Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
University of Basel, Basel, Switzerland.
Sci Rep. 2024 Oct 9;14(1):23543. doi: 10.1038/s41598-024-73164-7.
Trichuris trichiura is one of four soil-transmitted helminth species that, collectively, are responsible for a considerable public health burden. The World Health Organization recommends preventive chemotherapy as the main intervention to eliminate soil-transmitted helminthiasis as a public health problem. Clinical trials estimated the efficacy of different drugs and treatment regimen against T. trichiura and other soil-transmitted helminth species, whilst meta-analyses and modeling efforts were conducted to determine the most efficacious drugs and drug combinations. Of note, the diagnostic error was often neglected, and hence, cure rates (CRs) might be overestimated. We developed a Bayesian model, which estimates drug efficacy against T. trichiura, taking into account the transmission mechanism and the diagnostic error. The model was fitted to individual-level egg count data from an ensemble of seven trials with 29 treatments. We estimated the 'true' CRs, which were consistently lower than those reported in the literature. In our analysis, the treatment with the highest CR was combination therapy of albendazole plus pyrantel pamoate plus oxantel pamoate with a CR of 79% and an egg reduction rate (ERR) of 91%. Albendazole plus oxantel pamoate showed the highest ERR of 97% and a CR of 69%. Additionally, we estimated the intensity-dependent sensitivity of the Kato-Katz technique. For 24 eggs per gram of stool, the sensitivity was around 50% for a single Kato-Katz thick smear and increased to almost 70% for duplicate Kato-Katz thick smears. Combination therapies against soil-transmitted helminthiasis should be considered and the evaluation of infection intensity in low transmission settings via multiple Kato-Katz thick smears is recommended.
鞭虫是导致公共卫生负担的 4 种土源性蠕虫之一。世界卫生组织建议采用化学预防作为消除土源性蠕虫病这一公共卫生问题的主要干预措施。临床试验评估了不同药物和治疗方案对鞭虫和其他土源性蠕虫的疗效，同时也进行了荟萃分析和建模工作，以确定最有效的药物和药物组合。值得注意的是，诊断错误经常被忽视，因此，治愈率（CR）可能被高估。我们开发了一种贝叶斯模型，该模型考虑了传播机制和诊断错误，估计了针对鞭虫的药物疗效。该模型适用于来自七个试验的个体水平虫卵计数数据，这些试验共有 29 种治疗方法。我们估计了“真实”的 CR，这些 CR 始终低于文献中的报告值。在我们的分析中，CR 最高的治疗方法是阿苯达唑加吡喹酮加奥沙苯达唑联合治疗，CR 为 79%，虫卵减少率（ERR）为 91%。阿苯达唑加奥沙苯达唑的 ERR 最高，为 97%，CR 为 69%。此外，我们还估计了加藤厚涂片技术的强度依赖性敏感性。对于每克粪便 24 个虫卵，单个加藤厚涂片的敏感性约为 50%，而重复加藤厚涂片的敏感性增加到近 70%。应考虑针对土源性蠕虫病的联合治疗方法，并建议在低传播环境中通过多次加藤厚涂片评估感染强度。
