埃及高风险传播疫源地的曼氏血吸虫病能否持续得到控制？
Can human schistosomiasis mansoni control be sustained in high-risk transmission foci in Egypt?
作者信息
Elmorshedy Hala, Bergquist Robert, El-Ela Nadia Emam Abou, Eassa Safaa Mohamed, Elsakka Elham Elsayed, Barakat Rashida
机构信息
Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
Ingerod, Brastad, Sweden & University of Basel, Basel, Switzerland.
出版信息
Parasit Vectors. 2015 Jul 16;8:372. doi: 10.1186/s13071-015-0983-2.
BACKGROUND
Control of human schistosomiasis remains a longstanding issue on the agenda of the Egyptian Ministry of Health and Population (MOHP). Substantial impact on morbidity and prevalence of S. mansoni was widely reported after the National Schistosomiasis Control Program (NSCP) extended selective treatment with praziquantel (PZQ) to the Nile Delta in 1992 and upgrading this approach to mass drug administration (MDA) in 1997. Disease elimination, however, eludes NSCP as the micro-level includes many high-risk foci that sustain transmission, which has not been subjected to investigation.
METHODS
The study included five high-risk Nile Delta villages situated in the Kafr El-Sheikh Governorate. The total sample size amounted to 2382 individuals of both sexes and all ages. Diagnosis was based on four Kato-Katz slides from two consecutive stool samples. Data were investigated using SPSS, comparing proportions with the Chi square test and means with the Student t test, while strength of the associations were subjected to Odds Ratio (OR) analysis.
RESULTS
The overall prevalence of schistosomiasis in the study area was found to be 29%, while the mean geometric mean egg count (GMEC) was low (66.78 ± 4.4) indicating low intensity of infection. The mean village prevalence rates ranged from 16.5% to 49.5% and the GMECs from 35.2 to 86.2 eggs per gram (EPG) of stool. The difference of prevalence between villages was statistically significant at P < 0.05, and the prevalence was significantly higher among males than among females, P < 0.05, OR =1.4 and 95% CI (1.16-1.60). Infection peaked in the next youngest age group (5- ≤ 10 years of age) at an average prevalence of 50.8% with the GMEC reaching 209 EPG of stool in the village with the highest prevalence. The average prevalence and GMEC among children <5 years were 20.6% and 92.7 EPG, respectively.
CONCLUSION
Transmission of S mansoni in high-risk areas in the Nile Delta remains uninterrupted calling for improved, more comprehensive control strategies. Further investigations are needed to find out whether these results are due to inefficacy of PZQ, surviving immature worms or drug resistance.
背景
控制人类血吸虫病仍是埃及卫生与人口部（MOHP）议程上的一个长期问题。1992年国家血吸虫病控制项目（NSCP）将吡喹酮（PZQ）选择性治疗扩展至尼罗河三角洲，并于1997年将此方法升级为大规模药物治疗（MDA）后，有大量报告称这对曼氏血吸虫的发病率和流行率产生了重大影响。然而，疾病消除仍然是NSCP难以实现的目标，因为微观层面存在许多维持传播的高风险疫点，尚未对此进行调查。
方法
该研究包括位于卡夫尔谢赫省的五个尼罗河三角洲高风险村庄。样本总量为2382名各年龄段的男女个体。诊断基于连续两份粪便样本的四张加藤厚涂片。使用SPSS对数据进行调查，通过卡方检验比较比例，通过学生t检验比较均值，同时对关联强度进行比值比（OR）分析。
结果
研究区域内血吸虫病的总体流行率为29%，而平均几何均数虫卵计数（GMEC）较低（66.78±4.4），表明感染强度较低。村庄的平均流行率在16.5%至49.5%之间，GMEC在每克粪便35.2至86.2个虫卵（EPG）之间。村庄之间的流行率差异在P<0.05时具有统计学意义，男性的流行率显著高于女性，P<0.05，OR =1.4，95%置信区间（1. 16 - 1.60）。感染在次年轻年龄组（5至≤10岁）达到峰值，平均流行率为50.8%，在流行率最高的村庄中GMEC达到每克粪便209个EPG。5岁以下儿童的平均流行率和GMEC分别为20.6%和92.7个EPG。
结论
尼罗河三角洲高风险地区曼氏血吸虫的传播仍未中断，需要改进、更全面的控制策略。需要进一步调查以确定这些结果是否是由于PZQ无效、未成熟虫体存活或耐药性所致。
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