Costa Carlos Henrique Nery
Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Teresina, Brasil.
Cad Saude Publica. 2008 Dec;24(12):2959-63. doi: 10.1590/s0102-311x2008001200027.
The available hypotheses or explanations for the urbanization of American visceral leishmaniasis are insufficient. An alternative hypothesis is that changes in the ecology and biology of the vector, Lutzomyia longipalpis, might explain all the new urban epidemiological features of the disease. To tackle the knowledge gaps in this process, certain key research areas need to be prioritized: the role of dogs in expanding transmission in cities, community trials to evaluate new insecticides, and research on the ecological and molecular determinants of Leishmania chagasi transmission. Investment of public funds should focus on the development of a human vaccine, since such a vaccine now appears to be within reach. Even small effects from a vaccine could substantially reduce the impact of the disease, which in the last quarter century has challenged and defeated both the scientific community and the public health field around the world.
关于美国内脏利什曼病城市化的现有假说或解释并不充分。另一种假说认为，传播媒介长须罗蛉的生态和生物学变化可能解释了该疾病所有新的城市流行病学特征。为解决这一过程中的知识空白，需要优先考虑某些关键研究领域：狗在城市传播扩散中的作用、评估新型杀虫剂的社区试验，以及对恰加斯利什曼原虫传播的生态和分子决定因素的研究。公共资金的投入应集中在人类疫苗的研发上，因为现在看来这种疫苗已指日可待。即使疫苗产生的效果很小，也能大幅降低该疾病的影响，在过去四分之一世纪里，这种疾病一直困扰并难倒了世界各地的科学界和公共卫生领域。
