How Can Onchocerciasis Elimination in Africa Be Accelerated? Modeling the Impact of Increased Ivermectin Treatment Frequency and Complementary Vector Control
How Can Onchocerciasis Elimination in Africa Be Accelerated? Modeling the Impact of Increased Ivermectin Treatment Frequency and Complementary Vector Control
复制标题
DOI：
10.1093/cid/cix1137
复制
发表时间：
2018-06-15
影响因子：
11.8
通讯作者：
Stolk, Wilma A.
中科院分区：
文献类型：
--
作者：
Verver, Suzanne;Walker, Martin;Stolk, Wilma A.
背景。通过伊维菌素的大规模给药（MDA），在消除盘尾丝虫病方面取得了巨大进展。我们以符合 MDA 资格的地区为重点，调查了哪些地区可以通过继续目前的做法（每年使用伊维菌素进行 MDA）来实现到 2025 年消除目标，以及哪些地区需要加强或额外的病媒控制。我们没有考虑禁用 MDA 的盘尾丝虫病低流行地区和罗阿丝虫病共流行地区。方法。我们使用之前发布的 2 个数学模型 ONCHOSIM 和 EPIONCHO，模拟 80 种不同环境（由预控流行情况和过去 MDA 频率和覆盖范围定义）下不同未来治疗方案（每年、每两年或每季度 MDA，到 2025 年不同治疗覆盖率，有或没有病媒控制策略）下微丝蚴患病率的未来趋势，评估每种策略是否最终导致消除。结果。根据这两个模型，控制前微丝蚴流行率为 40%-50% 且每年 MDA ≥ 10 年的地区，如果尚未实现的话，可通过每年 MDA 进一步实现 7 年实现消除。对于大多数预控流行率为 70%-80% 的地区，ONCHOSIM 预测每年或每两年一次的 MDA 足以在 2025 年实现消除，而 EPIONCHO 预测即使采用补充性病媒控制也无法实现消除。结论。是否能在 2025 年实现消除取决于预控流行情况、控制历史以及从现在到 2025 年选择的策略。每两年一次或每季度一次的 MDA 将加快消除进程，但不能保证在高流行地区到 2025 年实现消除。对高流行地区长期同时进行 MDA 和病媒控制可能是有用的。
Background. Great strides have been made toward onchocerciasis elimination by mass drug administration (MDA) of ivermectin. Focusing on MDA-eligible areas, we investigated where the elimination goal can be achieved by 2025 by continuation of current practice (annual MDA with ivermectin) and where intensification or additional vector control is required. We did not consider areas hypoendemic for onchocerciasis with loiasis coendemicity where MDA is contraindicated.Methods. We used 2 previously published mathematical models, ONCHOSIM and EPIONCHO, to simulate future trends in microfilarial prevalence for 80 different settings (defined by precontrol endemicity and past MDA frequency and coverage) under different future treatment scenarios (annual, biannual, or quarterly MDA with different treatment coverage through 2025, with or without vector control strategies), assessing for each strategy whether it eventually leads to elimination.Results. Areas with 40%-50% precontrol microfilarial prevalence and >= 10 years of annual MDA may achieve elimination with a further 7 years of annual MDA, if not achieved already, according to both models. For most areas with 70%-80% precontrol prevalence, ONCHOSIM predicts that either annual or biannual MDA is sufficient to achieve elimination by 2025, whereas EPIONCHO predicts that elimination will not be achieved even with complementary vector control.Conclusions. Whether elimination will be reached by 2025 depends on precontrol endemicity, control history, and strategies chosen from now until 2025. Biannual or quarterly MDA will accelerate progress toward elimination but cannot guarantee it by 2025 in high-endemicity areas. Long-term concomitant MDA and vector control for high-endemicity areas might be useful.