King Charles H
Center for Global Health and Diseases, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
Mem Inst Oswaldo Cruz. 2006 Sep;101 Suppl 1:299-306. doi: 10.1590/s0074-02762006000900047.
Urinary schistosomiasis remains a significant burden for Africa and the Middle East. The success of population-based control programs will depend on their impact, over many years, on Schistosoma haematobium reinfection and associated disease. In a multi-year (1984-1992) control program in Kenya, we examined risk for S. haematobium reinfection and late disease during and after annual school-based treatment. In this setting, long-term risk of new infection was independently associated with location, age, hematuria, and incomplete treatment, but not with sex or frequency of water contact. Thus, very local environmental features and age-related factors played an important role in S. haematobium transmission, such that population-based control programs should optimally tailor their efforts to local conditions on a village-by-village basis. In 2001-2002, the late benefits of earlier participation in school-based antischistosomal therapy were estimated in a cohort of formerly-treated adult residents compared to never-treated adults from the same villages. Among age-matched subjects, current infection prevalence was lower among those who had received remote therapy. In addition, prevalence of bladder abnormality was lower in the treated group, who were free of severe bladder disease. Treatment of affected adults resulted in rapid resolution of infection and any detectable bladder abnormalities. We conclude that continued treatment into adulthood, as well as efforts at long-term prevention of infection (transmission control) are necessary to achieve optimal morbidity control in affected communities.
泌尿血吸虫病仍然是非洲和中东地区的一个重大负担。基于人群的控制项目能否成功，将取决于其多年来对埃及血吸虫再感染及相关疾病的影响。在肯尼亚一项为期多年（1984 - 1992年）的控制项目中，我们研究了在校年度治疗期间及之后埃及血吸虫再感染和晚期疾病的风险。在这种情况下，新感染的长期风险与地点、年龄、血尿和治疗不彻底独立相关，但与性别或接触水的频率无关。因此，非常局部的环境特征和与年龄相关的因素在埃及血吸虫传播中起重要作用，基于人群的控制项目应根据村庄的具体情况进行优化调整。在2001 - 2002年，与来自相同村庄未接受过治疗的成年人相比，对一组曾接受过治疗的成年居民估计了早期参与在校抗血吸虫治疗的后期益处。在年龄匹配的受试者中，接受过远程治疗的人当前感染率较低。此外，治疗组中膀胱异常的患病率较低，且无严重膀胱疾病。对受影响的成年人进行治疗可迅速消除感染和任何可检测到的膀胱异常。我们得出结论，为了在受影响社区实现最佳发病率控制，持续治疗至成年以及长期预防感染（传播控制）的努力是必要的。
