The impact of pyrethroid resistance of the efficacy and effectiveness of bednets for malaria control in Africa
The impact of pyrethroid resistance of the efficacy and effectiveness of bednets for malaria control in Africa
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DOI：
10.7554/elife.16090
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发表时间：
2016-08-22
期刊：
影响因子：
7.7
通讯作者：
Ranson, Hilary
中科院分区：
文献类型：
--
作者：
Churcher, Thomas S.;Lissenden, Natalie;Ranson, Hilary
长效拟除虫菊酯处理的蚊帐是预防疟疾的最重要工具。对拟除虫菊酯具有抗药性的按蚊现在在非洲无处不在，尽管其对公共卫生的影响仍不清楚，这阻碍了更昂贵蚊帐的部署。生物测定研究和实验性小屋试验的荟萃分析被用于说明拟除虫菊酯抗性如何改变标准蚊帐和含有三氧化二胡椒基丁醚（PBO）的蚊帐的功效，并评估其对疟疾控制的影响。新的蚊帐提供了大量的个人保护，直到高水平的抵抗力，虽然保护可能会减弱更快地抵抗更具抵抗力的蚊子种群随着蚊帐的年龄。传播动力学模型表明，即使是低水平的抵抗力也会增加疟疾的发病率，因为在蚊帐的使用寿命期间，蚊子的死亡率会降低，社区的总体保护也会降低。在某些耐药性情况下，改用PBO蚊帐可避免每人每年0.5例临床病例。
Long lasting pyrethroid treated bednets are the most important tool for preventing malaria. Pyrethroid resistant Anopheline mosquitoes are now ubiquitous in Africa, though the public health impact remains unclear, impeding the deployment of more expensive nets. Meta-analyses of bioassay studies and experimental hut trials are used to characterise how pyrethroid resistance changes the efficacy of standard bednets, and those containing the synergist piperonyl butoxide (PBO), and assess its impact on malaria control. New bednets provide substantial personal protection until high levels of resistance, though protection may wane faster against more resistant mosquito populations as nets age. Transmission dynamics models indicate that even low levels of resistance would increase the incidence of malaria due to reduced mosquito mortality and lower overall community protection over the life-time of the net. Switching to PBO bednets could avert up to 0.5 clinical cases per person per year in some resistance scenarios.