How does onchocerciasis-related skin and eye disease in Africa depend on cumulative exposure to infection and mass treatment?
How does onchocerciasis-related skin and eye disease in Africa depend on cumulative exposure to infection and mass treatment?
复制标题
非洲与盘尾丝虫病相关的皮肤和眼部疾病如何依赖于感染和大规模治疗的累积暴露？
DOI：
10.1371/journal.pntd.0009489
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发表时间：
2021-06
影响因子：
3.8
通讯作者：
Coffeng LE
中科院分区：
文献类型：
--
作者：
Vinkeles Melchers NVS;Stolk WA;Murdoch ME;Pedrique B;Kloek M;Bakker R;de Vlas SJ;Coffeng LE
非洲的盘尾丝虫病（河盲症）是通过伊维菌素大规模给药（MDA）消除的目标。盘尾丝虫病可引起各种类型的皮肤和眼部疾病。预测MDA对盘尾丝虫病发病率的影响对未来的政策制定是有用的。在此，我们在已建立的ONCHOSIM模型中引入了一个新的疾病模块，以预测盘尾丝虫病发病率随时间的趋势。我们开发了新的通用模型概念，由于累积暴露于死亡微丝蚴的症状发展，适应可逆（急性）和不可逆（慢性）的症状。该模型经过校准，以重现控制前的年龄模式以及在大量基于人群的研究中观察到的感染、眼部疾病和各种类型皮肤病患病率之间的关联。然后，我们使用新的疾病模块来预测MDA对30年时间范围内各种情况下发病率的影响。ONCHOSIM相当好地再现了观察到的疾病年龄模式和社区一级感染与疾病之间的关联。对于高度流行的设置与30年的年度MDA在60%的覆盖率，该模型预测70%至89%的慢性病发病率下降。这种相对下降与较高的MDA覆盖率相似，仅在控制前地方性较低的情况下略高。轻度色素脱失和视力损害的患病率下降幅度最低。急性临床表现（严重瘙痒，反应性皮肤病）的患病率下降了95%至100%后，30年的年度MDA，无论控制前的地方性。我们提出了通用模型的概念，预测由于接触寄生虫感染的历史，急性和慢性症状的趋势，并将其应用于盘尾丝虫病。我们的预测表明，盘尾丝虫病的发病率，特别是慢性表现，将仍然是一个公共卫生问题，在许多流行病学设置在非洲，即使在30年的MDA。盘尾丝虫病，也被称为河盲症，是世界范围内第二大常见的致盲传染病，但也会导致严重的皮肤病。目前正在非洲进行大规模的干预措施，以控制和消灭这一疾病，但这些干预措施对盘尾丝虫病发病率的影响基本上是未知的。在这里，我们预测的趋势，由于盘尾丝虫病的皮肤和眼睛疾病的广谱后长达30年的年度大规模药物管理（MDA）伊维菌素。为此，我们在已建立的ONCHOSIM模型中开发了一种新的疾病框架。我们发现，每年MDA将迅速降低急性临床症状的患病率，而慢性临床表现的患病率下降得慢得多。新的疾病框架得到了几个数据来源的验证，并充分再现了发病率趋势，使该框架考虑到非洲的治疗史，适用于更精确的疾病流行率预测。这些预测对于准确估计到2025年因盘尾丝虫病而损失的残疾调整生命年至关重要。
Onchocerciasis (river-blindness) in Africa is targeted for elimination through mass drug administration (MDA) with ivermectin. Onchocerciasis may cause various types of skin and eye disease. Predicting the impact of MDA on onchocercal morbidity is useful for future policy development. Here, we introduce a new disease module within the established ONCHOSIM model to predict trends over time in prevalence of onchocercal morbidity. We developed novel generic model concepts for development of symptoms due to cumulative exposure to dead microfilariae, accommodating both reversible (acute) and irreversible (chronic) symptoms. The model was calibrated to reproduce pre-control age patterns and associations between prevalences of infection, eye disease, and various types of skin disease as observed in a large set of population-based studies. We then used the new disease module to predict the impact of MDA on morbidity prevalence over a 30-year time frame for various scenarios. ONCHOSIM reproduced observed age-patterns in disease and community-level associations between infection and disease reasonably well. For highly endemic settings with 30 years of annual MDA at 60% coverage, the model predicted a 70% to 89% reduction in prevalence of chronic morbidity. This relative decline was similar with higher MDA coverage and only somewhat higher for settings with lower pre-control endemicity. The decline in prevalence was lowest for mild depigmentation and visual impairment. The prevalence of acute clinical manifestations (severe itch, reactive skin disease) declined by 95% to 100% after 30 years of annual MDA, regardless of pre-control endemicity. We present generic model concepts for predicting trends in acute and chronic symptoms due to history of exposure to parasitic worm infections, and apply this to onchocerciasis. Our predictions suggest that onchocercal morbidity, in particular chronic manifestations, will remain a public health concern in many epidemiological settings in Africa, even after 30 years of MDA. Onchocerciasis, also known as river blindness, is the second most common infectious cause of blindness worldwide, but also leads to serious skin conditions. Large-scale interventions are ongoing to control and eliminate the disease in Africa, yet the impact of these interventions on onchocercal morbidity is largely unknown. Here, we predict the trends in a wide spectrum of skin and eye disease due to onchocerciasis after up to 30 years of annual mass drug administration (MDA) with ivermectin. To this end, we have developed a novel disease framework within the established ONCHOSIM model. We show that annual MDA will rapidly reduce the prevalence of acute clinical conditions, whereas the prevalence of chronic clinical manifestations will decline much more slowly. The new disease framework was validated with several data sources and reproduced morbidity trends adequately, making the framework applicable for more refined disease prevalence predictions by taking account of treatment history in Africa. Such predictions are essential for accurate estimates of disability-adjusted life years lost due to onchocerciasis by 2025.
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影响因子：
3.7
作者：
Coffeng LE;Stolk WA;Hoerauf A;Habbema D;Bakker R;Hopkins AD;de Vlas SJ
通讯作者：
de Vlas SJ
影响因子：
3.8
作者：
Coffeng, Luc E.;Stolk, Wilma A.;Amazigo, Uche V.
通讯作者：
Amazigo, Uche V.
影响因子：
3.7
作者：
Baker C;Antonovics J
通讯作者：
Antonovics J
影响因子：
3.7
作者：
Banla, Meba;Tchalim, Solim;Soboslay, Peter T.
通讯作者：
Soboslay, Peter T.
影响因子：
168.9
作者：
ABIOSE, A;JONES, BR;MAHMOOD, AO
通讯作者：
MAHMOOD, AO