Simonsen Paul E, Meyrowitsch Dan W, Mukoko Dunstan A, Pedersen Erling M, Malecela-Lazaro Mwele N, Rwegoshora Rwehumbiza T, Ouma John H, Masese Naftal, Jaoko Walter G, Michael Edwin
Danish Bilharziasis Laboratory, Charlottenlund, Denmark.
Am J Trop Med Hyg. 2004 Jan;70(1):63-71.
The effect of repeated half-yearly mass treatment with diethylcarbamazine (DEC, 6 mg/kg body weight) on infection and transmission of Wuchereria bancrofti was assessed and compared in communities with high and low endemicity in eastern Africa, with pretreatment microfilaria (mf) and circulating filarial antigen (CFA) prevalences of 29.4% and 53.2% in the high endemicity community and 3.1% and 18.7% in the low endemicity community, respectively. Human infection was monitored by repeated cross-sectional surveys, and transmission by weekly light trap collection of vector mosquitoes in selected houses in each community. Treatments resulted in a progressive decrease in microfilaremia and circulating antigenemia in both communities, with relative reductions being considerably higher for mf than for CFA. Among pretreatment mf-positive individuals, more than 60% were diagnosed as mf negative and mean mf intensities were reduced by 99% in both communities after two treatment rounds. In contrast, only moderate reductions were seen in circulating antigenemia among pretreatment CFA-positive individuals, with mean intensities still being 24-39% of pretreatment values after two treatment rounds. Among the pretreatment mf/CFA-positive individuals, clearance to a CFA-negative status was negligible. Complete CFA clearance was only observed among pretreatment CFA-positive but mf negative individuals who also had much lower initial mean CFA levels than the mf-positive individuals. After treatment, the intensity of transmission decreased in the high-endemicity community, but this appeared mainly to be a consequence of a drought-induced reduction in vector density rather than to reduced mf load in the human population, since the proportion of mosquitoes carrying infective larvae was not reduced. No change in transmission or mosquito infectivity was observed after treatment in the low-endemicity community. Implications of these observations for the control of Bancroftian filariasis are discussed.
在东非高流行区和低流行区的社区中，评估并比较了每半年重复使用乙胺嗪（DEC，6毫克/千克体重）进行群体治疗对班氏吴策线虫感染和传播的影响。高流行区社区治疗前的微丝蚴（mf）和循环丝虫抗原（CFA）患病率分别为29.4%和53.2%，低流行区社区分别为3.1%和18.7%。通过重复的横断面调查监测人体感染情况，并通过每周在每个社区选定房屋中用灯光诱捕收集媒介蚊子来监测传播情况。治疗使两个社区的微丝蚴血症和循环抗原血症逐渐下降，mf的相对降幅比CFA大得多。在治疗前mf阳性个体中，两轮治疗后两个社区均有超过60%被诊断为mf阴性，平均mf强度降低了99%。相比之下，治疗前CFA阳性个体的循环抗原血症仅出现中度下降，两轮治疗后平均强度仍为治疗前值的24 - 39%。在治疗前mf/CFA阳性个体中，清除至CFA阴性状态的情况可忽略不计。仅在治疗前CFA阳性但mf阴性且初始平均CFA水平远低于mf阳性个体的个体中观察到完全清除CFA的情况。治疗后，高流行区社区的传播强度下降，但这似乎主要是干旱导致媒介密度降低的结果，而非人群中mf负荷降低所致，因为携带感染性幼虫的蚊子比例并未降低。在低流行区社区治疗后未观察到传播或蚊子感染性的变化。讨论了这些观察结果对班氏丝虫病控制的意义。
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