Human schistosomiasis in the post mass drug administration era.
Human schistosomiasis in the post mass drug administration era.
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DOI：
10.1016/s1473-3099(16)30475-3
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Woolhouse M
中科院分区：
文献类型：
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作者：
Mutapi F;Maizels R;Fenwick A;Woolhouse M
血吸虫病的流行病学正在发生深刻的变化，这是一种被忽视的热带疾病，由血吸虫属寄生蠕虫的慢性感染引起。血吸虫病影响到全世界2.4亿人，主要是在撒哈拉以南非洲。使用吡喹酮（PZQ）药物的大规模药物管理（MDA）方案的出现和扩散导致了接受有效治疗的人数大幅增加，主要是学龄儿童，接近流行地区的大多数人在其一生中接受一次或多次治疗的程度。PZQ治疗不仅可以治愈感染，还可以使宿主摆脱寄生虫的强大免疫调节作用，同时增强对关键寄生虫抗原的暴露，加速保护性获得性免疫的发展，这需要多年的自然发展。在种群水平上，这些变化构成了寄生虫生态学的实质性改变，因为寄生虫更有可能不仅直接暴露于PZQ，而且暴露于具有改变的免疫表型的宿主。在这里，我们考虑了这对有害生物学和免疫流行病学以及公共卫生的影响。我们预计，这可能对慢性病理学、自然免疫、疫苗开发策略、免疫疾病和药物疗效产生重大影响。这使得一个复杂的画面，只有在几十年的时间尺度上才会变得明显。我们建议在推出MDA计划的同时进行仔细的监测和评估，以确保实现并维持对人口的可观健康益处。
Profound changes are occurring in the epidemiology of schistosomiasis, a neglected tropical disease caused by a chronic infection with parasitic helminths of the genus Schistosoma. Schistosomiasis affects 240 million people worldwide, mostly in sub-Saharan Africa. The advent and proliferation of mass drug administration (MDA) programs using the drug praziquantel (PZQ) is resulting in substantial increases in the number of people, mainly school-aged children, being effectively treated, approaching the point where the majority of people in endemic areas will receive one or more treatments during their lifetimes. PZQ treatment not only cures infection but also frees the host from the powerful immunomodulatory action of the parasites and simultaneously enhances exposure to key parasite antigens, accelerating the development of protective acquired immunity, which takes many years to develop naturally. At a population level these changes constitute a substantial alteration to schistosome ecology in that the parasites are more likely to be exposed not only to PZQ directly but also to hosts with altered immune phenotypes. Here, we consider the consequences of this for schistosome biology and immuno-epidemiology and for public health. We anticipate that there could be significant impacts on chronic pathology, natural immunity, vaccine development strategies, immune disorders and drug efficacy. This makes for a complex picture that only will become apparent over timescales of decades. We recommend careful monitoring and evaluation to accompany the roll-out of MDA programs in order to ensure that the considerable health benefits to populations are achieved and sustained.