Kloetzel K
Departamento de Medicina Social, Escola de Medicina, Universidade Federal de Pelotas, Brasil.
Mem Inst Oswaldo Cruz. 1992;87 Suppl 4:221-6. doi: 10.1590/s0074-02761992000800034.
Our views are based, among other, on a recent study of a district of União dos Palmares (Alagoas). Although being a very compact community (32 city blocks holding two thousand families), transmission is very uneven, the geometric mean egg counts in the various blocks ranging between extremes of 96 and 1920. (Results do not correlate with the availability of domestic water supply). We thus are led to conclude that: (a) transmission is primarily peridomestic, resulting from pollution of open ditches and other collections of water; (b) control of transmission can be done on a selective basis, requiring quite modest investments. Given the inefficacy of population-based chemotherapy, when used alone, the author insists that this alternative cannot any longer be overlooked. He also regrets the emphasis placed upon vaccine development; allegations that this would, at any rate, prevent severe morbidity can be dismissed, since-whatever the cause-morbidity due to schistosomiasis has been rapidly declining in Northeast Brazil.
我们的观点，尤其基于最近对帕尔马雷斯联盟（阿拉戈斯州）一个地区的研究。尽管这是一个非常紧凑的社区（32个街区住着两千户家庭），但传播情况极不均衡，各个街区的虫卵几何平均计数在96至1920的极端值之间。（结果与家庭供水的可获得性无关）。因此我们得出结论：（a）传播主要是家庭周边传播，是由露天沟渠和其他集水区的污染导致的；（b）传播控制可以有选择地进行，所需投资相当适度。鉴于基于人群的化疗单独使用时效果不佳，作者坚持认为这种选择再也不能被忽视。他还对过于强调疫苗研发表示遗憾；那种认为疫苗无论如何都能预防严重发病的说法可以被驳回，因为——无论原因是什么——巴西东北部因血吸虫病导致的发病率一直在迅速下降。
