Unité d'Immunologie, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
Département de Biochimie, Université des Comores/Centre Universitaire de Patsy, Patsy, Comoros.
Malar J. 2017 Sep 26;16(1):387. doi: 10.1186/s12936-017-2027-1.
The Comoros are an archipelago located in the Indian Ocean between the eastern coasts of Africa and north of Madagascar. Malaria transmission appeared late in the 19th century due to the intensification of human migration. The story of malaria transmission for the past century is depicted to provide useful lessons for the future. Currently, malaria transmission occurs differently on each island; thus, control strategies must be adapted for each particular island. Tentative malaria control in Comoros has a long history of success and failure. This study reviews the data available as a basis for recommendations for the future.
There has been much effort to reach a pre-eradication state in Anjouan and Moheli, but only control steps have been taken in the Great Comoro. To date, the primary strategy used is mass treatment of the population using artemisinin-based combination therapy (ACT), which is similar to the strategy deployed during the 1950s in other countries. ACT appears efficient in two of the three islands; however, the sustainability of the strategy is unknown. This sustainability is compromised by (i) the huge level of uncontrolled exchange between the Comoro Islands and their neighbours, increasing the risk of introducing ACT-resistant strains, (ii) the use of large quantities of pesticides for agriculture usually associated with the resistance of mosquitoes, and (iii) the cost of the actions themselves.
In view of the history of malaria in this area, the first recommendation is to enhance the training of health workers and the population. The second step is to establish a national strategy to assess malaria and related factors, which is currently lacking. A survey to assess the drug sensitivity of the parasites is particularly important in a context of low transmission associated with mass treatment of the population. The last point should be to secure financial support, which is not obvious in a context of pre-elimination. The Comoro Islands are thus a living laboratory to experiments with strategies for elimination, but the future is complex.
科摩罗群岛位于印度洋，位于非洲东海岸和马达加斯加北部之间。疟疾传播始于 19 世纪，原因是人类迁徙加剧。本文旨在描述过去一个世纪的疟疾传播历史，为未来提供有用的经验教训。目前，各岛屿的疟疾传播方式不同，因此必须针对每个特定岛屿制定控制策略。科摩罗群岛的疟疾控制工作历史悠久，既有成功也有失败。本研究回顾了现有数据，为未来提出建议提供了依据。
安朱罗和莫埃利一直在努力达到消除前的状态，但大科摩罗只采取了控制措施。迄今为止，主要策略是使用青蒿素为基础的联合疗法（ACT）对人群进行大规模治疗，这与上世纪 50 年代在其他国家部署的策略类似。ACT 在其中两个岛屿上似乎有效；然而，该策略的可持续性尚不清楚。这种可持续性受到以下因素的影响：（i）科摩罗群岛及其邻国之间不受控制的大量交流，增加了引入抗 ACT 株的风险；（ii）农业上大量使用杀虫剂通常会导致蚊子产生抗药性；（iii）行动本身的成本。
鉴于该地区的疟疾历史，第一个建议是加强卫生工作者和民众的培训。第二步是建立国家战略来评估疟疾和相关因素，而目前缺乏这一战略。在人群大规模治疗的低传播背景下，评估寄生虫药物敏感性的调查尤为重要。最后一点应该是确保财政支持，而在消除前的背景下，这一点并不明显。科摩罗群岛因此成为一个消除策略的实验室，但未来的情况很复杂。
