Mass Administration of Ivermectin for the Elimination of Onchocerciasis Significantly Reduced and Maintained Low the Prevalence of Strongyloides stercoralis in Esmeraldas, Ecuador.
Mass Administration of Ivermectin for the Elimination of Onchocerciasis Significantly Reduced and Maintained Low the Prevalence of Strongyloides stercoralis in Esmeraldas, Ecuador.
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DOI：
10.1371/journal.pntd.0004150
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发表时间：
2015-11
影响因子：
3.8
通讯作者：
Bisoffi Z
中科院分区：
文献类型：
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作者：
Anselmi M;Buonfrate D;Guevara Espinoza A;Prandi R;Marquez M;Gobbo M;Montresor A;Albonico M;Racines Orbe M;Martin Moreira J;Bisoffi Z
评价伊维菌素大规模给药对类圆线虫病和其他土源性蠕虫病的疗效。我们对在埃斯梅拉达斯（厄瓜多尔）进行的调查期间收集的数据进行了回顾性分析，在这些地区每年向全体人口施用伊维菌素以控制盘尾丝虫病。分析了1990年（伊维菌素开始分发之前）至2013年（干预中断后6年）进行的5次调查的数据。调查还包括因盘尾丝虫病不是地方病而未分发伊维菌素的地区。在不同的调查中使用了不同的实验室技术（直接粪便涂片、甲醛-乙醚浓度、IFAT和IVD ELISA用于粪类圆线虫）。在分发伊维菌素的地区，类圆线虫病的流行率从1990年的6.8%下降到1996年和1999年的零。2013年，儿童的粪便检查患病率为0，血清学患病率为1.3%，成人为0.7%和2.7%。在伊维菌素分布未覆盖的地区，1996年和1999年的流行率分别为23.5%和16.1%。2013年，儿童粪便检查和血清学检查的患病率分别为0.6%和9.3%，成人分别为2.3%和17.9%。其他土源性蠕虫病：伊维菌素分布区，T. trichiura显著降低，而A.蛔虫和钩虫似乎未受影响。伊维菌素的周期性大量分布对类圆线虫病的流行有显著影响，对鞭虫病影响较小，对蛔虫和钩虫感染显然没有影响。 粪类圆线虫（Ss）是一种土壤传播蠕虫（STH），尚未成为控制计划的目标，尽管它在世界许多地区高度流行，并可能导致严重后果，特别是对免疫抑制患者，具有高致死率。不幸的是，阿苯达唑，最常用于控制其他STH（钩虫，蛔虫和鞭虫）的药物，对SS几乎没有影响。药物的选择，伊维菌素，已被广泛用于大规模药物管理（MDA）的丝虫盘尾丝虫和班氏吴策线虫。在厄瓜多尔的埃斯梅拉达斯省，我们研究了1990年（MDA启动前）至2013年（MDA停止后6年）在农村社区的Ss（和其他STH）患病率，其中MDA定期执行盘尾丝虫病与邻近社区相比，伊维菌素没有分发，因为盘尾丝虫病不存在。在无MDA的地区，SS患病率多年来一直很高，而在MDA患病率下降到零，并在MDA停止后6年仍然很低。观察到T.鞭毛虫将伊维菌素添加到STH的MDA方案中将有助于控制Ss感染。
To evaluate the effect of ivermectin mass drug administration on strongyloidiasis and other soil transmitted helminthiases. We conducted a retrospective analysis of data collected in Esmeraldas (Ecuador) during surveys conducted in areas where ivermectin was annually administered to the entire population for the control of onchocerciasis. Data from 5 surveys, conducted between 1990 (before the start of the distribution of ivermectin) and 2013 (six years after the interruption of the intervention) were analyzed. The surveys also comprised areas where ivermectin was not distributed because onchocerciasis was not endemic. Different laboratory techniques were used in the different surveys (direct fecal smear, formol-ether concentration, IFAT and IVD ELISA for Strongyloides stercoralis). In the areas where ivermectin was distributed the strongyloidiasis prevalence fell from 6.8% in 1990 to zero in 1996 and 1999. In 2013 prevalence in children was zero with stool examination and 1.3% with serology, in adult 0.7% and 2.7%. In areas not covered by ivermectin distribution the prevalence was 23.5% and 16.1% in 1996 and 1999, respectively. In 2013 the prevalence was 0.6% with fecal exam and 9.3% with serology in children and 2.3% and 17.9% in adults. Regarding other soil transmitted helminthiases: in areas where ivermectin was distributed the prevalence of T. trichiura was significantly reduced, while A. lumbricoides and hookworms were seemingly unaffected. Periodic mass distribution of ivermectin had a significant impact on the prevalence of strongyloidiasis, less on trichuriasis and apparently no effect on ascariasis and hookworm infections. Strongyloides stercoralis (Ss) is a soil-transmitted helminth (STH) that is not yet targeted by control programs, although it is highly prevalent in many areas of the world and may cause severe consequences, in particular to immunosuppressed patients, with a high fatality rate. Unfortunately, albendazole, the drug most commonly used for the control of the other STH (hookworm, Ascaris lumbricoides and Trichuris trichiura) has little effect on Ss. The drug of choice, ivermectin, has been extensively used in mass drug administration (MDA) for the filarial worms Onchocerca volvulus and Wuchereria bancrofti. In the province of Esmeraldas, in Ecuador, we studied Ss (and other STH) prevalence from 1990 (prior to MDA initiation) to 2013 (6 years after MDA cessation) in rural communities where MDA was regularly executed for onchocerciasis compared with neighboring communities where ivermectin was not distributed because onchocerciasis was not present. Ss prevalence remained high over the years in the areas with no MDA, while in those with MDA prevalence fell to zero, and remained very low 6 years after MDA cessation. A less important effect was observed for T. trichiura. Adding ivermectin to MDA programs for STH would importantly contribute to the control of Ss infection.