Community-directed vector control to enhance mass drug administration for onchocerciasis elimination in Africa

摘要 盘尾丝虫病，或称河盲症，是人类公认的被忽视的热带疾病之一。这个 这种疾病是由丝虫寄生虫螺旋体引起的，这种寄生虫由黑蝇(Simulium)传播 SPP)。20世纪80年代，伊维菌素首次被证明是一种有效的微丝杀菌剂。作为一名 结果，开始了控制或消除盘尾丝虫病的国际计划，采用了 伊维菌素对受灾社区的大规模用药策略。基于长期丙二醛 方案已在非洲的一些疫源地和几乎所有的疫源地消除了盘尾丝虫病。 拉丁美洲。这些成功导致了重点的转变，从疾病控制的目标 《关于被忽视热带地区的伦敦宣言》所载的消灭盘尾丝虫病目标 疾病，制定了到2020年从非洲消除盘尾丝虫病的目标。尽管取得了这些成功， 仅靠丙二醛可能不足以及时中断非洲许多地区的传播 伦敦宣言的目标，可能根本不能中断传输，其中向量 人口密度很高。在这些领域，将有必要用其他干预措施补充MDA。这个 乌干达的经验已经证明了综合利用病媒控制和 伊维菌素丙二醛，已导致该国9个地区的螺旋体传播中断 在短短7年内发生了17个病灶。然而，传统上对黑蝇的控制依赖于对媒介的杀虫剂处理。 繁育地点，这是一种昂贵且后勤困难的方法。在这里，我们提出一种不同的 控制稻纵卷叶蜂黑蝇媒介的范例，也就是让受影响的群落参与 这一过程。这个项目是最近项目(1)的结果，开发一个捕蝇器来取代 用于昆虫学监测旋毛虫传播的人类着陆收集和，(2)开发一种 能够预测媒介黑蝇繁殖地的遥感算法。第一个项目产生了 在埃斯佩兰萨窗口捕捉器(EWT)的开发中，这是一个由当地可用材料建造的平台 廉价的材料，其性能相当于或超过人类登陆队收集的载体 物种。EWT可以由当地居民成功运营，并已被证明是显著的 降低咬合率。在第二项努力中，我们进行了初步研究，证明 征召当地居民从检测到的媒介繁殖点移除拖尾植被可以减少当地 咬合率超过80%。将在此项目中通过组合评估的总体假设 现场实验和数学模型研究的主要内容是社区指导的媒介控制努力 使用优化的诱捕器，局部减少繁殖栖息地或它们的某种组合将减少媒介 咬合率达到可以通过联合注射丙二醛来消灭卷曲线虫病的程度，即使在某些地区也是如此 那里的媒介密度很高。

ABSTRACT Onchocerciasis, or river blindness, is one of the recognized neglected tropical diseases of mankind. The disease is caused by the filarial parasite Onchocerca volvulus, which is spread by black flies (Simulium spp). In the 1980s, ivermectin was first shown to be a potent microfilaricide against O. volvulus. As a result, international programs were begun to either control or eliminate onchocerciasis, employing a strategy of mass drug administration (MDA) of ivermectin to afflicted communities. Long term MDA based programs have resulted in the elimination of onchocerciasis from some foci in Africa and almost all foci in Latin America. These successes have resulted in a change in focus from a goal of disease control of onchocerciasis to a goal of elimination, enshrined in the London Declaration on Neglected Tropical Diseases, which set a goal of eliminating onchocerciasis from Africa by 2020. Despite these successes, MDA alone will probably not be sufficient to interrupt transmission in many regions of Africa in time to meet the London Declaration goals, and may not be capable of interrupting transmission at all where vector densities are high. In such areas, it will be necessary to supplement MDA with other interventions. The experience of Uganda has demonstrated the power of utilizing a combination of vector control and ivermectin MDA, which has resulted in the interruption of transmission of O. volvulus in 9 of the country’s 17 foci in just 7 years. However, black fly control has traditionally relied upon insecticide treatment of vector breeding sites, an approach that is expensive and logistically difficult. Here we propose a different paradigm for the control of the black fly vectors of O. volvulus, that of involving the afflicted communities in this process. This project is an outgrowth of recent projects (1) to develop a black fly trap to replace human landing collections for entomological monitoring of O. volvulus transmission and, (2) to develop a remote sensing algorithm capable of predicting vector black fly breeding habitats. The first project resulted in the development of the Esperanza Window Trap (EWT), a platform constructed from locally available inexpensive materials, which equals or out performs a human landing team for the collection of vector species. The EWT can be successfully operated by local residents and has been shown to significantly reduce biting rates. In the second effort, we have conducted preliminary studies that demonstrate that enlisting local residents to remove trailing vegetation from detected vector breeding sites can reduce local biting rates by over 80%. The overall hypothesis that will be evaluated in this project through a combination of field experiments and mathematical modeling studies is that community directed vector control efforts using optimized traps, local reduction of breeding habitat or some combination of these will reduce vector biting rates to a point where O. volvulus may be eliminated by co-administration of MDA, even in areas where vector density is high.