Proof-of-Principle of Onchocerciasis Elimination with Ivermectin Treatment in Endemic Foci in Africa: Final Results of a Study in Mali and Senegal
Proof-of-Principle of Onchocerciasis Elimination with Ivermectin Treatment in Endemic Foci in Africa: Final Results of a Study in Mali and Senegal
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DOI：
10.1371/journal.pntd.0001825
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发表时间：
2012-09-01
影响因子：
3.8
通讯作者：
Remme, Jan H. F.
中科院分区：
文献类型：
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作者：
Traore, Mamadou O.;Sarr, Moussa D.;Remme, Jan H. F.
背景资料：伊维菌素的大规模治疗控制了盘尾丝虫病这一公共卫生问题，但尚不清楚它是否也能阻断传播并消除非洲地方病疫源地的寄生虫，因为非洲的病媒效率很高。在马里和塞内加尔的三个高流行病疫源地进行了一项纵向研究，每年或每六个月进行一次伊维菌素治疗，为期15至17年，以评估感染和传播的残留水平，并测试是否可以安全地停止治疗。本文报告了最后一次治疗后5年的最终评估结果。方法/主要发现：在131个村庄进行了皮肤切片调查，对29，753人进行了检查，并使用特异性DNA探针分析了492，600只黑蝇是否存在盘尾丝虫幼虫。最后一次治疗后，感染和传播水平呈下降趋势。两个监测点在末次治疗后3 ~ 4年微丝蚴率和媒介感染率均为零。在第三个地点，在停止治疗前感染水平相对较高，在停止治疗后3至5年，感染和传播也持续下降到非常低的水平。所有的感染和传播指标低于假定的阈值elimination.Conclusion/Significance：这项研究已经建立了证据的原则，消除盘尾丝虫病伊维菌素治疗是可行的，至少在一些地方性疫源地在非洲。研究结果有助于目前在非洲从控制盘尾丝虫病到消灭盘尾丝虫病的演变。
Background: Mass treatment with ivermectin controls onchocerciasis as a public health problem, but it was not known if it could also interrupt transmission and eliminate the parasite in endemic foci in Africa where vectors are highly efficient. A longitudinal study was undertaken in three hyperendemic foci in Mali and Senegal with 15 to 17 years of annual or six-monthly ivermectin treatment in order to assess residual levels of infection and transmission, and test whether treatment could be safely stopped. This article reports the results of the final evaluations up to 5 years after the last treatment.Methodology/Principal Findings: Skin snip surveys were undertaken in 131 villages where 29,753 people were examined and 492,600 blackflies were analyzed for the presence of Onchocerca volvulus larva using a specific DNA probe. There was a declining trend in infection and transmission levels after the last treatment. In two sites the prevalence of microfilaria and vector infectivity rate were zero 3 to 4 years after the last treatment. In the third site, where infection levels were comparatively high before stopping treatment, there was also a consistent decline in infection and transmission to very low levels 3 to 5 years after stopping treatment. All infection and transmission indicators were below postulated thresholds for elimination.Conclusion/Significance: The study has established the proof of principle that onchocerciasis elimination with ivermectin treatment is feasible in at least some endemic foci in Africa. The study results have been instrumental for the current evolution from onchocerciasis control to elimination in Africa.