Killeen G F, McKenzie F E, Foy B D, Schieffelin C, Billingsley P F, Beier J C
Department of Tropical Medicine, School of Public Health and Tropical Medicine, Center for Infectious Diseases, Tulane University Health Sciences Center, New Orleans, Louisiana 70112-2824, USA.
Am J Trop Med Hyg. 2000 May;62(5):545-51. doi: 10.4269/ajtmh.2000.62.545.
We have used a relatively simple but accurate model for predicting the impact of integrated transmission control on the malaria entomologic inoculation rate (EIR) at four endemic sites from across sub-Saharan Africa and the southwest Pacific. The simulated campaign incorporated modestly effective vaccine coverage, bed net use, and larval control. The results indicate that such campaigns would reduce EIRs at all four sites by 30- to 50-fold. Even without the vaccine, 15- to 25-fold reductions of EIR were predicted, implying that integrated control with a few modestly effective tools can meaningfully reduce malaria transmission in a range of endemic settings. The model accurately predicts the effects of bed nets and indoor spraying and demonstrates that they are the most effective tools available for reducing EIR. However, the impact of domestic adult vector control is amplified by measures for reducing the rate of emergence of vectors or the level of infectiousness of the human reservoir. We conclude that available tools, including currently neglected methods for larval control, can reduce malaria transmission intensity enough to alleviate mortality. Integrated control programs should be implemented to the fullest extent possible, even in areas of intense transmission, using simple models as decision-making tools. However, we also conclude that to eliminate malaria in many areas of intense transmission is beyond the scope of methods which developing nations can currently afford. New, cost-effective, practical tools are needed if malaria is ever to be eliminated from highly endemic areas.
我们使用了一个相对简单但准确的模型，来预测综合传播控制对撒哈拉以南非洲和西南太平洋四个流行地区疟疾昆虫接种率（EIR）的影响。模拟活动纳入了适度有效的疫苗接种覆盖率、蚊帐使用和幼虫控制措施。结果表明，此类活动将使所有四个地区的EIR降低30至50倍。即使不使用疫苗，预计EIR也会降低15至25倍，这意味着使用一些适度有效的工具进行综合控制能够在一系列流行环境中切实降低疟疾传播。该模型准确预测了蚊帐和室内喷洒的效果，并表明它们是降低EIR最有效的工具。然而，通过降低病媒出现率或人类宿主感染性水平的措施，可增强家庭成年病媒控制的效果。我们得出结论，现有工具，包括目前被忽视的幼虫控制方法，能够降低疟疾传播强度，足以减轻死亡率。即使在传播强烈的地区，也应尽可能全面实施综合控制计划，使用简单模型作为决策工具。然而，我们也得出结论，在许多传播强烈的地区消除疟疾超出了发展中国家目前所能承受的方法范围。如果要从高度流行地区消除疟疾，就需要新的、具有成本效益的实用工具。
