Chammartin Frédérique, Houngbedji Clarisse A, Hürlimann Eveline, Yapi Richard B, Silué Kigbafori D, Soro Gotianwa, Kouamé Ferdinand N, N Goran Eliézer K, Utzinger Jürg, Raso Giovanna, Vounatsou Penelope
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Unité de Formation et de Recherche des Sciences de la Nature, Université Nangui Abrogua, Abidjan, Côte d'Ivoire.
PLoS Negl Trop Dis. 2014 Dec 18;8(12):e3407. doi: 10.1371/journal.pntd.0003407. eCollection 2014 Dec.
Schistosoma haematobium and Schistosoma mansoni are blood flukes that cause urogenital and intestinal schistosomiasis, respectively. In Côte d'Ivoire, both species are endemic and control efforts are being scaled up. Accurate knowledge of the geographical distribution, including delineation of high-risk areas, is a central feature for spatial targeting of interventions. Thus far, model-based predictive risk mapping of schistosomiasis has relied on historical data of separate parasite species.
We analyzed data pertaining to Schistosoma infection among school-aged children obtained from a national, cross-sectional survey conducted between November 2011 and February 2012. More than 5,000 children in 92 schools across Côte d'Ivoire participated. Bayesian geostatistical multinomial models were developed to assess infection risk, including S. haematobium-S. mansoni co-infection. The predicted risk of schistosomiasis was utilized to estimate the number of children that need preventive chemotherapy with praziquantel according to World Health Organization guidelines.
We estimated that 8.9% of school-aged children in Côte d'Ivoire are affected by schistosomiasis; 5.3% with S. haematobium and 3.8% with S. mansoni. Approximately 2 million annualized praziquantel treatments would be required for preventive chemotherapy at health districts level. The distinct spatial patterns of S. haematobium and S. mansoni imply that co-infection is of little importance across the country.
CONCLUSIONS/SIGNIFICANCE: We provide a comprehensive analysis of the spatial distribution of schistosomiasis risk among school-aged children in Côte d'Ivoire and a strong empirical basis for a rational targeting of control interventions.
埃及血吸虫和曼氏血吸虫是分别导致泌尿生殖系统血吸虫病和肠道血吸虫病的血吸虫。在科特迪瓦，这两种血吸虫均为地方病，且防治工作正在扩大规模。准确了解地理分布，包括划定高风险区域，是干预措施空间定位的核心要素。迄今为止，基于模型的血吸虫病预测风险绘图一直依赖于各寄生虫物种的历史数据。
我们分析了2011年11月至2012年2月期间开展的一项全国性横断面调查所获取的学龄儿童血吸虫感染数据。科特迪瓦92所学校的5000多名儿童参与了调查。我们建立了贝叶斯地理统计多项模型来评估感染风险，包括埃及血吸虫-曼氏血吸虫合并感染。根据世界卫生组织的指南，利用血吸虫病的预测风险来估计需要接受吡喹酮预防性化疗的儿童数量。
我们估计科特迪瓦8.9%的学龄儿童感染了血吸虫病；5.3%感染埃及血吸虫，3.8%感染曼氏血吸虫。在卫生区层面进行预防性化疗每年大约需要200万次吡喹酮治疗。埃及血吸虫和曼氏血吸虫不同的空间分布模式表明，在全国范围内合并感染并不重要。
结论/意义：我们对科特迪瓦学龄儿童血吸虫病风险的空间分布进行了全面分析，并为合理定位控制干预措施提供了有力的实证依据。
