Soil-Transmitted Helminthiases (STH) and Deworming

描述(由申请人提供)：拟议的热带医学中心的基本目标是通过开展和促进跨学科的卓越研究，改善人口，特别是世界上被忽视的热带病流行地区的人口的健康。其具体目标包括：i)促进和开展高质量的热带医学基础、临床和流行病学研究；ii)参与与当地、国家和国际研究人员的合作研究；iii)致力于培训和指导学生和初级研究人员。这一使命和目标的第一个具体实例在拟议的三个研究项目中得到说明，这些项目侧重于在被忽视的热带病中造成最大疾病负担的三种疾病，即通过土壤传播的蛔虫病、钩虫病和鞭虫病。这些疾病在秘鲁亚马逊地区是高度流行的，拟议的热带医学中心将设在那里。每个研究项目都针对高危群体(即学龄前儿童、学龄儿童和育龄妇女)的重要研究空白，以便世界卫生组织等全球机构和国家当局(及其合作伙伴)能够立即利用研究结果为卫生政策和干预措施提供信息。 驱虫策略。最终，这项研究将有助于减少由土壤传播的蠕虫硫酶造成的发病率、死亡率和残疾，目前估计影响到生活在世界各地资源匮乏社区的20亿人。 相关性：拟建的热带医学中心将设在秘鲁的亚马逊地区，并将成为以被忽视的热带病为重点的基础、临床和流行病学研究的卓越研究中心。由于土壤传播的蠕虫硫酶造成的疾病负担很高，这一疾病集群将构成新中心的首批研究重点。 项目1：将驱虫纳入综合儿童保健，通过驱虫改善资源匮乏的LMICs的儿童生长和发育 项目负责人(PL)：卡萨皮亚，M. 描述(由申请人提供)：学龄前儿童是可归因于土传蠕虫感染(STH)的三个高危群体之一。在这个年龄段，STH感染最重要的是蛔虫和鞭虫感染。世卫组织建议对12个月大的学龄前儿童进行驱虫，但没有经验证据表明何种驱虫暴露(就给药年龄和给药频率而言)对健康最有利。因此，这项研究项目建议跟踪一组学龄前儿童，这些儿童已知在12到24个月大的时候有不同的驱虫暴露史。通过跟踪这些儿童至五岁，将衡量累积的健康益处，并确定最佳驱虫策略。预计这些健康福利将延伸到儿童后期和以后。研究结果还将用于为全球性病流行地区的驱虫卫生政策和战略提供信息。 相关性：在12至24个月龄期间存在一个重要的机会窗口，此时健康和营养干预措施在短期和长期健康中都发挥着至关重要的作用。它是 衡量这种健康影响很重要，不仅因为它填补了研究空白，还因为它对项目经理和其他合作伙伴是有用的反馈。在对五岁以下儿童的跟踪研究中，这项队列研究将提供关于以下物质对健康影响的关键实证证据 针对这个高危年龄段的不同驱虫策略。

DESCRIPTION (provided by applicant): The essential goal of the proposed Tropical Medicine Center is to improve the health of populations, especially those in neglected tropical disease-endemic regions of the world, by undertaking and promoting interdisciplinary research excellence. Its specific objectives include: i) the promotion and conduct of high quality basic, clinical and epidemiological research in tropical medicine; ii) engagement in collaborative research with local, national and international researchers; and iii) commitment to the training and mentoring of students and junior investigators. The first concrete examples of this mission and objectives are illustrated in the three proposed research projects which focus on three diseases causing the highest burden of disease among the neglected tropical diseases, i.e., the soil-transmitted helminthiases of ascariasis, hookworm disease and trichuriasis. These diseases are highly endemic in the Amazon region of Peru where the proposed Tropical Medicine Center will be situated. Each research project addresses important research gaps in a high-risk group (i.e., preschool-age children, school-age children and women of reproductive age) such that results will be able to be used immediately by global agencies like the World Health Organization and national authorities (and their partners) to inform health policy and intervention strategy on deworming. Ultimately, this research will contribute to reducing the morbidity, mortality and disability caused by the soil-transmitted helminthiases which currently are estimated to affect two billion people living in resource-poor communities around the world. RELEVANCE: The proposed Tropical Medicine Center will be based in the Amazon region of Peru and will be a center of research excellence in basic, clinical and epidemiological research focusing on neglected tropical diseases. Because of the high burden of disease caused by the soil-transmitted helminthiases, this cluster of diseases will constitute the inaugural research focus of the new Center. Project 1: Improving Childhood Growth and Development in Resource-Poor LMICs with Deworming by Incorporating Deworming in Integrated Child Health Care Project Leader (PL): Casapia, M. DESCRIPTION (provided by applicant): Preschool-age children are one of the three high risk groups for morbidity attributable to soil-transmitted helminth infections (STH). At this age, the STH infections of most importance are Ascaris and Trichuris infections. WHO recommends deworming of preschool-age children as of 12 months of age, but there is no empirical evidence on what deworming exposure (in terms of age at administration and frequency of administration) has the most beneficial impact on health. This research project therefore proposes to follow a cohort of preschool-age children who are known to have had different deworming exposure histories between 12 and 24 months of age. By following these children up to five years of age, cumulative health benefits will be measured and the optimal deworming strategy identified. It is expected that these health benefits will extend into later childhood and beyond. Research results will also be used to inform deworming health policy and strategies in STH-endemic regions globally. RELEVANCE: An important window of opportunity exists between 12 and 24 months of age when health and nutrition interventions play a vital role in both short and long term health. It is important to measure this health impact, not only because it fills a research gap, but also because it is useful feedback for program managers, and other partners. In following children up to five years of age, this cohort study will provide key empirical evidence on the health impact of different deworming strategies targeted to this high risk age.