Coosemans M, D'Alessandro U
Institut de Médecine Tropicale Prince Léopold, Antwerpen, Belgique.
Bull Soc Pathol Exot. 2001 Jul;94(2 Pt 2):169-73.
Insecticide Treated Nets (ITNs) represent for Malaria Control Programmes an important and efficacious tool for decreasing malaria incidence. In a large number of countries outside Africa, where in most cases malaria is unstable or the risk of epidemics is high, the long-term efficacy of ITNs is widely accepted. However, it is unclear whether this applies to situations where transmission is intermediate or intense. Comparisons of epidemiological data from areas with different transmission levels led to contradictory results in terms of the long-term impact of ITNs in Africa. Besides the methodological problems, these comparisons do not take into account the mortality indirectly linked to malaria and the time distribution of infective bites. This discussion helps in drawing attention to the possible risk of shifting mortality and morbidity to older age groups. Although an increased incidence of cerebral malaria cannot be ruled out in areas of intense transmission, the overall impact will probably be beneficial. These non-conclusive comparisons should not slow down the implementation of ITN programmes. The first report on the long-term effect of ITNs contradicts the more pessimistic predictions. Simply reducing the transmission peaks could substantially decrease malaria mortality and morbidity The improvement of the distribution and re-impregnation systems should make ITNs more operational.
经杀虫剂处理的蚊帐（ITNs）对疟疾控制项目而言，是降低疟疾发病率的一项重要且有效的工具。在非洲以外的许多国家，在大多数情况下疟疾并不稳定或流行风险很高，ITNs的长期有效性已被广泛认可。然而，尚不清楚这是否适用于传播处于中等或高强度的情况。对不同传播水平地区的流行病学数据进行比较，就ITNs在非洲的长期影响而言，得出了相互矛盾的结果。除了方法学问题外，这些比较没有考虑到与疟疾间接相关的死亡率以及感染性叮咬的时间分布。这种讨论有助于引起人们对将死亡率和发病率转移到老年人群体的潜在风险的关注。尽管在高强度传播地区不能排除脑型疟疾发病率增加的可能性，但总体影响可能是有益的。这些尚无定论的比较不应减缓ITN项目的实施。关于ITNs长期效果的第一份报告与更为悲观的预测相矛盾。仅仅降低传播高峰就可以大幅降低疟疾死亡率和发病率。改善分发和重新浸渍系统应使ITNs更具实用性。
