英国利物浦热带医学院Eleanore D Sternberg团队研究了致命室内诱饵对科特迪瓦地区疟疾传播的影响和成本效益。2021年2月27日，该研究发表在《柳叶刀》杂志上。

需要新的病媒控制工具来维持与疟疾的斗争。致命的房屋诱饵是一种方法，它针对试图进入房屋吸血的蚊子。研究组评估了由In2Care屋檐管组成的致命室内诱捕物（提供了针对寻找宿主的蚊子的点源杀虫剂治疗），结合了旨在减少蚊子进入的房屋隔挡。

2016年9月26日至2019年4月10日，研究组在科特迪瓦中部进行了一项双臂分组随机对照试验，共有40个村级分组。所有家庭都得到了新的杀虫剂处理过的蚊帐（每两个人一张蚊帐）。研究组为分配到治疗组的集群内的合适家庭提供隔挡加屋檐管，屋檐管使用拟除虫菊酯β-氟氯氰菊酯的10%可湿性粉末制剂进行处理。主要终点是6个月至10岁儿童队列中2年以上活跃病例检测记录的临床疟疾发病率。

共有3022间房屋接受了隔挡加屋檐管，干预集群的平均覆盖率为70%。对照组共招募1300名符合条件的儿童，干预组招募了1260名。随访2年后，对照组疟疾发病率为2.29/儿童-年，干预组为1.43/儿童-年，风险比为0.62，差异显著。

成本效益模拟表明，与科特迪瓦现有的卫生保健活动相比，隔挡加檐管干预措施的成本效益为74%，与撒哈拉以南非洲其他核心病媒控制干预措施的成本效益相似。随访期间未报告与干预相关的严重不良事件。

研究结果表明，除杀虫剂处理过的蚊帐的效果外，隔挡加屋檐管亦可以额外提供防治疟疾的保护，为补充现有病媒控制工具提供了一种新的、具有成本效益的战略。

附：英文原文

Title: Impact and cost-effectiveness of a lethal house lure against malaria transmission in central Cte d'Ivoire: a two-arm, cluster-randomised controlled trial

Author: Eleanore D Sternberg, Jackie Cook, Ludovic P Ahoua Alou, Serge Brice Assi, Alphonsine A Koffi, Dimi T Doudou, Carine J Aoura, Rosine Z Wolie, Welbeck A Oumbouke, Eve Worrall, Immo Kleinschmidt, Raphael NGuessan, Matthew B Thomas

Issue&Volume: 2021/02/27

Abstract:

Background

New vector control tools are required to sustain the fight against malaria. Lethal house lures, which target mosquitoes as they attempt to enter houses to blood feed, are one approach. Here we evaluated lethal house lures consisting of In2Care (Wageningen, Netherlands) Eave Tubes, which provide point-source insecticide treatments against host-seeking mosquitoes, in combination with house screening, which aims to reduce mosquito entry.

Methods

We did a two-arm, cluster-randomised controlled trial with 40 village-level clusters in central Cte d'Ivoire between Sept 26, 2016, and April 10, 2019. All households received new insecticide-treated nets at universal coverage (one bednet per two people). Suitable households within the clusters assigned to the treatment group were offered screening plus Eave Tubes, with Eave Tubes treated using a 10% wettable powder formulation of the pyrethroid β-cyfluthrin. Because of the nature of the intervention, treatment could not be masked for households and field teams, but all analyses were blinded. The primary endpoint was clinical malaria incidence recorded by active case detection over 2 years in cohorts of children aged 6 months to 10 years. This trial is registered with ISRCTN, ISRCTN18145556.

Findings

3022 houses received screening plus Eave Tubes, with an average coverage of 70% across the intervention clusters. 1300 eligible children were recruited for active case detection in the control group and 1260 in the intervention group. During the 2-year follow-up period, malaria case incidence was 2·29 per child-year (95% CI 1·97–2·61) in the control group and 1·43 per child-year (1·21–1·65) in the intervention group (hazard ratio 0·62, 95% CI 0·51–0·76; p<0·0001). Cost-effectiveness simulations suggested that screening plus Eave Tubes has a 74·0% chance of representing a cost-effective intervention, compared with existing healthcare activities in Cte d'Ivoire, and is similarly cost-effective to other core vector control interventions across sub-Saharan Africa. No serious adverse events associated with the intervention were reported during follow-up.

Interpretation

Screening plus Eave Tubes can provide protection against malaria in addition to the effects of insecticide-treated nets, offering potential for a new, cost-effective strategy to supplement existing vector control tools. Additional trials are needed to confirm these initial results and further optimise Eave Tubes and the lethal house lure concept to facilitate adoption.

DOI: 10.1016/S0140-6736(21)00250-6

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00250-6/fulltext