Meyrowitsch D W, Simonsen P E
Danish Bilharziasis Laboratory, Charlottenlund, Denmark.
Trans R Soc Trop Med Hyg. 1998 Jan-Feb;92(1):98-103. doi: 10.1016/s0035-9203(98)90973-7.
The long-term effect of 4 strategies for control of bancroftian filariasis using mass diethylcarbamazine (DEC) chemotherapy was assessed and compared in 4 endemic communities in Tanzania over a period of 4 years. The strategies were the standard 12 d treatment (strategy I), semi-annual single dose treatment (strategy II), monthly low dose treatment (strategy III), and DEC-medicated salt treatment (strategy IV). Treatment was given only during the first year. All strategies resulted in considerable reductions in microfilaraemia, with maximum effects occurring 1-2 years after start of treatment. At 2 years, the greatest reductions were seen for strategies III and IV, followed by strategy II and finally strategy I. The overall performance of the 4 strategies evaluated over the 4 years period followed the same sequence. Between the 2 years and 4 years follow-up surveys, a significant increase in microfilarial (mf) burden occurred in all 4 communities, but the mf geometric mean intensities (GMI) remained low. Thus, in individuals who were microfilaraemic before treatment, the rates of microfilaraemia were 66%, 44%, 34% and 43%, and the mf GMIs were 6.8%, 3.3%, 0.5% and 0.7%, of pre-treatment level, 4 years after start of treatment with strategies I, II, III and IV, respectively. Most individuals who developed microfilaraemia between the 2 years and 4 years follow-up surveys had been microfilaraemic before the start of treatment. Hence, the rate of development of microfilaraemia was much higher (18 times on average in the 4 communities) among those who were microfilaraemic before treatment than among those who were amicrofilaraemic. The long-lasting effect of treatment adds a promising potential to the use of mass DEC chemotherapy for the control of bancroftian filariasis.
在坦桑尼亚的4个流行社区，对使用乙胺嗪（DEC）群体化疗控制班氏丝虫病的4种策略的长期效果进行了为期4年的评估和比较。这些策略分别是标准的12天治疗（策略I）、半年单剂量治疗（策略II）、每月低剂量治疗（策略III）和含DEC的盐治疗（策略IV）。仅在第一年进行治疗。所有策略均使微丝蚴血症显著降低，治疗开始后1 - 2年效果最为明显。在2年时，策略III和IV的降低幅度最大，其次是策略II，最后是策略I。在4年期间评估的这4种策略的总体表现遵循相同顺序。在2年和4年的随访调查之间，所有4个社区的微丝蚴（mf）负担均显著增加，但mf几何平均强度（GMI）仍较低。因此，在治疗前为微丝蚴血症的个体中，在使用策略I、II、III和IV治疗4年后，微丝蚴血症发生率分别为治疗前水平的66%、44%、34%和43%，mf GMI分别为治疗前水平的6.8%、3.3%、0.5%和0.7%。在2年和4年随访调查之间出现微丝蚴血症的大多数个体在治疗开始前就是微丝蚴血症患者。因此，治疗前为微丝蚴血症的个体中微丝蚴血症的发生率比无微丝蚴血症的个体高得多（4个社区平均高18倍）。治疗的持久效果为使用DEC群体化疗控制班氏丝虫病增添了一个有前景的潜力。
