Gryseels B
Department of Parasitology, University of Leiden, The Netherlands.
Am J Trop Med Hyg. 1996 Nov;55(5 Suppl):103-8. doi: 10.4269/ajtmh.1996.55.103.
In this paper, gaps in our understanding of the dynamics of infection, transmission, pathology, and control of schistosomiasis, and the possible contribution of modeling are briefly discussed. The measurement of prevalences and intensities of infection by egg counts has shortcomings; a recently developed model of egg count variations contributes to a better interpretation of survey data, and suggests that true prevalences and worm loads in endemic communities may be considerably underestimated. The question as to whether schistosome populations are regulated by host-dependent or transmission-related factors is still being debated; recent scientific advances and operational control experiences tend to favor the first mechanism, with important implications for control and research strategies. However, there is still a lack of field data to feed models of the dynamics of transmission. We still know little about the dynamics and even the importance of schistosomiasis morbidity, although more objective data are now becoming available through ultrasound studies. Models of the development of early- and late-stage morbidity could substantially contribute to more cost-effective strategies of passive and active chemotherapy. Modeling can also contribute to a better understanding and improvement of results of ongoing control efforts, particularly concerning the impact of repeated chemotherapy, and its complex interaction with many biological and social factors on infection, transmission, and morbidity.
本文简要讨论了我们在血吸虫病感染、传播、病理学及控制动态方面理解上的差距，以及建模可能做出的贡献。通过虫卵计数来测量感染率和感染强度存在缺陷；最近开发的虫卵计数变化模型有助于更好地解释调查数据，并表明流行社区的真实感染率和虫负荷可能被大大低估。关于血吸虫种群是受宿主相关因素还是传播相关因素调节的问题仍在争论中；最近的科学进展和实际控制经验倾向于支持第一种机制，这对控制和研究策略具有重要意义。然而，仍然缺乏用于传播动态模型的数据。尽管现在通过超声研究可以获得更多客观数据，但我们对血吸虫病发病机制及其重要性仍然知之甚少。早期和晚期发病机制的模型可以为更具成本效益的被动和主动化疗策略做出重大贡献。建模还可以有助于更好地理解和改进正在进行的控制工作的结果，特别是关于重复化疗的影响，以及它与许多生物和社会因素在感染、传播和发病方面的复杂相互作用。
