Studies towards infectious disease elimination on the Bijagos Archipelago of Guinea Bissau

到目前为止，天花是唯一已经完全根除的人类传染病；但一些所谓的被忽视的热带病(NTDS)是全球根除的目标，或者至少是在世界大部分地区根除的目标，这些疾病在低收入国家的贫穷农村社区造成巨大的疾病负担。在减少世界一些地区的非传染性疾病病例数量方面取得了很大进展，但显然需要对其中大多数病例进行进一步研究，以开发新的工具和消除战略。20世纪60年代试图在全球根除疟疾但未获成功的问题重新提上议事日程，斯里兰卡于2016年消灭了疟疾，但显然不会使用旧方法从非洲根除疟疾。自1984年以来，我们一直致力于在冈比亚消除致盲沙眼，这是全球目标消除的非传染性疾病之一，并表明可以通过口服单剂量抗生素阿奇霉素治愈。自那时以来，制造商已向沙眼项目捐赠了5亿剂阿奇霉素，冈比亚最近达到了世界卫生组织的消除目标，但沙眼仍是全球导致失明的主要传染病。过去6年来，我们一直在研究几内亚比绍偏远比亚戈斯群岛的沙眼，它仍然是导致失明的一个重要原因，并在了解沙眼在哪里传播以及如何控制方面取得了相当大的进展。我们在未来两年的目标是在岛屿上建立一个消除沙眼的计划，使用阿奇霉素进行大规模治疗和健康教育来减少传播，并制定一个监测计划，以确保沙眼不会再次出现。我们还计划研究疟疾在岛屿上的传播，以期确定在这种情况下最有希望消除疟疾的战略，并绘制其他非传染性疾病的分布图。该项目将由安娜·拉斯特领导，她是一名传染病临床讲师，最近在比亚戈斯群岛完成了沙眼方面的博士学位，并精通当地语言。在两年的时间里，我们将在岛屿上建立一个实验室和杀虫剂，培训工作人员如何进行实地调查，如何诊断疟疾和非传染性疾病以及如何控制蚊子种群，确定沙眼和疟疾在哪里传播以及如何传播，并查明岛屿上还有哪些非传染性疾病，我们将处于有利地位，可以尝试消除这些疾病的新干预措施。这些岛屿是评估消除疾病的新工具和战略的影响的特别好地方，因为它们相对孤立，可以随机分配给一个或另一个战略。

So far, smallpox is the only infectious disease of humans that has been completely eradicated; but a number of so-called Neglected Tropical Diseases (NTDs), which cause a huge burden of disease among poor rural communities in low income countries, are targeted for global eradication, or at least for elimination from large parts of the world. Great progress has been made in reducing the number of cases of NTDs in some parts of the world but it has become clear that, for most of them, further research is needed to develop new tools and elimination strategies. Global eradication of malaria, which was attempted unsuccessfully in the 1960s, is back on the agenda, and malaria was eliminated from Sri Lanka in 2016, but it is clear that malaria will not be eliminated from Africa using the old methods. We have been working on the elimination of blinding trachoma, one of the NTDs targeted for global elimination, in The Gambia since 1984, and showed that it could be cured with a single dose of the antibiotic azithromycin, given by mouth. 500 million doses of azithromycin have been donated to trachoma programmes by the manufacturer since then, and The Gambia has recently met the World Health Organization's elimination targets, but trachoma remains the leading infectious cause of blindness worldwide. For the past 6 years we have been studying trachoma in the remote Bijagos Islands of Guinea Bissau where it remains an important cause of blindness, and have made considerable progress in understanding where it is being transmitted and how it might be controlled. Our aim in the next two years is to set up a trachoma elimination programme on the islands, using mass treatment with azithromycin and health education to reduce transmission, and a surveillance programme to make sure it is not re-introduced. We also plan to study the transmission of malaria on the islands, with a view to identifying the most promising strategies for malaria elimination in this setting, and to map the distribution of other NTDs. The programme will be led by Anna Last, a clinical lecturer in infectious diseases, who has recently completed a PhD on trachoma in the Bijagos Islands, and is fluent in the local language. In two years time we will have established a laboratory and insectary on the islands, trained staff in how to do field surveys, how to diagnose malaria and NTDs and how to control mosquito populations, worked out where and how trachoma and malaria are being transmitted, and found out which other NTDs are present on the islands, we will be in a strong position to try out new interventions for eliminating these diseases. The islands are a particularly good place to evaluate the impact new tools and strategies for disease elimination, since they are relatively isolated, and can be randomly allocated to one strategy or another.