Treatment of asymptomatic carriers with artemether-lumefantrine: an opportunity to reduce the burden of malaria?
Treatment of asymptomatic carriers with artemether-lumefantrine: an opportunity to reduce the burden of malaria?
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DOI：
10.1186/1475-2875-9-30
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发表时间：
2010-01-22
期刊：
影响因子：
3
通讯作者：
Gaye, Oumar
中科院分区：
文献类型：
--
作者：
Ogutu, Bernhards;Tiono, Alfred B.;Gaye, Oumar
背景：在整个非洲增加对疟疾预防和治疗战略的投资和承诺，使这一疾病的发病率显著下降。然而，显然有必要采取进一步的干预措施，以实现到2015年疟疾发病率逆转的国际目标。本文讨论了一种创新的疟疾控制策略的预期作用--以社区为基础，以青蒿素为基础的联合疗法(ACT)治疗恶性疟原虫无症状携带者。该领域的主要科学家于2009年4月在巴塞尔举行的咨询委员会会议上审议了这种干预的可能性。本文总结了与会者之间进行的讨论。假设的提出：无症状携带者不寻求治疗其感染，因此构成寄生虫的宿主，从而构成真正的公共卫生风险。作为监测干预策略的一部分，对无症状恶性疟原虫个体的系统识别和治疗应该会减少寄生虫库，如果这个库大大减少，它将影响疾病传播。检验假设：本文考虑了可以从这种策略中受益的人群，并审查了与治疗表面健康的个人相关的伦理问题，这些人代表着被忽视的公共卫生风险。还讨论了对无症状携带者的治疗可能损害保护性免疫的发展，从而导致疟疾发病率的“反弹”和年龄升级。对于政策制定者来说，考虑将ACT治疗无症状携带者作为其疟疾控制方案中的一种新工具，重要的是要证明这种战略可以产生显著的好处，而不会对ACT的疗效和目标人群的健康产生负面影响。假设的实施：在某些传播环境中，使用ACT治疗无症状携带者是一种创新和必要的工具，可以打破感染循环。安全有效的药物可以挽救儿童的生命，但只要蚊子可以从无症状的携带者那里再次感染，缓刑只是暂时的。随着快速诊断测试的改进，可以更容易地识别无症状携带者，消除寄生虫池是指日可待的。
Background: Increased investment and commitment to malaria prevention and treatment strategies across Africa has produced impressive reductions in the incidence of this disease. Nevertheless, it is clear that further interventions will be necessary to meet the international target of a reversal in the incidence of malaria by 2015. This article discusses the prospective role of an innovative malaria control strategy - the community-based treatment of asymptomatic carriers of Plasmodium falciparum, with artemisinin-based combination therapy (ACT). The potential of this intervention was considered by key scientists in the field at an Advisory Board meeting held in Basel, in April 2009. This article summarizes the discussions that took place among the participants.Presentation of the hypothesis: Asymptomatic carriers do not seek treatment for their infection and, therefore, constitute a reservoir of parasites and thus a real public-health risk. The systematic identification and treatment of individuals with asymptomatic P. falciparum as part of a surveillance intervention strategy should reduce the parasite reservoir, and if this pool is greatly reduced, it will impact disease transmission.Testing the hypothesis: This article considers the populations that could benefit from such a strategy and examines the ethical issues associated with the treatment of apparently healthy individuals, who represent a neglected public health risk. The potential for the treatment of asymptomatic carriers to impair the development of protective immunity, resulting in a 'rebound' and age escalation of malaria incidence, is also discussed. For policymakers to consider the treatment of asymptomatic carriers with ACT as a new tool in their malaria control programmes, it will be important to demonstrate that such a strategy can produce significant benefits, without having a negative impact on the efficacy of ACT and the health of the target population.Implications of the hypothesis: The treatment of asymptomatic carriers with ACT is an innovative and essential tool for breaking the cycle of infection in some transmission settings. Safe and effective medicines can save the lives of children, but the reprieve is only temporary so long as the mosquitoes can become re-infected from the asymptomatic carriers. With improvements in rapid diagnostic tests that allow easier identification of asymptomatic carriers, the elimination of the pool of parasites is within reach.