Reduced Efficacy of Praziquantel Against Schistosoma mansoni Is Associated With Multiple Rounds of Mass Drug Administration
Reduced Efficacy of Praziquantel Against Schistosoma mansoni Is Associated With Multiple Rounds of Mass Drug Administration
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DOI：
10.1093/cid/ciw506
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发表时间：
2016-11-01
影响因子：
11.8
通讯作者：
Webster, Joanne P.
中科院分区：
文献类型：
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作者：
Crellen, Thomas;Walker, Martin;Webster, Joanne P.
背景吡喹酮的大规模药物管理（MDA）是撒哈拉以南非洲血吸虫病控制的基石。这种策略的有效性取决于吡喹酮持续的高疗效;然而，很少使用适当的统计方法来监测药物疗效，可以发现早期的衰退迹象。我们进行了一项重复的横断面研究，检查了乌干达6所学校感染曼氏血吸虫的儿童，这些学校以前接受过1至9轮含吡喹酮的MDA。我们收集了12个S。414例6-12岁儿童吡喹酮治疗前及治疗后25-27天的曼氏卵计数。我们使用统计模型估计个体患者的卵子减少率（ERRs），以探讨协变量的影响，包括先前MDA轮次的数量。在接受过8或9轮MDA的学校中，平均ERR（95%贝叶斯可信区间[BCI]，88.23%-93.64%）在统计学上显著低于接受过5轮（95% BCI，96.13%-99.08%）或1轮（95% BCI，95.51%-98.96%）MDA的学校的平均水平。我们估计，分别有5.11%、4.55%和16.42%的接受过1轮、5轮和8-9轮MDA的学校儿童的ERRs低于世界卫生组织设定的吡喹酮最佳疗效的90%阈值。吡喹酮在MDA暴露较高的学校中的疗效降低可能对血吸虫病控制方案的有效性构成威胁。我们呼吁对MDA中使用的驱虫药的疗效进行密切监测。
Background. Mass drug administration (MDA) with praziquantel is the cornerstone of schistosomiasis control in sub-Saharan Africa. The effectiveness of this strategy is dependent on the continued high efficacy of praziquantel; however, drug efficacy is rarely monitored using appropriate statistical approaches that can detect early signs of wane.Methods. We conducted a repeated cross-sectional study, examining children infected with Schistosoma mansoni from 6 schools in Uganda that had previously received between 1 and 9 rounds of MDA with praziquantel. We collected up to 12 S. mansoni egg counts from 414 children aged 6-12 years before and 25-27 days after treatment with praziquantel. We estimated individual patient egg reduction rates (ERRs) using a statistical model to explore the influence of covariates, including the number of prior MDA rounds.Results. The average ERR among children within schools that had received 8 or 9 previous rounds of MDA (95% Bayesian credible interval [BCI], 88.23%-93.64%) was statistically significantly lower than the average in schools that had received 5 rounds (95% BCI, 96.13%-99.08%) or 1 round (95% BCI, 95.51%-98.96%) of MDA. We estimate that 5.11%, 4.55%, and 16.42% of children from schools that had received 1, 5, and 8-9 rounds of MDA, respectively, had ERRs below the 90% threshold of optimal praziquantel efficacy set by the World Health Organization.Conclusions. The reduced efficacy of praziquantel in schools with a higher exposure to MDA may pose a threat to the effectiveness of schistosomiasis control programs. We call for the efficacy of anthelmintic drugs used in MDA to be closely monitored.