Ramaiah K D, Thiruvengadam B, Vanamail P, Subramanian S, Gunasekaran S, Nilamani N, Das P K
Vector Control Research Centre, Pondicherry, India.
Trop Med Int Health. 2009 Aug;14(8):870-6. doi: 10.1111/j.1365-3156.2009.02307.x. Epub 2009 Jun 22.
A diethylcarbamazine (DEC)-fortified salt intervention programme was implemented between 1982 and 1986 in Karaikal district, Union territory of Pondicherry, south India, to control Culex transmitted bancroftian filariasis. The intervention reduced the microfilaria (Mf) rate from 4.49% to 0.08%. To eliminate the residual microfilaraemia, the health department detected and treated Mf carriers from 1987 to 2005 and mass-administered drugs in 2004 and 2005. Surveillance from 1987 to 2005 revealed persistent microfilaraemia in 0.03-0.42% of the population. In 2006, we conducted a more detailed Mf survey and a child antigenaemia (Ag) survey in 15 urban wards and 17 rural villages. These surveys showed an overall Mf rate of 0.46% in the high-risk urban areas and 0.18% in the rural areas; none of the sampled children was positive for Ag. All detected Mf carriers were >20 years old. The age of the youngest Mf carrier was 30 years in urban and 21 years in rural areas, which suggests that transmission was interrupted and there was no incidence of new Mf case after cessation of DEC salt programme. Eleven of 15 urban and 15 of 17 villages were totally free from microfilaraemia. Nevertheless, three of 15 surveyed urban localities and two of 17 villages showed >1% Mf rate. Thus, it seems that (i) post-intervention very low levels of microfilaraemia can continue as long as 20 years; (ii) 0.60-0.70% Mf rate is a safe level and at this level recrudescence of infection may not occur; (iii) there can be isolated localities with >1% Mf rate and their detection for further intervention measures could be challenging in larger control/elimination programmes and (iv) the residual infection mostly gets concentrated in the adult population, in underdeveloped urban areas and in historically highly endemic or large endemic rural areas. These groups and areas should be targeted with rigorous intervention measures such as mass drug administration to eliminate the residual infection.
1982年至1986年期间,在印度南部本地治里联邦属地的卡莱卡尔地区实施了一项乙胺嗪(DEC)强化盐干预计划,以控制由库蚊传播的班氏丝虫病。该干预措施使微丝蚴(Mf)率从4.49%降至0.08%。为消除残留的微丝蚴血症,卫生部门在1987年至2005年期间对Mf携带者进行了检测和治疗,并在2004年和2005年进行了群体药物给药。1987年至2005年的监测显示,0.03%至0.42%的人群中存在持续性微丝蚴血症。2006年,我们在15个城市街区和17个乡村进行了更详细的Mf调查和儿童抗原血症(Ag)调查。这些调查显示,高危城市地区的总体Mf率为0.46%,农村地区为0.18%;所有抽样儿童的Ag检测均为阴性。所有检测到的Mf携带者年龄均超过20岁。城市中最年轻的Mf携带者年龄为30岁,农村为21岁,这表明传播已被阻断,在DEC盐计划停止后没有新的Mf病例发生。15个城市街区中的11个和17个村庄中的15个完全没有微丝蚴血症。然而,15个被调查的城市地区中有3个和17个村庄中有2个的Mf率超过1%。因此,似乎(i)干预后极低水平的微丝蚴血症可能持续长达20年;(ii)0.60%至0.70%的Mf率是一个安全水平,在此水平感染可能不会复发;(iii)可能存在Mf率超过1%的孤立地区,在更大规模的控制/消除计划中对其进行检测以采取进一步干预措施可能具有挑战性;(iv)残留感染大多集中在成年人群、欠发达城市地区以及历史上高度流行或大面积流行的农村地区。这些群体和地区应采取诸如群体药物给药等严格干预措施,以消除残留感染。