阿苯达唑和伊维菌素用于控制阿根廷西北部粪类圆线虫和钩虫高流行地区的土源性蠕虫：一项基于社区的实用性研究。
Albendazole and ivermectin for the control of soil-transmitted helminths in an area with high prevalence of Strongyloides stercoralis and hookworm in northwestern Argentina: A community-based pragmatic study.
作者信息
Echazú Adriana, Juarez Marisa, Vargas Paola A, Cajal Silvana P, Cimino Ruben O, Heredia Viviana, Caropresi Silvia, Paredes Gladys, Arias Luis M, Abril Marcelo, Gold Silvia, Lammie Patrick, Krolewiecki Alejandro J
机构信息
Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta-Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina.
Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
出版信息
PLoS Negl Trop Dis. 2017 Oct 9;11(10):e0006003. doi: 10.1371/journal.pntd.0006003. eCollection 2017 Oct.
BACKGROUND
Recommendations for soil-transmitted helminth (STH) control give a key role to deworming of school and pre-school age children with albendazole or mebendazole; which might be insufficient to achieve adequate control, particularly against Strongyloides stercoralis. The impact of preventive chemotherapy (PC) against STH morbidity is still incompletely understood. The aim of this study was to assess the effectiveness of a community-based program with albendazole and ivermectin in a high transmission setting for S. stercoralis and hookworm.
METHODOLOGY
Community-based pragmatic trial conducted in Tartagal, Argentina; from 2012 to 2015. Six communities (5070 people) were enrolled for community-based PC with albendazole and ivermectin. Two communities (2721 people) were re-treated for second and third rounds. STH prevalence, anemia and malnutrition were explored through consecutive surveys. Anthropometric assessment of children, stool analysis, complete blood count and NIE-ELISA serology for S. stercoralis were performed.
PRINCIPAL FINDINGS
STH infection was associated with anemia and stunting in the baseline survey that included all communities and showed a STH prevalence of 47.6% (almost exclusively hookworm and S. stercoralis). Among communities with multiple interventions, STH prevalence decreased from 62% to 23% (p<0.001) after the first PC; anemia also diminished from 52% to 12% (p<0.001). After two interventions S. stercoralis seroprevalence declined, from 51% to 14% (p<0.001) and stunting prevalence decreased, from 19% to 12% (p = 0.009).
CONCLUSIONS
Hookworm' infections are associated with anemia in the general population and nutritional impairment in children. S. stercoralis is also associated with anemia. Community-based deworming with albendazole and ivermectin is effective for the reduction of STH prevalence and morbidity in communities with high prevalence of hookworm and S. stercoralis.
背景
土壤传播性蠕虫（STH）控制建议将使用阿苯达唑或甲苯达唑对学龄儿童和学龄前儿童进行驱虫作为关键措施；但这可能不足以实现充分控制，尤其是针对粪类圆线虫。预防性化疗（PC）对STH发病率的影响仍未完全明确。本研究的目的是评估在粪类圆线虫和钩虫高传播地区开展的一项以社区为基础、使用阿苯达唑和伊维菌素的项目的有效性。
方法
2012年至2015年在阿根廷的塔尔塔加尔进行了一项基于社区的实用试验。六个社区（5070人）参与了基于社区的使用阿苯达唑和伊维菌素的PC项目。两个社区（2721人）接受了第二轮和第三轮再治疗。通过连续调查探究STH患病率、贫血和营养不良情况。对儿童进行人体测量评估、粪便分析、全血细胞计数以及针对粪类圆线虫的NIE-ELISA血清学检测。
主要发现
在包括所有社区的基线调查中，STH感染与贫血和发育迟缓相关，STH患病率为47.6%（几乎均为钩虫和粪类圆线虫）。在接受多次干预的社区中，首次PC后STH患病率从62%降至23%（p<0.001）；贫血率也从52%降至了12%（p<0.001）。经过两次干预后，粪类圆线虫血清阳性率从51%降至14%（p<0.001），发育迟缓患病率从19%降至12%（p = 0.009）。
结论
钩虫感染在普通人群中与贫血相关，在儿童中与营养损害相关。粪类圆线虫也与贫血相关。在钩虫和粪类圆线虫高流行社区，以社区为基础使用阿苯达唑和伊维菌素进行驱虫对于降低STH患病率和发病率是有效的。
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