Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands; Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi.
Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands.
Lancet Infect Dis. 2020 Jul;20(7):e165-e172. doi: 10.1016/S1473-3099(20)30254-1. Epub 2020 May 5.
Although preventive chemotherapy has been instrumental in reducing schistosomiasis incidence worldwide, serious challenges remain. These problems include the omission of certain groups from campaigns of mass drug administration, the existence of persistent disease hotspots, and the risk of recrudescent infections. Central to these challenges is the fact that the diagnostic tools currently used to establish the burden of infection are not sensitive enough, especially in low-endemic settings, which results in underestimation of the true prevalence of active Schistosoma spp infections. This central issue necessitates that the current schistosomiasis control strategies recommended by WHO are re-evaluated and, possibly, adapted. More targeted interventions and novel approaches have been used to estimate the prevalence of schistosomiasis, such as establishing infection burden by use of precision mapping, which provides high resolution spatial information that delineates variations in prevalence within a defined geographical area. Such information is instrumental in guiding targeted intervention campaigns. However, the need for highly accurate diagnostic tools in such strategies is a crucial factor that is often neglected. The availability of highly sensitive diagnostic tests also opens up the possibility of applying strategies of sample pooling to reduce the cost of control programmes. To interrupt the transmission of, and eventually eliminate, schistosomiasis, better local targeting of preventive chemotherapy, in combination with highly sensitive diagnostic tools, is crucial.
尽管预防性化疗在全球范围内降低了血吸虫病的发病率，但仍存在严重的挑战。这些问题包括大规模药物治疗活动中遗漏某些人群、持续存在的疾病热点以及复发性感染的风险。这些挑战的核心是，目前用于确定感染负担的诊断工具不够敏感，尤其是在低流行地区，这导致对活动性血吸虫病感染的真实流行率的低估。这一核心问题需要重新评估和可能调整世界卫生组织目前推荐的血吸虫病控制策略。已经使用了更有针对性的干预措施和新方法来估计血吸虫病的流行率，例如通过精密绘图来确定感染负担，这提供了高分辨率的空间信息，描绘了在一个特定地理区域内流行率的变化。这些信息对于指导有针对性的干预活动至关重要。然而，此类策略中需要高度准确的诊断工具是一个经常被忽视的关键因素。高度敏感的诊断测试的可用性也为应用样本汇集策略提供了可能性，以降低控制项目的成本。为了阻断并最终消除血吸虫病的传播，更好地进行有针对性的预防性化疗，并结合高度敏感的诊断工具，是至关重要的。
