Simonsen P E, Meyrowitsch D W, Makunde W H, Magnussen P
Danish Bilharziasis Laboratory, Charlottenlund.
Am J Trop Med Hyg. 1995 Sep;53(3):267-72. doi: 10.4269/ajtmh.1995.53.267.
The efficacy of two strategies for control of Bancroftian filariasis using selective rather than community-wide diethylcarbamazine (DEC) chemotherapy was evaluated and compared in two endemic communities of north-eastern Tanzania, with pretreatment microfilariae (mf) prevalences of 22% and 38%, and geometric mean intensities (GMIs) of 668 mf/ml and 735 mf/ml of blood. All mf-positive cases in the first community were offered treatment with 6 mg of DEC/kg of body weight a day for 12 days (group 1), and those in the second community were offered treatment with two doses of 6 mg of DEC/kg of body weight at an interval of six months (group 2). The effect of treatment was followed both among those treated and at the community level. In treated individuals, there was a rapid decrease in the mf load that was significantly greater among those receiving the 12-day standard dose. One year after the start of treatment, the mf clearance rates were 59% and 39% and the GMIs were reduced by 99% and 97% among treated individuals in groups 1 and 2, respectively. However, at the community level, the mf prevalences were 16.3% and 27.9% (reduced by 27% and 26%) and the GMIs were 129 mf/ml and 224 mf/ml (reduced by 81% and 70%) one year after the start of treatment with the two regimens, respectively, suggesting that transmission continued at a significant level in the villages after treatment. The limitations of selective chemotherapy are discussed, and it is argued that strategies based on mass DEC chemotherapy would be more effective in reducing the microfilarial load in the community and thereby in reducing transmission.
在坦桑尼亚东北部的两个流行社区，对使用选择性而非全社区范围的乙胺嗪（DEC）化疗控制班氏丝虫病的两种策略的疗效进行了评估和比较。这两个社区治疗前的微丝蚴（mf）患病率分别为22%和38%，血液中的几何平均强度（GMI）分别为668 mf/ml和735 mf/ml。第一个社区的所有mf阳性病例每天接受6毫克DEC/千克体重的治疗，持续12天（第1组），第二个社区的病例接受两剂6毫克DEC/千克体重的治疗，间隔6个月（第2组）。在接受治疗者个体以及社区层面都对治疗效果进行了跟踪。在接受治疗的个体中，mf负荷迅速下降，接受12天标准剂量治疗者的下降幅度显著更大。治疗开始一年后，第1组和第2组接受治疗个体的mf清除率分别为59%和39%，GMI分别降低了99%和97%。然而，在社区层面，两种治疗方案开始治疗一年后，mf患病率分别为16.3%和27.9%（分别降低了27%和26%），GMI分别为129 mf/ml和224 mf/ml（分别降低了81%和70%），这表明治疗后村庄中的传播仍在显著水平持续。讨论了选择性化疗的局限性，并认为基于大规模DEC化疗的策略在降低社区微丝蚴负荷从而减少传播方面会更有效。
