Department of Global Health, University of Washington, Seattle, WA, United States.
DeWorm3, Natural History Museum, London, United Kingdom.
PLoS Negl Trop Dis. 2018 Jan 18;12(1):e0005955. doi: 10.1371/journal.pntd.0005955. eCollection 2018 Jan.
Current global helminth control guidelines focus on regular deworming of targeted populations for morbidity control. However, water, sanitation, and hygiene (WASH) interventions may also be important for reducing helminth transmission. We evaluated the impact of different potential helminth protective packages on infection prevalence, including repeated treatment with albendazole and praziquantel with and without WASH access.
METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cohort study nested within a randomized trial of empiric deworming of HIV-infected adults in Kenya. Helminth infections and infection intensity were diagnosed using semi-quantitative real-time PCR. We conducted a manual forward stepwise model building approach to identify if there are packages of interventions that may be protective against an STH infection of any species (combined outcome) and each helminth species individually. We conducted secondary analyses using the same approach only amongst individuals with no anthelmintis exposure. We used interaction terms to test for potential intervention synergy. Approximately 22% of the 701 stool samples provided were helminth-infected, most of which were of low to moderate intensity. The odds of infection with any STH species were lower for individuals who were treated with albendazole (aOR:0.11, 95%CI: 0.05, 0.20, p<0.001), adjusting for age and sex. Although most WASH conditions demonstrated minimal additional benefit in reducing the probability of infection with any STH species, access to safe flooring did appear to offer some additional protection (aOR:0.34, 95%CI: 0.20, 0.56, p<0.001). For schistosomiasis, only treatment with praziquantel was protective (aOR:0.30 95%CI: 0.14, 0.60, p = 0.001). Amongst individuals who were not treated with albendazole or praziquantel, the most protective intervention package to reduce probability of STH infections included safe flooring (aOR:0.34, 95%CI: 0.20, 0.59, p<0.001) and latrine access (aOR:0.59, 95%CI: 0.35, 0.99, p = 0.05). Across all species, there was no evidence of synergy or antagonism between anthelmintic chemotherapy with albendazole or praziquantel and WASH resources.
CONCLUSIONS/SIGNIFICANCE: Deworming is effective in reducing the probability of helminth infections amongst HIV-infected adults. With the exception of safe flooring, WASH offers minimal additional benefit. However, WASH does appear to significantly reduce infection prevalence in adults who are not treated with chemotherapy.
ClinicalTrials.gov, NCT00507221.
当前全球的寄生虫病控制指南侧重于针对特定人群的定期驱虫，以控制发病率。然而，水、环境卫生和个人卫生（WASH）干预措施对于减少寄生虫传播也可能很重要。我们评估了不同潜在寄生虫保护方案对感染率的影响，包括使用阿苯达唑和吡喹酮进行重复治疗，以及是否有 WASH 条件。
方法/主要发现：我们在肯尼亚进行了一项嵌套在针对艾滋病毒感染者经验性驱虫的随机试验中的队列研究。使用半定量实时 PCR 诊断寄生虫感染和感染强度。我们采用手动向前逐步模型构建方法来确定是否有任何可能针对任何 STH 感染（综合结果）和每种寄生虫物种的干预方案。我们仅在没有驱虫暴露的个体中使用相同的方法进行二次分析。我们使用交互项来测试潜在的干预协同作用。大约 22%的 701 份粪便样本被感染，其中大多数为低至中度强度。与未接受阿苯达唑治疗的个体相比，接受阿苯达唑治疗的个体感染任何 STH 物种的几率较低（调整年龄和性别后，OR：0.11，95%CI：0.05，0.20，p<0.001）。尽管大多数 WASH 条件在降低任何 STH 物种感染的概率方面表现出最小的额外益处，但获得安全地板似乎确实提供了一些额外的保护（调整年龄和性别后，OR：0.34，95%CI：0.20，0.56，p<0.001）。对于血吸虫病，只有吡喹酮治疗具有保护作用（OR：0.30，95%CI：0.14，0.60，p = 0.001）。在未接受阿苯达唑或吡喹酮治疗的个体中，减少 STH 感染概率的最具保护作用的干预方案包括安全地板（OR：0.34，95%CI：0.20，0.59，p<0.001）和厕所使用（OR：0.59，95%CI：0.35，0.99，p = 0.05）。在所有物种中，阿苯达唑或吡喹酮驱虫化学疗法与 WASH 资源之间没有协同作用或拮抗作用的证据。
结论/意义：驱虫在降低艾滋病毒感染者寄生虫感染的概率方面是有效的。除了安全地板外，WASH 提供的益处很小。然而，WASH 似乎确实可以显著降低未接受化疗的成年人的感染率。
ClinicalTrials.gov，NCT00507221。
