Molyneux D H, Nantulya V
Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
Eye (Lond). 2005 Oct;19(10):1050-6. doi: 10.1038/sj.eye.6701961.
The control of river blindness (onchocerciasis) has been one of the major public health achievements of recent decades. Initially, vector control was used to stop transmission of the parasite Onchocerca volvulus by blackflies (Simulium) but the introduction of ivermectin (Mectizan) as a means of morbidity control enabled new strategies of distribution to be developed based on community directed treatment. The donation of Mectizan by Merck & Co. Inc. for onchocerciasis control in 1987 'as long as needed' was a public health landmark to be followed by a donation from GlaxoSmithKline of albendazole in 1997 for lymphatic filariasis to which Merck also responded by agreeing to extend their donation to include the coadministration of Mectizan and albendazole. Both the drugs, however, have wider impacts than those specific to filarial parasites and are effective against a range of intestinal parasites, whilst ivermectin has an important effect on ectoparasites. The wider benefits of the annual public health intervention-collateral benefits--therefore include deworming, improved nutritional status, increased growth, improved school performance and attendance, and improved haemoglobin status as a result of the impact of albendazole on hookworm, a major cause of anaemia. More recently, studies suggest that worm-free children have a significantly reduced frequency of malaria specific episodes of fever and Ascaris-infected children have a two-fold higher frequency of cerebral or severe malaria than those without Ascaris. These findings suggest that programmes based on annual interventions to control river blindness and lymphatic filariasis can contribute disproportionately more to a range of public health problems than has been hitherto recognized, thereby assisting in attaining the millennium development goal targets.
盘尾丝虫病（河盲症）的防治是近几十年来主要的公共卫生成就之一。最初，通过病媒控制来阻断寄生虫旋盘尾丝虫由蚋（蚋属）传播，但伊维菌素（美迪善）作为一种控制发病率的手段被引入后，基于社区导向治疗的新分发策略得以发展。1987年，默克公司捐赠美迪善用于盘尾丝虫病防治“按需供应”，这是公共卫生领域的一个里程碑，随后葛兰素史克公司于1997年捐赠阿苯达唑用于淋巴丝虫病防治，默克公司也做出回应，同意扩大其捐赠范围，将美迪善与阿苯达唑联合使用。然而，这两种药物的影响比特定于丝虫寄生虫的影响更为广泛，对一系列肠道寄生虫有效，同时伊维菌素对外寄生虫有重要作用。因此，年度公共卫生干预的更广泛益处——附带益处——包括驱虫、改善营养状况、促进生长、提高学业成绩和出勤率，以及由于阿苯达唑对钩虫（贫血的主要原因）的作用而改善血红蛋白状况。最近的研究表明，体内无寄生虫的儿童疟疾特定发热发作频率显著降低，感染蛔虫的儿童患脑部或严重疟疾的频率是未感染蛔虫儿童的两倍。这些发现表明，基于年度干预措施来控制盘尾丝虫病和淋巴丝虫病的项目，对一系列公共卫生问题的贡献可能比迄今所认识到的要大得多，从而有助于实现千年发展目标。
