Systematic Review and Meta-analysis of the Impact of Chemical-Based Mollusciciding for Control of Schistosoma mansoni and S. haematobium Transmission.
Systematic Review and Meta-analysis of the Impact of Chemical-Based Mollusciciding for Control of Schistosoma mansoni and S. haematobium Transmission.
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DOI：
10.1371/journal.pntd.0004290
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发表时间：
2015-12
影响因子：
3.8
通讯作者：
Bertsch D
中科院分区：
文献类型：
--
作者：
King CH;Sutherland LJ;Bertsch D
血吸虫病控制项目在世界范围内正在推进，在减少疾病方面有许多好处。然而，即使在治疗覆盖率较高的地区，再次感染和复发的风险仍然存在。在寻找更好地预防新的血吸虫感染的方法时，人们的注意力重新回到了一种较旧的传播控制策略上，即化学灭螺，以抑制导致曼氏血吸虫和血吸虫传播的中间宿主蜗牛物种。这项系统综述和荟萃分析的目的是总结以往以杀虫剂为基础的布林斯和Biomphalaria spp.的防治经验。并估计其对当地人类血吸虫感染的影响。这项审查是在Propero(CRD42013006869)最初注册的。研究是通过在线数据库搜索和私人档案的手工搜索来确定的。符合条件的研究包括2014年1月之前进行的已发表或未发表的灭螺现场试验，涉及曼氏链球菌或血瘤链球菌的宿主蜗牛，主要重点是氯硝柳胺的使用。在纳入的63篇论文中，杀螺剂的剂量有很大的差异，治疗间隔从3-52周不等，取决于地点、水源和使用类型。在报告患病率的35项研究中，随机效应荟萃分析表明，平均而言，在灭螺过程中感染几率降低77%(OR 0.23，CI95%0.17，0.31)，如果结合药物治疗，影响会增加，随着时间的推移，影响会逐渐增大。在报告局部发病的17项研究中，新感染的风险降低了%(相对危险度0.36，95%，0.25，0.5)，但附加药物治疗似乎不影响发病效果。尽管实施杀螺剂控制存在障碍，但其对当地传播的影响通常是强烈的，尽管不完整。根据过去的经验，定期局部灭螺可能对在高危地区消灭血吸虫病做出重大贡献。在非洲、南美、亚洲和菲律宾的高危地区，血吸虫感染是慢性寄生虫病的主要原因。在过去的几十年里，许多国家的项目实施了定期药物治疗，以控制或预防血吸虫感染的晚期并发症。然而，这些定期治疗并不能阻止寄生虫的传播，当人类污水污染当地水体，寄生虫卵感染中间宿主蜗牛时，就会发生这种情况。在这篇系统的综述中，我们整理了过去使用化学媒介灭螺预防血吸虫病的经验。在目前的口服药物疗法出现之前，这种方法在许多受血吸虫影响的国家使用，如果应用得当，有可能显著减少传播。我们对63项研究(执行1953-1981年)进行的荟萃分析归类了各种各样的水处理方法和使用的时间表。在报告人类感染的研究中，我们发现，灭螺降低了大多数但不是所有地点的当地人类流行率和感染发生率。综合研究的估计表明，仅灭螺一项通常可将新感染病例减少%，当地流行率在一段时间内有所下降。如果提供药物治疗，这一下降速度更快，幅度更大(减少了84%)。
Programs for schistosomiasis control are advancing worldwide, with many benefits noted in terms of disease reduction. Yet risk of reinfection and recurrent disease remain, even in areas with high treatment coverage. In the search for means to better prevent new Schistosoma infections, attention has returned to an older strategy for transmission control, i.e., chemical mollusciciding, to suppress intermediate host snail species responsible for S. mansoni and S. haematobium transmission. The objective of this systematic review and meta-analysis was to summarize prior experience in molluscicide-based control of Bulinus and Biomphalaria spp. snails, and estimate its impact on local human Schistosoma infection. The review was registered at inception with PROSPERO (CRD42013006869). Studies were identified by online database searches and hand searches of private archives. Eligible studies included published or unpublished mollusciciding field trials performed before January 2014 involving host snails for S. mansoni or S. haematobium, with a primary focus on the use of niclosamide. Among 63 included papers, there was large variability in terms of molluscicide dosing, and treatment intervals varied from 3–52 weeks depending on location, water source, and type of application. Among 35 studies reporting on prevalence, random effects meta-analysis indicated that, on average, odds of infection were reduced 77% (OR 0.23, CI95% 0.17, 0.31) during the course of mollusciciding, with increased impact if combined with drug therapy, and progressively greater impact over time. In 17 studies reporting local incidence, risk of new infection was reduced 64% (RR 0.36 CI95% 0.25, 0.5), but additional drug treatment did not appear to influence incidence effects. While there are hurdles to implementing molluscicide control, its impact on local transmission is typically strong, albeit incomplete. Based on past experience, regular focal mollusciciding is likely to contribute significantly to the move toward elimination of schistosomiasis in high risk areas. Infection with Schistosoma blood flukes is a leading cause of chronic parasitic disease in at-risk areas of Africa, South America, Asia, and the Philippines. Over past decades, many national programs have implemented regular drug treatment to control or prevent the advanced complications of Schistosoma infection. However, these periodic treatments do not stop transmission of the parasite, which occurs when human sewage contaminates local water bodies and parasite eggs infect intermediate host snails. In this systematic review, we collated past experience of using chemically-mediated snail control for prevention of schistosomiasis. This approach, used in many Schistosoma-affected countries before the advent of the current oral drug regimens, has the potential to significantly reduce transmission if properly applied. Our meta-analysis of 63 studies (performed 1953–1981) catalogued a wide variety of water treatments and schedules employed. Among studies reporting on human infection, we found that snail control reduced local human prevalence and incidence of infection in most, but not all locations. Estimates from the aggregated studies indicate that snail control (alone) typically reduced new infections by 64% and local prevalence declined over a period of years. This decline was accelerated and more profound (84% reduction) if drug treatment was also made available.