Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
Instituto de Investigaciones, Centro Universitario de Zacapa, Universidad de San Carlos de Guatemala, Zacapa, Guatemala.
PLoS Negl Trop Dis. 2021 May 13;15(5):e0009309. doi: 10.1371/journal.pntd.0009309. eCollection 2021 May.
Elimination of visceral leishmaniasis (VL) in Southeast Asia and global control of cutaneous leishmaniasis (CL) and VL are priorities of the World Health Organization (WHO). But is the existing evidence good enough for public health recommendations? This meta-review summarises the available and new evidence for vector control with the aims of establishing what is known about the value of vector control for the control of CL and VL, establishing gaps in knowledge, and particularly focusing on key recommendations for further scientific work. This meta-review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, including (1) systematic reviews and meta-analyses (SRs/MAs) for (2) vector control methods and strategies and (3) for the control of CL and/or VL. Nine SRs/MAs were included, with different research questions and inclusion/exclusion criteria. The methods analysed for vector control can be broadly classified into (1) indoor residual spraying (IRS); (2) insecticide-treated nets (ITNs; including insecticide-impregnated bednets); (3) insecticide-treated curtains (ITCs; including insecticide-treated house screening); (4) insecticide-treated bedsheets (ITSs) and insecticide-treated fabrics (ITFs; including insecticide-treated clothing) and (5) durable wall lining (treated with insecticides) and other environmental measures to protect the house; (6) control of the reservoir host; and (7) strengthening vector control operations through health education. The existing SRs/MAs include a large variation of different primary studies, even for the same specific research sub-question. Also, the SRs/MAs are outdated, using available information until earlier than 2018 only. Assessing the quality of the SRs/MAs, there is a considerable degree of variation. It is therefore very difficult to summarise the results of the available SRs/MAs, with contradictory results for both vector indices and-if available-human transmission data. Conclusions of this meta-review are that (1) existing SRs/MAs and their results make policy recommendations for evidence-based vector control difficult; (2) further work is needed to establish efficacy and community effectiveness of key vector control methods with specific SRs and MAs (3) including vector and human transmission parameters; and (4) attempting to conclude with recommendations in different transmission scenarios.
消除东南亚内脏利什曼病（VL）和全球控制皮肤利什曼病（CL）和 VL 是世界卫生组织（WHO）的优先事项。但是，现有的证据是否足以支持公共卫生建议？本次荟萃分析总结了现有的和新的关于病媒控制的证据，旨在确定病媒控制在控制 CL 和 VL 方面的价值，确定知识空白，并特别关注进一步科学工作的关键建议。本荟萃分析遵循系统评价和荟萃分析（PRISMA）的首选报告项目标准，包括：（1）针对病媒控制方法和策略的系统评价和荟萃分析（SRs/MAs），（2）用于控制 CL 和/或 VL 的系统评价和荟萃分析（SRs/MAs）。纳入了 9 项 SRs/MAs，其研究问题和纳入/排除标准不同。用于病媒控制的方法可大致分为：（1）室内滞留喷洒（IRS）；（2）经杀虫剂处理的蚊帐（ITNs；包括经杀虫剂浸渍的蚊帐）；（3）经杀虫剂处理的窗帘（ITCs；包括经杀虫剂处理的房屋筛网）；（4）经杀虫剂处理的床单（ITSs）和经杀虫剂处理的织物（ITFs；包括经杀虫剂处理的衣物）和（5）耐用墙壁衬里（用杀虫剂处理）和其他保护房屋的环境措施；（6）控制储存宿主；（7）通过健康教育加强病媒控制行动。现有的 SRs/MAs 包括大量不同的原始研究，即使是针对相同的具体研究子问题也是如此。此外，SRs/MAs 已经过时，仅使用截至 2018 年之前的现有信息。评估 SRs/MAs 的质量，存在相当大的差异。因此，很难总结现有的 SRs/MAs 的结果，对于病媒指数和（如果有）人类传播数据，结果都存在矛盾。本次荟萃分析的结论是：（1）现有的 SRs/MAs 及其结果使得基于证据的病媒控制政策建议变得困难；（2）需要进一步开展工作，以通过特定的 SRs 和 MAs 确定关键病媒控制方法的功效和社区效果；（3）包括病媒和人类传播参数；（4）尝试在不同传播情况下得出结论并提出建议。
