当的健康教育/改善儿童和母亲的水卫生状况相结合，以提出更持久的解决办法。
Where very young children come into contact with water containing schistosome cercariae, infections occur and schistosomiasis can be found. In high transmission environments, where mothers daily bathe their children with environmentally drawn water, many infants and preschool-aged children have schistosomiasis. This ‘new’ burden, inclusive of co-infections with Schistosoma haematobium and Schistosoma mansoni, is being formally explored as infected children are not presently targeted to receive praziquantel (PZQ) within current preventive chemotherapy campaigns. Thus an important PZQ treatment gap exists whereby infected children might wait up to 4–5 years before receiving first treatment in school. International treatment guidelines, set within national treatment platforms, are presently being modified to provide earlier access to medication(s). Although detailed pharmacokinetic studies are needed, to facilitate pragmatic dosing in the field, an extended ‘dose pole’ has been devised and epidemiological monitoring has shown that administration of PZQ (40 mg/kg), in either crushed tablet or liquid suspension, is both safe and effective in this younger age-class; drug efficacy, however, against S. mansoni appears to diminish after repeated rounds of treatment. Thus use of PZQ should be combined with appropriate health education/water hygiene improvements for both child and mother to bring forth a more enduring solution.