Njenga S M, Wamae C N, Njomo D W, Mwandawiro C S, Molyneux D H
Kenya Medical Research Institute, P.O. Box 19464, Post Code 00202, Nairobi, Kenya.
Trans R Soc Trop Med Hyg. 2008 Oct;102(10):1017-24. doi: 10.1016/j.trstmh.2008.04.039. Epub 2008 Jun 11.
Annual single-dose mass treatment of endemic populations with a combination of either diethylcarbamazine (DEC) or ivermectin plus albendazole is recommended as the mainstay of lymphatic filariasis elimination programmes. We evaluated the impact of two rounds of annual mass drug administration (MDA) of DEC and albendazole on bancroftian filariasis in a pilot elimination programme in an endemic area of Kenya. Overall prevalence of microfilaraemia decreased by 65.4%, whereas community microfilarial load decreased by 84% after the two MDAs. The prevalence of parasite antigenaemia determined by immunochromatographic test (ICT) declined significantly by 43.5% after the two MDAs. We also studied the effect of mass treatment on the sensitivity of the ICT. Although the sensitivity of the test before treatment was high (89.9%; kappa=0.909) sensitivity was lower after two MDAs (59.3%; kappa=0.644). The finding raises concern about the reliability of the ICT in long-term monitoring of infection and for establishing programmatic endpoints. The results of the present study indicate a relatively high effectiveness of MDA using a DEC/albendazole combination against Wuchereria bancrofti infection and, therefore, it may be a useful strategy to eliminate lymphatic filariasis in onchocerciasis-free areas.
建议对流行地区人群每年进行一次乙胺嗪(DEC)或伊维菌素加阿苯达唑联合单剂量群体治疗,作为淋巴丝虫病消除计划的主要手段。我们在肯尼亚一个流行地区的试点消除计划中,评估了两轮每年进行的DEC和阿苯达唑群体药物给药(MDA)对班氏丝虫病的影响。两轮MDA后,微丝蚴血症的总体患病率下降了65.4%,而社区微丝蚴负荷下降了84%。通过免疫层析试验(ICT)测定的寄生虫抗原血症患病率在两轮MDA后显著下降了43.5%。我们还研究了群体治疗对ICT敏感性的影响。尽管治疗前该试验的敏感性较高(89.9%;kappa=0.909),但两轮MDA后敏感性较低(59.3%;kappa=0.644)。这一发现引发了对ICT在感染长期监测和确定项目终点方面可靠性的担忧。本研究结果表明,使用DEC/阿苯达唑联合进行MDA对班氏吴策线虫感染具有较高的有效性,因此,在无盘尾丝虫病地区,这可能是消除淋巴丝虫病的一种有用策略。