Mali International Center for Excellence in Research: Filariasis

消除淋巴丝虫病全球计划（GPELF）于2000年启动，目标是通过每年大规模药物管理（MDA）来阻止淋巴丝虫病（LF）的传播。对马里人口的初步调查表明，班氏吴策线虫（W.班克罗夫特）感染在锡卡索地区是高度地方性的。 W. 2001年（在阿苯达唑和伊维菌素的年度MDA开始之前），在6个村庄的基线人类和昆虫学研究中证实了该地区班氏体的流行和传播，并在MDA期间从2002年至2007年每年监测。用校正后的厚片夜血涂片法测定成人志愿者的微丝蚴血症，用免疫层析卡法测定< 5岁儿童的循环丝虫抗原。从7月到12月，通过人类登陆捕获收集蚊子。在第六轮MDA后12个月，686名受试者中没有一人出现微丝蚴血症。更重要的是，在120名接受检测的儿童中，没有检测到循环抗原，而在MDA设立之前，这一比例为53%（103/194）。感染性叮咬/人/年的数量从2002年的4.8次下降到2007年的0.04次，在最后一轮MDA后12个月，仅观察到一只含有单一感染性幼虫的蚊子。这种传播的急剧减少是否会在MDA停止后持续下去还有待观察。 在马里班氏吴策线虫高度流行的6个村庄进行了7轮年度大规模药物管理后，达到了世卫组织停止大规模药物管理的标准，并于2008年停止治疗。启动了监测以发现复发。 随后5年的监测依赖于各种方法，包括6-7岁奥尔兹的循环丝虫抗原（CFA）和抗体检测（Wb 123）。通过解剖冈比亚按蚊复合体标本进行昆虫学监测，每月收集使用人类登陆捕获（HLC）和除虫菊喷雾捕获（PSC）的方法。冈比亚按蚊复合群的班氏吴策线虫感染也使用了逆转录酶聚合酶链反应（RT-PCR），mosquitoes.here的样本库显示，随着监测的进展，使用免疫层析检测（ICT）的儿童CFA年患病率从2009年的0%（0/289）、2011年的2.7%（8/301）、2012年的3.9%（11/285）增加到2013年的4.5%（14/309）（趋势卡方= 11.85，p= 0.0006）。2012年，当同时评估Wb 123抗体时，5/285（1.8%）的抗体阳性与使用ELISA检测CFA的CFA患病率（5/285）相似。通过使用HLC进行昆虫学评估，从解剖的12，951只蚊子中仅观察到2只感染WB的按蚊，但这些池中均没有感染性L3幼虫。使用PSC方法和RT-PCR，未观察到阳性池。虽然CFA阳性儿童被用作主要的监测工具，成人（8-65岁）也进行了评估。与儿童不同，成人的CFA患病率在2009年、2011年和2012年分别从4.9%（39/800）降至3.5%（28/795）和2.8%（50/1，812）（趋势卡方= 7.361，p=0.0067）。2009年（2.6%（1/39））和2011年（8.3%（3/36））发现部分ICT阳性个体患有微丝蚴血症。 与这些研究不同的是，其他研究评估了来自利什曼原虫共同流行地区的丝虫感染患者对白蛉唾液产物的先天反应。 迄今为止，这些产品似乎是免疫惰性的，正在进行后续研究，以了解这些产品的基础。

The Global Programme to Eliminate Lymphatic Filariasis (GPELF) was launched in 2000 with the goal of stopping transmission of lymphatic filariasis (LF) through yearly mass drug administration (MDA). Preliminary surveys of the human population in Mali suggested that Wuchereria bancrofti (W. bancrofti) infection was highly endemic in the Sikasso district. W. bancrofti prevalence and transmission in this region were confirmed in baseline human and entomologic studies in 6 villages in 2001 (prior to the start of yearly MDA with albendazole and ivermectin) and monitored yearly from 2002 to 2007 during MDA. Microfilaremia was determined by calibrated thick smear of night blood in adult volunteers and circulating filarial antigen was measured using immunochromatographic card test in children < 5 years of age. Mosquitoes were collected by human landing catch from July to December. None of the 686 subjects tested were microfilaremic 12 months after the sixth MDA round. More importantly, circulating antigen was not detected in any of the 120 children tested, as compared with 53% (103/194) before the institution of MDA. The number of infective bites/human/year decreased from 4.8 in 2002 to 0.04 in 2007, and only one mosquito containing a single infective larva was observed 12 months after the final MDA round. Whether this dramatic reduction in transmission will be sustained following cessation of MDA remains to be seen. After 7 annual rounds of mass drug administration (MDA) in 6 Malian villages highly endemic for Wuchereria bancrofti, the WHO criteria for stopping MDA were met and treatment ceased in 2008. Surveillance was initiated to detect recrudescence. Surveillance over the subsequent 5 years relied on a variety of methods including circulating filarial antigen (CFA) and antibody tests (Wb123) in 6-7 year olds. Entomological surveillance was performed through dissection of Anopheles gambiae complex specimens collected monthly using human landing catch (HLC) and pyrethrum spray catch (PSC) methods. Infection with Wuchereria bancrofti of Anopheles gambiae complex also used reverse-transcriptase polymerase chain reaction (RT-PCR) of pools of mosquitoes.here were increases in annual CFA prevalence rates using immunochromatographic tests (ICT) in children as surveillance progressed from 0% (0/289) in 2009, 2.7% (8/301) in 2011, 3.9% (11/285) in 2012 to 4.5% (14/309) in 2013 (Trend Chi2= 11.85, p= 0.0006). In 2012, when Wb123 antibody was assessed concurrently, there was antibody positivity in 5/285 (1.8%) that was similar to that of the CFA prevalence using an ELISA for CFA (5/285). By using HLC for entomologic assessments, only two Wb-infected Anopheles were observed from the 12,951 mosquitoes dissected, but none of these pools had infective L3 larvae. Using the PSC method and RT-PCR, no positive pools were observed. Although CFA positivity in children was used as the major surveillance tool, adults (8-65 years old) were also assessed. Unlike the children, the adults showed a decrease in the CFA prevalence from 4.9% (39/800) to 3.5% (28/795) and 2.8% (50/1,812) respectively in 2009, 2011 and 2012 (Trend Chi2= 7.361, p=0.0067). Some of the ICT positive individuals were found to be microfilaremic in 2009 (2.6% (1/39)) and 2011 (8.3% (3/36). Separate from these studies are others in which filarial-infected patients from leishmania co-endemic regions were assessed for innate responses to sandfly salivary products. To date, these products appear to be immunologically inert and follow-up studies to understand the basis of these are being performed.