密集型与标准驱虫治疗对乌干达维多利亚湖渔业社区过敏相关结局、寄生虫感染强度和寄生虫相关发病率的影响：来自 LaVIISWA 集群随机试验的结果。
The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial.
机构信息
Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe.
Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
出版信息
Clin Infect Dis. 2019 May 2;68(10):1665-1674. doi: 10.1093/cid/ciy761.
BACKGROUND
The prevalence of allergy-related diseases is increasing in low-income countries. Parasitic helminths, common in these settings, may be protective. We hypothesized that intensive, community-wide, anthelminthic mass drug administration (MDA) would increase allergy-related diseases, while reducing helminth-related morbidity.
METHODS
In an open, cluster-randomized trial (ISRCTN47196031), we randomized 26 high-schistosomiasis-transmission fishing villages in Lake Victoria, Uganda, in a 1:1 ratio to receive community-wide intensive (quarterly single-dose praziquantel plus albendazole daily for 3 days) or standard (annual praziquantel plus 6 monthly single-dose albendazole) MDA. Primary outcomes were recent wheezing, skin prick test positivity (SPT), and allergen-specific immunoglobulin E (asIgE) after 3 years of intervention. Secondary outcomes included helminths, haemoglobin, and hepatosplenomegaly.
RESULTS
The outcome survey comprised 3350 individuals. Intensive MDA had no effect on wheezing (risk ratio [RR] 1.11, 95% confidence interval [CI] 0.64-1.93), SPT (RR 1.10, 95% CI 0.85-1.42), or asIgE (RR 0.96, 95% CI 0.82-1.12). Intensive MDA reduced Schistosoma mansoni infection intensity: the prevalence from Kato Katz examinations of single stool samples from each patient was 23% versus 39% (RR 0.70, 95% CI 0.55-0.88), but the urine circulating cathodic antigen test remained positive in 85% participants in both trial arms. Hookworm prevalence was 8% versus 11% (RR 0.55, 95% CI 0.31-1.00). There were no differences in anemia or hepatospenomegaly between trial arms.
CONCLUSIONS
Despite reductions in S. mansoni intensity and hookworm prevalence, intensive MDA had no effect on atopy, allergy-related diseases, or helminth-related pathology. This could be due to sustained low-intensity infections; thus, a causal link between helminths and allergy outcomes cannot be discounted. Intensive community-based MDA has a limited impact in high-schistosomiasis-transmission fishing communities, in the absence of other interventions.
CLINICAL TRIALS REGISTRATION
ISRCTN47196031.
背景
在低收入国家，与过敏相关的疾病发病率正在上升。在这些环境中很常见的寄生虫蠕虫可能具有保护作用。我们假设密集的、社区范围的驱虫大规模药物管理（MDA）会增加与过敏相关的疾病，同时减少与寄生虫相关的发病率。
方法
在一项开放、群组随机试验（ISRCTN47196031）中，我们将乌干达维多利亚湖 26 个高血吸虫病传播渔村以 1:1 的比例随机分为接受社区范围密集（每季度单剂量吡喹酮加阿苯达唑，连续 3 天）或标准（每年吡喹酮加 6 个月单剂量阿苯达唑）MDA。主要结局是 3 年后近期喘息、皮肤点刺试验阳性（SPT）和过敏原特异性免疫球蛋白 E（asIgE）。次要结局包括寄生虫、血红蛋白和肝脾肿大。
结果
结果调查包括 3350 人。密集 MDA 对喘息（风险比 [RR] 1.11，95%置信区间 [CI] 0.64-1.93）、SPT（RR 1.10，95% CI 0.85-1.42）或 asIgE（RR 0.96，95% CI 0.82-1.12）没有影响。密集 MDA 降低了曼氏血吸虫感染强度：从每位患者的单个粪便样本的加藤氏检查中，患病率为 23%对 39%（RR 0.70，95% CI 0.55-0.88），但尿液循环阴极抗原试验在试验组的 85%参与者中仍然呈阳性。钩虫的患病率为 8%对 11%（RR 0.55，95% CI 0.31-1.00）。试验组之间的贫血或肝脾肿大没有差异。
结论
尽管曼氏血吸虫强度和钩虫流行率有所下降，但密集 MDA 对过敏、与过敏相关的疾病或与寄生虫相关的病理学没有影响。这可能是由于持续的低强度感染所致；因此，不能排除寄生虫与过敏结果之间的因果关系。在没有其他干预措施的情况下，密集的基于社区的 MDA 在高血吸虫病传播渔村的影响有限。
临床试验注册
ISRCTN47196031。
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