Sciences Economiques et Sociales de la Santé et Traitement de de l'Information Médicale (SESSTIM), Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche médicale (INSERM), Aix Marseille Université, 13005 Marseille, France.
Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, 75018 Paris, France.
Int J Environ Res Public Health. 2020 Dec 24;18(1):76. doi: 10.3390/ijerph18010076.
In central Senegal, malaria incidence declined in response to scaling-up of control measures from 2000 to 2010 and has since remained stable, making elimination unlikely in the short term. Additional control measures are needed to reduce transmission. We simulated chemoprophylaxis interventions targeting malaria hotspots using a metapopulation mathematical model, based on a differential-equation framework and incorporating human mobility. The model was fitted to weekly malaria incidence from 45 villages. Three approaches for selecting intervention targets were compared: (a) villages with malaria cases during the low transmission season of the previous year; (b) villages with highest incidence during the high transmission season of the previous year; (c) villages with highest connectivity with adjacent populations. Our results showed that intervention strategies targeting hotspots would be effective in reducing malaria incidence in both targeted and untargeted areas. Regardless of the intervention strategy used, pre-elimination (1-5 cases per 1000 per year) would not be reached without simultaneously increasing vector control by more than 10%. A cornerstone of malaria control and elimination is the effective targeting of strategic locations. Mathematical tools help to identify those locations and estimate the impact in silico.
在塞内加尔中部，疟疾发病率在 2000 年至 2010 年期间随着控制措施的扩大而下降，此后一直保持稳定，因此短期内不太可能消除疟疾。需要采取额外的控制措施来减少传播。我们使用基于偏微分方程框架并整合人类流动性的时空传染病传播模型，模拟了针对疟疾热点的化学预防干预措施。该模型根据 45 个村庄的每周疟疾发病率进行了拟合。比较了三种选择干预目标的方法：(a) 上一年低传播季节有疟疾病例的村庄；(b) 上一年高传播季节发病率最高的村庄；(c) 与相邻人群连接性最高的村庄。结果表明，针对热点地区的干预策略将有效降低目标和非目标地区的疟疾发病率。无论使用哪种干预策略，如果不同时将病媒控制增加 10%以上，就无法实现消除前（每年每 1000 人 1-5 例）的目标。疟疾控制和消除的基石是对战略地点的有效定位。数学工具有助于识别这些地点并在虚拟环境中估计其影响。
