Barcelona Institute for Global Health, Hospital Clínic Universitat de Barcelona, Barcelona, Spain.
Barcelona Institute for Global Health, Hospital Clínic Universitat de Barcelona, Barcelona, Spain; Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Argentina.
Lancet Infect Dis. 2022 Nov;22(11):e341-e347. doi: 10.1016/S1473-3099(22)00369-3. Epub 2022 Jul 15.
In 2020, WHO recognised the importance of strongyloidiasis alongside soil-transmitted helminths (STH) in their 2021-30 roadmap, which aspires to target Strongyloides stercoralis with preventive chemotherapy by use of ivermectin. Combination treatment with both albendazole, the primary drug used to treat STH, and ivermectin, would improve the efficiency of mass drug administration targeting both STH and S stercoralis. In this Personal View, we discuss the challenges and opportunities towards the development of an efficient control programme for strongyloidiasis, particularly if it is to run concurrently with STH control. We argue the need to define the prevalence threshold to implement preventive chemotherapy for S stercoralis, the target populations and optimal dosing schedules, and discuss the added benefits of a fixed-dose coformulation of ivermectin and albendazole. Implementation of an efficient control programme will require improvements to current diagnostics, and validation of new diagnostics, to target and monitor S stercoralis infections, and consideration of the challenges of multispecies diagnostics for S stercoralis and STH control. Finally, the evolution of ivermectin resistance represents a credible risk to control S stercoralis; we argue that genome-wide approaches, together with improved genome resources, are needed to characterise and prevent the emergence of resistance. Overcoming these challenges will help to reduce strongyloidiasis burden and enhance the feasibility of controlling it worldwide.
2020 年，世界卫生组织（WHO）在其 2021-2030 年路线图中认识到强烈线虫病与土壤传播性蠕虫（STH）同样重要，该路线图旨在通过使用伊维菌素对粪类圆线虫（Strongyloides stercoralis）进行预防性化疗。阿苯达唑（用于治疗 STH 的主要药物）和伊维菌素联合治疗将提高针对 STH 和 S 粪类圆线虫进行大规模药物治疗的效率。在本个人观点中，我们讨论了为粪类圆线虫病制定有效控制计划的挑战和机遇，特别是如果要与 STH 控制同时进行的话。我们认为有必要定义实施粪类圆线虫预防性化疗的患病率阈值，确定目标人群和最佳剂量方案，并讨论伊维菌素和阿苯达唑固定剂量复方的额外益处。实施有效的控制计划需要改进当前的诊断方法，并验证新的诊断方法，以针对和监测粪类圆线虫感染，并考虑针对粪类圆线虫和 STH 控制的多物种诊断的挑战。最后，伊维菌素耐药性的演变是控制粪类圆线虫的一个可信风险；我们认为需要采用全基因组方法，结合改进的基因组资源，对耐药性进行特征描述和预防。克服这些挑战将有助于减轻粪类圆线虫病的负担，并提高在全球范围内控制它的可行性。
