Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda.
PLoS One. 2012;7(12):e50325. doi: 10.1371/journal.pone.0050325. Epub 2012 Dec 7.
Helminth infections may modulate immune responses to unrelated pathogens and allergens; these effects may commence prenatally. We addressed the hypothesis that anthelminthic treatment in pregnancy and early childhood would improve responses to immunisation and modulate disease incidence in early childhood with both beneficial and detrimental effects.
A randomised, double-blind, placebo-controlled trial was conducted in Entebbe, Uganda [ISRCTN32849447]. In three independent randomisations, 2507 pregnant women were allocated to receive single-dose albendazole or placebo, and praziquantel or placebo; 2016 of their offspring were randomised to receive quarterly single-dose albendazole or placebo from age 15 months to 5 years. Primary outcomes were post-immunisation recall responses to BCG and tetanus antigens, and incidence of malaria, diarrhoea, and pneumonia; incidence of eczema was an important secondary outcome. Analysis was by intention-to-treat. Of 2345 live births, 1622 (69%) children remained in follow-up at age 5 years. 68% of mothers at enrolment, and 11% of five-year-olds, had helminth infections. Maternal hookworm and Schistosoma mansoni were effectively treated by albendazole and praziquantel, respectively; and childhood hookworm and Ascaris by quarterly albendazole. Incidence rates of malaria, diarrhoea, pneumonia, and eczema were 34, 65, 10 and 5 per 100 py, respectively. Albendazole during pregnancy caused an increased rate of eczema in the children (HR 1.58 (95% CI 1.15-2.17), p = 0.005). Quarterly albendazole during childhood was associated with reduced incidence of clinical malaria (HR 0.85 (95% CI 0.73-0.98), p = 0.03). There were no consistent effects of the interventions on any other outcome.
Routine use of albendazole in pregnancy may not always be beneficial, even in tropical developing countries. By contrast, regular albendazole treatment in preschool children may have an additional benefit for malaria control where helminths and malaria are co-endemic. Given the low helminth prevalence in our children, the effect of albendazole on malaria is likely to be direct.
Current Controlled Trials ISRCTN32849447.
寄生虫感染可能会调节对无关病原体和过敏原的免疫反应；这些影响可能在产前开始。我们研究了一个假设，即在怀孕期间和幼儿期进行驱虫治疗是否会改善免疫反应，并调节幼儿期的疾病发病率，同时产生有益和有害的影响。
在乌干达恩德培进行了一项随机、双盲、安慰剂对照试验[ISRCTN32849447]。在三次独立的随机分组中，2507 名孕妇被分配接受单次剂量的阿苯达唑或安慰剂，以及吡喹酮或安慰剂；其中 2016 名婴儿的后代从 15 个月到 5 岁时被随机分配接受每季度单次剂量的阿苯达唑或安慰剂。主要结局是接种卡介苗和破伤风抗原后的回忆反应，以及疟疾、腹泻和肺炎的发病率；湿疹的发病率是一个重要的次要结局。分析采用意向治疗。在 2345 例活产中，有 1622 例（69%）儿童在 5 岁时仍在随访中。68%的孕妇和 11%的 5 岁儿童有寄生虫感染。阿苯达唑有效治疗了母亲的钩虫和曼氏血吸虫感染，吡喹酮有效治疗了儿童的钩虫和蛔虫感染；每季度阿苯达唑可有效预防儿童的钩虫和蛔虫感染。疟疾、腹泻、肺炎和湿疹的发病率分别为每 100 人每年 34、65、10 和 5 例。怀孕期间使用阿苯达唑会导致儿童湿疹发病率增加（HR 1.58（95%CI 1.15-2.17），p=0.005）。儿童期每季度使用阿苯达唑与临床疟疾发病率降低相关（HR 0.85（95%CI 0.73-0.98），p=0.03）。这些干预措施对任何其他结果都没有一致的影响。
在热带发展中国家，即使在寄生虫感染普遍的情况下，怀孕期间常规使用阿苯达唑也不一定有益。相比之下，在寄生虫和疟疾同时流行的地区，对学龄前儿童进行定期阿苯达唑治疗可能对疟疾控制有额外的益处。考虑到我们儿童的寄生虫感染率较低，阿苯达唑对疟疾的影响可能是直接的。
当前对照试验 ISRCTN32849447。
