Favre Tereza C, Pereira Ana Paula B, Beck Lilian C N H, Galvão Aline F, Pieri Otávio S
Laboratory of Ecoepidemiology and Control of Schistosomiasis and Soil-Transmitted Helminthiases, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
Laboratory of Ecoepidemiology and Control of Schistosomiasis and Soil-Transmitted Helminthiases, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
Acta Trop. 2015 Sep;149:155-62. doi: 10.1016/j.actatropica.2015.04.024. Epub 2015 May 1.
This study evaluated a school-based and a community-based scheme for diagnosis, treatment and follow-up of schistosomiasis mansoni among school-aged children in views of resolution CD49.R19 of the Pan American Health Organization toward the elimination of schistosomiasis as a public health problem in the Americas and subsequent commitments endorsed by the Brazilian government. The school-aged population from a representative municipality of the endemic area of Northeastern Brazil was randomly allocated to either school-based or community-based scheme. The two schemes were compared with regard to coverage of diagnosis by the Kato-Katz method (KK) at baseline, treatment of the positives for Schistosoma mansoni with praziquantel, treatment of the positives for soil-transmitted helminthes (STH) with mebendazole, as well as follow-up of treatment efficacy and reinfection assessed respectively at four and 12 months after treatment. Nutritional status of the positives for S. mansoni was assessed at baseline and re-assessed at 12 months after treatment. Coverage of diagnosis and treatment was satisfactory (>75%) in both schemes. Diagnosis coverage at baseline and at 12 months was significantly higher in the community scheme, whereas treatment coverage did not differ significantly between the two schemes either at baseline or at 12 months. The number of children covered per day was significantly higher in the schools than in the community at baseline but not at follow-up, when daily coverage was higher in the community. With regard to S. mansoni, overall treatment efficacy rate at four months was 90.8%, and reinfection rate at 12 months was 21.6%. For STH, overall treatment efficacy was 45.4% and reinfection, 32.8%. The nutritional status of the positives for S. mansoni at baseline did not change significantly at 12 months post-treatment. Actions targeted at this particularly vulnerable high-risk group should combine school-based and community-based interventions as well as preventive measures to reduce transmission.
鉴于泛美卫生组织关于在美洲消除作为公共卫生问题的曼氏血吸虫病的第CD49.R19号决议以及巴西政府随后认可的承诺，本研究评估了一项针对学龄儿童曼氏血吸虫病诊断、治疗和随访的校内和社区方案。来自巴西东北部流行区一个代表性市镇的学龄人口被随机分配到校内或社区方案。比较了这两种方案在基线时采用加藤厚涂片法（KK）的诊断覆盖率、用吡喹酮治疗曼氏血吸虫病阳性病例、用甲苯达唑治疗土壤传播蠕虫（STH）阳性病例，以及分别在治疗后4个月和12个月评估的治疗效果和再感染随访情况。在基线时评估曼氏血吸虫病阳性病例的营养状况，并在治疗后12个月重新评估。两种方案的诊断和治疗覆盖率均令人满意（>75%）。社区方案在基线和12个月时的诊断覆盖率显著更高，而两种方案在基线或12个月时的治疗覆盖率没有显著差异。在基线时，学校每天覆盖的儿童人数显著高于社区，但在随访时并非如此，此时社区的每日覆盖率更高。关于曼氏血吸虫病，4个月时的总体治疗有效率为90.8%，12个月时的再感染率为21.6%。对于STH，总体治疗有效率为45.4%，再感染率为32.8%。治疗后12个月，曼氏血吸虫病阳性病例的基线营养状况没有显著变化。针对这一特别脆弱的高危群体的行动应结合校内和社区干预措施以及预防措施以减少传播。
