Machado P A
Am J Trop Med Hyg. 1982 Jan;31(1):76-86. doi: 10.4269/ajtmh.1982.31.76.
Schistosomiasis mansoni is increasingly epidemic and is one of the three worst threats to public health in Brazil. The Brazilian schistosomiasis control program aims to control the disease and, eventually, its transmission. It uses a new ecological approach, trying to find a breaking point in the chain of transmission. There are some known vulnerable links, but the breaking point may be at a higher level in more stable links than in less stable ones. An adaptable methodology, taking into account local peculiarities, is actively developed for each settlement. Chemotherapy may play an important role in screening the input links with low breaking point. Adaptable methodology leads to the identification of ecosystems in which costly and time-consuming sanitary measures may be postponed as far as schistosomiasis control is concerned. The program was tested during 4 years (1975 - 1979) in the State of Rio Grande do Norte, Brazil, and results surpassed expectation; however, appraisal of a schistosomiasis control program takes not years but decades. The available results indicate that schistosomiasis control should be given long-term evaluation. Research on epidemiological systems analysis, identification of variables, and quantification of probabilities are pressing needs. The lack of sound and comprehensive knowledge of the transmission ecosystem imposes the use of an adaptable methodology which will not produce merely a series of unfruitful control attempts if the assay conditions are adequately identified and results are properly analyzed in a continuous, active manner.
曼氏血吸虫病的流行日益加剧，是巴西公共卫生面临的三大最严重威胁之一。巴西的血吸虫病控制项目旨在控制该病，并最终控制其传播。该项目采用了一种新的生态方法，试图找到传播链中的一个断点。虽然存在一些已知的脆弱环节，但断点可能在更稳定的环节中处于比不稳定环节更高的层次。针对每个定居点，正在积极开发一种考虑当地特点的适应性方法。化疗在筛查断点较低的输入环节方面可能发挥重要作用。适应性方法能够识别出在血吸虫病控制方面，那些成本高昂且耗时的卫生措施可能可以推迟实施的生态系统。该项目于1975年至1979年在巴西北里奥格兰德州进行了4年的测试，结果超出预期；然而，对血吸虫病控制项目的评估需要数十年而非数年时间。现有结果表明，血吸虫病控制应进行长期评估。对流行病学系统分析、变量识别和概率量化的研究是迫切需求。由于对传播生态系统缺乏完善和全面的了解，因此需要使用一种适应性方法，如果能够充分确定试验条件并以持续、积极的方式对结果进行正确分析，这种方法就不会仅仅产生一系列无果而终的控制尝试。
