What is required in terms of mass drug administration to interrupt the transmission of schistosome parasites in regions of endemic infection?
What is required in terms of mass drug administration to interrupt the transmission of schistosome parasites in regions of endemic infection?
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DOI：
10.1186/s13071-015-1157-y
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发表时间：
2015-10-22
影响因子：
3.2
通讯作者：
Truscott, J. E.
中科院分区：
文献类型：
--
作者：
Anderson, R. M.;Turner, H. C.;Truscott, J. E.
背景：血吸虫病在54个国家流行，但在所有蠕虫病中，大规模药物管理的覆盖率最低。然而，随着通过捐赠获得的药物越来越多，世界卫生组织制定了一个目标，即在流行国家将覆盖率提高到75%的高危儿童，并在一些地区消除。在本文中，我们评估的影响，血吸虫病的世界卫生组织的目标，在控制和elimination.Methods：我们使用的年龄结构的确定性模型，在人类社区的传播和大规模药物管理的效果。该模型拟合的基线数据从纵向再感染研究在肯尼亚和验证对随后的再感染数据。我们研究了当前治疗趋势对宿主蠕虫负担的影响，外推以满足世卫组织的目标，以及其对重要参数不确定性的敏感性。我们评估实现elimination.Results的可行性：模型结果表明，目前的治疗趋势，外推到世界卫生组织的目标，是能够大大减少宿主蠕虫的负担。如果在2020年以后继续保持相同的覆盖率，就有可能消除低到中等传播率的情况，在这些情况下，传播强度由基本生殖数R-0确定。在所有环境中，低水平的成人覆盖率对蠕虫负担有重大影响。对再感染调查的模型验证表明，年龄结构的模型是能够匹配治疗后的数据，以及在鸡蛋产量，但在学龄儿童和年轻人的再感染的一些细节目前没有很好的representation.Conclusions：我们的工作表明，目前的世卫组织的治疗目标应该是成功的，在治疗的社区带来了重大的减少寄生虫感染。如果持续15年以上，它们很可能导致消灭，至少在传播率较低的地区是这样。
Background: Schistosomiasis is endemic in 54 countries, but has one of the lowest coverages by mass drug administration of all helminth diseases. However, with increasing drug availability through donation, the World Health Organisation has set a goal of increasing coverage to 75 % of at-risk children in endemic countries and elimination in some regions. In this paper, we assess the impact on schistosomiasis of the WHO goals in terms of control and elimination.Methods: We use an age-structured deterministic model of schistosome transmission in a human community and the effect of mass drug administration. The model is fitted to baseline data from a longitudinal re-infection study in Kenya and validated against the subsequent re-infection data. We examine the impact on host worm burden of the current treatment trend, extrapolated to meet the WHO goals, and its sensitivity to uncertainty in important parameters. We assess the feasibility of achieving elimination.Results: Model results show that the current treatment trend, extrapolated to the WHO goals, is able to greatly reduce host worm burdens. If coverage is continued at the same level beyond 2020, elimination is possible for low to moderate transmission settings, where transmission intensity is defined by the basic reproduction number, R-0. Low levels of adult coverage have a significant impact on worm burden in all settings. Model validation against the re-infection survey demonstrates that the age-structured model is able to match post-treatment data well in terms of egg output, but that some details of re-infection among school children and young adults are not currently well represented.Conclusions: Our work suggests that the current WHO treatment goals should be successful in bringing about a major reduction in schistosome infection in treated communities. If continued over a 15 year period, they are likely to result in elimination, at least in areas with lower transmission.