Graduate Group in Demography, Population Studies Center, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA 19104-16298, USA.
Expert Rev Anti Infect Ther. 2010 Feb;8(2):219-34. doi: 10.1586/eri.09.119.
Parasites found in the human gastrointestinal tract can be largely categorized into two groups, protozoa and helminths. The soil-transmitted helminths (Ascaris lumbricoides, hookworm and Trichuris trichiura) are the most prevalent, infecting an estimated one-sixth of the global population. Infection rates are highest in children living in sub-Saharan Africa, followed by Asia and then Latin America and the Caribbean. The current momentum towards global drug delivery for their control is at a historical high through the efforts of numerous initiatives increasingly acting in coordination with donors, governments and local communities. Together, they have delivered enormous quantities of drugs, especially anthelmintics to children through nationwide annual or biannual mass drug administration largely coordinated through schools. However, a much larger and rapidly growing childhood population in these regions remains untreated and suffering from more than one parasite. Mass drug administration has profound potential for control but is not without considerable challenges and concerns. A principal barrier is funding. Stimulating a research and development pipeline, supporting the necessary clinical trials to refine treatment, in addition to procuring and deploying drugs (and sustaining these supply chains), requires substantial funding and resources that do not presently exist. Limited options for chemotherapy raise concerns about drug resistance developing through overuse, however, satisfactory pharmaco-epidemiology and monitoring for drug resistance requires more developed health infrastructures than are generally available. Further, the limited pharmacopeia does not include any effective second-line options if resistance emerges, and the research and development pipeline is severely depressed. Herein, we discuss the major gastrointestinal protozoa and helminths reviewing their impact on child health, changing epidemiology and how this relates to their control.
人体胃肠道中的寄生虫大致可分为两类，原生动物和蠕虫。土壤传播的蠕虫（蛔虫、钩虫和鞭虫）最为普遍，估计全球有六分之一的人口受到感染。感染率在撒哈拉以南非洲的儿童中最高，其次是亚洲，然后是拉丁美洲和加勒比地区。目前，通过众多举措的努力，全球药物输送控制寄生虫的势头达到了历史最高水平，这些举措越来越协调一致地与捐助者、政府和当地社区合作。通过学校协调，他们共同向儿童提供了大量药物，尤其是驱虫药，用于全国范围内每年或每两年一次的大规模药物管理。然而，这些地区的儿童人口数量更多，而且增长迅速，他们仍然未得到治疗，且受到不止一种寄生虫的感染。大规模药物管理具有控制寄生虫的巨大潜力，但也并非没有相当大的挑战和担忧。一个主要的障碍是资金。刺激研发管道，支持必要的临床试验以完善治疗方法，以及采购和部署药物（并维持这些供应链），需要大量的资金和资源，而目前并不存在这些资金和资源。化疗选择有限引起了人们对过度使用导致药物耐药性发展的担忧，然而，要进行令人满意的药物耐药性药物流行病学和监测，需要比目前更发达的卫生基础设施。此外，如果出现耐药性，有限的药物目录中不包括任何有效的二线治疗选择，而且研发管道严重受挫。在此，我们讨论了主要的胃肠道原生动物和蠕虫，回顾了它们对儿童健康的影响、不断变化的流行病学以及这与寄生虫控制的关系。
