南非开普敦的反常蠕虫病和贾第虫病：流行病学与防治
Paradoxical helminthiasis and giardiasis in Cape Town, South Africa: epidemiology and control.
作者信息
Adams Vera J, Markus Miles B, Adams Joanita F A, Jordaan Esme, Curtis Bronwyn, Dhansay Muhammad A, Obihara Charlie C, Fincham John E
机构信息
Medical Research Council of South Africa, Cape Town, South Africa.
出版信息
Afr Health Sci. 2005 Sep;5(3):276-80. doi: 10.5555/afhs.2005.5.3.276.
BACKGROUND
South Africa has endorsed a World Health Assembly (WHA) resolution calling for control of soil-transmitted helminths (STHs). In Cape Town, services and housing that exist in old-established suburbs should minimise the prevalence of intestinal parasitic infections, even when residents are poor. Where families live in shacks in densely-populated areas without effective sanitation, more than 90% of children can be infected by STHs. The humoral immune response to worms theoretically favours infection by Mycobacterium tuberculosis and HIV.
OBJECTIVES
Obtain estimates of gender-, age-, school-related and overall prevalence of helminthiasis and giardiasis in a low-income but well-serviced community. Assess possible sources of infection. Alert health services to the need for control measures and the threat from protozoal pathogens. Warn that the immune response to intestinal parasites may favour tuberculosis (TB) and HIV/AIDS.
METHODS
A cross-sectional study of the prevalence of helminthiasis and giardiasis was carried out in a large, non-selective sample of children attending nine schools. Gender, school and age effects were related to non-medical preventive services, sewage disposal practices and possible sources of infection.
RESULTS
The overall STH infestation rate was 55.8%. Prevalence was inluenced by school and age but not by gender. Eggs and cysts were seen at the following prevalence: Ascaris 24.8%; Trichuris 50.6%; Hymenolepis nana 2.2%; Enterobius 0.6%; Giardia 17.3%; hookworm 0.08%; and Trichostrongylus 0.1%. Approximately 60% of sewage sludge is used in a form that will contain viable eggs and cysts.
CONCLUSION
Prevalence trends in this old community in Cape Town could indicate infection by swallowing eggs or cysts on food or in water, more than by exposure to polluted soil. Sewage sludge and effluent might be sources of infection. In adjacent, under serviced, newer communities, promiscuous defecation occurs. Probable vectors are discussed. The immune response to intestinal parasites might be a risk factor for HIV/AIDS and TB.
背景
南非已批准一项世界卫生大会（WHA）决议，呼吁控制土壤传播的蠕虫（STH）。在开普敦，老旧郊区现有的服务设施和住房应尽量降低肠道寄生虫感染的患病率，即便居民贫困。在人口密集且缺乏有效卫生设施、家庭居住在棚屋中的地区，超过90%的儿童可能感染土壤传播的蠕虫。理论上，对蠕虫的体液免疫反应有利于结核分枝杆菌和艾滋病毒的感染。
目的
估计一个低收入但服务良好的社区中蛔虫病、鞭虫病、绦虫病、蛲虫病和贾第虫病在性别、年龄、学校相关及总体上的患病率。评估可能的感染源。提醒卫生服务部门注意控制措施的必要性以及原生动物病原体带来的威胁。警告肠道寄生虫的免疫反应可能有利于结核病（TB）和艾滋病毒/艾滋病的发生。
方法
对九所学校的大量非选择性儿童样本进行蛔虫病和贾第虫病患病率的横断面研究。性别、学校和年龄效应与非医疗预防服务、污水处理方式及可能的感染源相关。
结果
土壤传播的蠕虫总体感染率为55.8%。患病率受学校和年龄影响，但不受性别影响。虫卵和包囊的检出率如下：蛔虫24.8%；鞭虫50.6%；微小膜壳绦虫2.2%；蛲虫0.6%；贾第虫17.3%；钩虫0.08%；毛圆线虫0.1%。约60%的污水污泥以含有活虫卵和包囊的形式被使用。
结论
开普敦这个老旧社区的患病率趋势可能表明，感染途径更多是通过吞食食物或水中的虫卵或包囊，而非接触受污染的土壤。污水污泥和废水可能是感染源。在相邻的、服务不足的新社区，存在随意排便现象。文中讨论了可能的传播媒介。对肠道寄生虫的免疫反应可能是艾滋病毒/艾滋病和结核病的一个危险因素。
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