Kyelem D, Sanou S, Boatin B, Medlock J, Coulibaly S, Molyneux D H
Lymphatic Filariasis Programme, Ministry of Health, 03 BP 7009, Ouagadougou, Burkina Faso.
Ann Trop Med Parasitol. 2003 Dec;97(8):827-38. doi: 10.1179/000349803225002462.
Parasitological and clinical surveys were used to determine the long-term impact of ivermectin on the prevalence of Wuchereria bancrofti and Mansonella perstans filarial infections, when the drug was given under community-directed-treatment strategies for onchocerciasis control. The study was undertaken in 11 communities in south-western Burkina Faso. Six of the villages investigated had been treated with ivermectin at least once a year for five of 6 years, with a mean coverage of approximately 65% in each round. The other five, adjacent villages, which were matched with the ivermectin-treated communities by size, ethnicity and social and economic activities, had never been treated because they were not endemic for onchocerciasis. Each subject was checked by the microscopical examination of a smear of 'night' blood, by measurement of the level of circulating antigens from adult W. bancrofti, and by clinical examination for hydrocele (if male) and lymphoedema. The prevalences of lymphoedema and hydrocele in the treated villages were similar to those in the untreated. The prevalences and intensities of W. bancrofti and M. perstans microfilaraemia were, however, significantly lower in the ivermectin-treated communities. The implications of this study are discussed in relation to the old Onchocerciasis Control Programme (OCP) and to the ongoing African Programme for Onchocerciasis (APOC), where extensive and sustained ivermectin distribution is planned through community-based treatment programmes. As with onchocerciasis in Africa, the success of annual treatments to control lymphatic filariasis will depend not only on the number of regular rounds of treatment given but on adequate coverages being achieved in each round. Wherever ivermectin is being distributed alone, for onchocerciasis control, its impact on other filarial infections, notably W. bancrofti, should be evaluated routinely. Any opportunity to add donated albendazole to such distributions should be taken, both to limit the transmission of W. bancrofti and for the wider public-health benefits.
在以社区指导治疗策略控制盘尾丝虫病的情况下，采用寄生虫学和临床调查来确定伊维菌素对班氏吴策线虫和常现曼森线虫丝虫感染率的长期影响。该研究在布基纳法索西南部的11个社区开展。所调查的6个村庄在6年中的5年里每年至少接受一次伊维菌素治疗，每轮平均覆盖率约为65%。另外5个相邻村庄，在规模、种族以及社会和经济活动方面与接受伊维菌素治疗的社区相匹配，由于它们不是盘尾丝虫病的流行区，所以从未接受过治疗。对每名受试者进行了“夜间”血涂片显微镜检查、检测成年班氏吴策线虫循环抗原水平，并进行了临床检查以诊断鞘膜积液（男性）和淋巴水肿。接受治疗村庄的淋巴水肿和鞘膜积液患病率与未治疗村庄相似。然而，在接受伊维菌素治疗的社区中，班氏吴策线虫和常现曼森线虫微丝蚴血症的患病率和强度显著较低。结合旧的盘尾丝虫病控制计划（OCP）和正在进行的非洲盘尾丝虫病防治计划（APOC）对本研究的意义进行了讨论，在APOC中，计划通过基于社区的治疗方案广泛且持续地分发伊维菌素。与非洲的盘尾丝虫病一样，每年进行治疗以控制淋巴丝虫病的成功不仅取决于定期治疗的轮数，还取决于每轮治疗能否实现足够的覆盖率。无论何处单独分发伊维菌素以控制盘尾丝虫病，都应定期评估其对其他丝虫感染（尤其是班氏吴策线虫）的影响。应利用任何机会在这类分发中添加捐赠的阿苯达唑，以限制班氏吴策线虫的传播并获得更广泛的公共卫生效益。
