Department of Entomology and Plant Pathology, Auburn University, Auburn, AL 36849, USA.
Acta Trop. 2011 Sep;120 Suppl 1:S100-8. doi: 10.1016/j.actatropica.2010.08.009. Epub 2010 Aug 27.
We review and analyze approaches over a 65 year period that have proven successful for onchocerciasis control in several different epidemiological settings. These include vector control with the goal of transmission interruption versus the use of mass drug administration using ivermectin (Mectizan(®)) monotherapy. Ivermectin has proven exceedingly effective because it is highly efficacious against Onchocerca volvulus microfilariae, the etiological agent of onchocercal skin and ocular disease and the infective stage for the vector. For these reasons, the drug was donated by the Merck Company for regional control programs in Africa and the Americas. Recurrent treatment with ivermectin at semi-annual intervals also impacts adult worms and result in loss of fecundity and increased mortality. Using a strategy of 6-monthly treatments with high coverage rates, the Onchocerciasis Elimination Program for the Americas has interrupted transmission in seven of the thirteen foci in the Americas and is on track to eliminate onchocerciasis in the region by 2015. Treatments given annually or semi-annually for 15-17 years in three hyperendemic onchocerciasis foci in Mali and Senegal also have resulted in a few infections in the human population with transmission levels below thresholds postulated for elimination. Follow-up evaluations did not detect any recrudescence of infection or transmission, suggesting that onchocerciasis elimination could be feasible with Mectizan(®) treatment in some endemic foci in Africa.
我们回顾和分析了 65 年来在几种不同的流行病学环境中成功控制盘尾丝虫病的方法。这些方法包括以阻断传播为目标的病媒控制，以及使用伊维菌素（Mectizan®）单药疗法进行大规模药物治疗。伊维菌素已被证明非常有效，因为它对盘尾丝虫微丝蚴具有高度疗效，而微丝蚴是盘尾丝虫病皮肤和眼部疾病的病原体，也是病媒的感染阶段。出于这些原因，默克公司将该药物捐赠给非洲和美洲的区域控制项目。每半年用伊维菌素进行重复治疗也会影响成虫，并导致其丧失生殖力和增加死亡率。使用每六个月用高覆盖率进行治疗的策略，美洲盘尾丝虫病消除计划已在美洲的 13 个流行点中的 7 个中断了传播，并有望在 2015 年之前在该地区消除盘尾丝虫病。在马里和塞内加尔的三个高度流行的盘尾丝虫病流行点中，每年或每半年用伊维菌素治疗 15-17 年，也导致了一些人群感染，传播水平低于假设的消除阈值。后续评估未发现任何感染或传播的复发，这表明在非洲的一些流行点，使用 Mectizan®治疗可能可以消除盘尾丝虫病。
