Sensitive diagnostic tools and targeted drug administration strategies are needed to eliminate schistosomiasis
Sensitive diagnostic tools and targeted drug administration strategies are needed to eliminate schistosomiasis
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DOI：
10.1016/s1473-3099(20)30254-1
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发表时间：
2020-07-01
影响因子：
56.3
通讯作者：
van Dam, Govert J.
中科院分区：
文献类型：
--
作者：
Amoah, Abena S.;Hoekstra, Pytsje T.;van Dam, Govert J.
尽管预防性化疗有助于降低全球血吸虫病发病率，但仍然存在严峻的挑战。这些问题包括大规模药物管理运动中遗漏了某些群体、持续存在的疾病热点以及感染复发的风险。这些挑战的核心是，目前用于确定感染负担的诊断工具不够灵敏，特别是在低流行地区，这导致低估了活动性血吸虫感染的真实流行率。这一核心问题需要重新评估并可能调整世卫组织建议的现行血吸虫病控制策略。更有针对性的干预措施和新方法已被用来估计血吸虫病的患病率，例如通过使用精确制图确定感染负担，它提供了高分辨率的空间信息，描绘了特定地理区域内患病率的变化。此类信息有助于指导有针对性的干预活动。然而，此类策略中对高精度诊断工具的需求是一个经常被忽视的关键因素。高灵敏度诊断测试的可用性也开启了应用样本池策略来降低控制计划成本的可能性。为了阻断血吸虫病的传播并最终消除血吸虫病，更好的局部靶向预防性化疗与高度敏感的诊断工具相结合至关重要。
Although preventive chemotherapy has been instrumental in reducing schistosomiasis incidence worldwide, serious challenges remain. These problems include the omission of certain groups from campaigns of mass drug administration, the existence of persistent disease hotspots, and the risk of recrudescent infections. Central to these challenges is the fact that the diagnostic tools currently used to establish the burden of infection are not sensitive enough, especially in low-endemic settings, which results in underestimation of the true prevalence of active Schistosoma spp infections. This central issue necessitates that the current schistosomiasis control strategies recommended by WHO are re-evaluated and, possibly, adapted. More targeted interventions and novel approaches have been used to estimate the prevalence of schistosomiasis, such as establishing infection burden by use of precision mapping, which provides high resolution spatial information that delineates variations in prevalence within a defined geographical area. Such information is instrumental in guiding targeted intervention campaigns. However, the need for highly accurate diagnostic tools in such strategies is a crucial factor that is often neglected. The availability of highly sensitive diagnostic tests also opens up the possibility of applying strategies of sample pooling to reduce the cost of control programmes. To interrupt the transmission of, and eventually eliminate, schistosomiasis, better local targeting of preventive chemotherapy, in combination with highly sensitive diagnostic tools, is crucial.