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研究评估2020年和2025年血吸虫病全球目标的进展情况
作者:小柯机器人 发布时间:2019/12/26 14:18:39

英国伦敦卫生与热带医学院Arminder K. Deol研究组对实现2020年和2025年血吸虫病全球目标的进展情况进行了评估。相关论文于2019年12月26日发表在《新英格兰医学杂志》上。

世界卫生组织(WHO)以“一个没有血吸虫病的世界”为愿景,制定了雄心勃勃的目标,即在2020年之前控制住这一致命疾病,并在2025年之前将其作为公共卫生问题彻底消除。随着这些重要节点的临近,若要计划取得成功,就必须经验性地评估WHO的计划指南。

研究组整理和分析了9个国家(撒哈拉以南8个非洲国家和也门)血吸虫病控制项目的多年横断面数据。根据血吸虫的种类(曼氏血吸虫和埃及血吸虫)、治疗轮数、总患病率和严重感染率对数据进行分析。疾病控制定义为聚集在所有监测点的重度感染率低于5%,疾病消除定义为所有监测点的重度感染率低于1%。重度感染定义为每克粪便中至少有400枚曼氏血吸虫卵,或每10毫升尿液中至少有50枚埃及血吸虫卵。

除尼日尔这个国家外,其他8个国家项目均在两轮及以下便达到了疾病控制的目标,这比WHO现行指导方针预测的(5-10年)要早。与基线时具有中高流行性的地区相比,低流行性地区的项目更有可能达到疾病控制或疾病消除的目标,尽管该消除目标只针对埃及血吸虫感染。在总体流行率和重度感染的分层关系中,不同国家的差异很明显,这一发现突出了在所有流行病学环境中使用一个指标来定义疾病控制或消除的困难。

这些数据表明,需要更频繁地重新评估国家血吸虫病控制项目的进展和治疗策略,并充分考虑当地的流行病学数据,以确定治疗效果,并对资源进行适当分配,努力实现全球目标。

附:英文原文

Title: Schistosomiasis — Assessing Progress toward the 2020 and 2025 Global Goals

Author: Arminder K. Deol, Ph.D.,, Fiona M. Fleming, Ph.D.,, Beatriz Calvo-Urbano, Ph.D.,, Martin Walker, Ph.D.,, Victor Bucumi, M.D.,, Issah Gnandou, M.D.,, Edridah M. Tukahebwa, Ph.D.,, Samuel Jemu, M.Sc.,, Upendo J. Mwingira, M.D.,, Abdulhakeem Alkohlani, M.D.,, Mahamadou Traoré, M.D.,, Eugene Ruberanziza, M.D.,, Seydou Touré, M.D.,, Maria-Gloria Basáez, Ph.D.,, Michael D. French, Ph.D.,, and Joanne P. Webster, Ph.D.

Issue&Volume: 2019-12-25

Abstract: 

BACKGROUND
With the vision of “a world free of schistosomiasis,” the World Health Organization (WHO) set ambitious goals of control of this debilitating disease and its elimination as a public health problem by 2020 and 2025, respectively. As these milestones become imminent, and if programs are to succeed, it is important to evaluate the WHO programmatic guidelines empirically.

METHODS
We collated and analyzed multiyear cross-sectional data from nine national schistosomiasis control programs (in eight countries in sub-Saharan Africa and in Yemen). Data were analyzed according to schistosome species (Schistosoma mansoni or S. haematobium), number of treatment rounds, overall prevalence, and prevalence of heavy-intensity infection. Disease control was defined as a prevalence of heavy-intensity infection of less than 5% aggregated across sentinel sites, and the elimination target was defined as a prevalence of heavy-intensity infection of less than 1% in all sentinel sites. Heavy-intensity infection was defined as at least 400 eggs per gram of feces for S. mansoni infection or as more than 50 eggs per 10 ml of urine for S. haematobium infection.

RESULTS
All but one country program (Niger) reached the disease-control target by two treatment rounds or less, which is earlier than projected by current WHO guidelines (5 to 10 years). Programs in areas with low endemicity levels at baseline were more likely to reach both the control and elimination targets than were programs in areas with moderate and high endemicity levels at baseline, although the elimination target was reached only for S. mansoni infection (in Burkina Faso, Burundi, and Rwanda within three treatment rounds). Intracountry variation was evident in the relationships between overall prevalence and heavy-intensity infection (stratified according to treatment rounds), a finding that highlights the challenges of using one metric to define control or elimination across all epidemiologic settings.

CONCLUSIONS
These data suggest the need to reevaluate progress and treatment strategies in national schistosomiasis control programs more frequently, with local epidemiologic data taken into consideration, in order to determine the treatment effect and appropriate resource allocations and move closer to achieving the global goals.

DOI: 10.1056/NEJMoa1812165

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1812165

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home