Molyneux D H
Liverpool School of Tropical Medicine, U.K.
Int J Parasitol. 1998 Jun;28(6):927-34. doi: 10.1016/s0020-7519(98)00067-8.
This paper summarises the impact of different changes (environmental, ecological, developmental) on the one hand, with the impact of control measures on the other. The former group of changes have tended to exacerbate the incidence and prevalence of vector-borne parasitic diseases while the reduced public funds available for the health sector have reduced disease surveillance systems. However, some vector control/eradication programmes have been successful. Vector control in onchocerciasis and Chagas' disease and immediate host control in Guinea worm have reduced the public health importance of these disease. This contrasts, with malaria, where the complexity of different ecological situations and the variable vector ecology have made control difficult and epidemics frequent and unpredictable. Advances in our knowledge of how to implement and sustain insecticide-impregnated bednets which reduce morbidity and mortality in under 5-year olds will be a key issue for the coming years. In African trypanosomiasis and leishmaniasis, where control is dependent on effective diagnosis and surveillance followed by high-cost drug treatment, the health services are faced with major challenges--lack of drug availability and diagnostics no vector control--the diseases in some areas assuming epidemic status yet health services are unable to respond. Human African trypanosomiasis and visceral leishmaniasis are fatal if untreated, and require an emergency response approach. Changing vector distribution of Glossina is related to the ability of riverine flies of Glossina palpalis group to adapt to new vegetation patterns. In leishmaniasis changes have occurred in the distribution of the disease associated with development impact, urbanisation, civil unrest and changed agroforestry practice.
本文一方面总结了不同变化（环境、生态、发展方面）的影响，另一方面总结了控制措施的影响。前一类变化往往加剧了媒介传播寄生虫病的发病率和流行程度，而卫生部门可用公共资金的减少削弱了疾病监测系统。然而，一些病媒控制/根除计划取得了成功。盘尾丝虫病和恰加斯病的病媒控制以及几内亚蠕虫病的直接宿主控制降低了这些疾病对公共卫生的重要性。这与疟疾形成对比，在疟疾方面，不同生态情况的复杂性和病媒生态的多变性使得控制困难，疫情频繁且不可预测。未来几年，我们在如何实施和维持能降低五岁以下儿童发病率和死亡率的杀虫剂浸渍蚊帐方面取得的知识进展将是一个关键问题。在非洲锥虫病和利什曼病方面，控制依赖于有效的诊断和监测，随后进行高成本的药物治疗，卫生服务面临重大挑战——缺乏药物供应和诊断手段，没有病媒控制——这些疾病在一些地区呈流行状态，但卫生服务却无法应对。如果不治疗，人类非洲锥虫病和内脏利什曼病会致命，需要采取应急措施。舌蝇分布的变化与须舌蝇属河流型蝇类适应新植被模式的能力有关。在利什曼病方面，疾病分布已随着发展影响、城市化、内乱和农业林业实践的改变而发生变化。
