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Abstract：
BACKGROUND: Current soil-transmitted helminth (STH) control guidelines endorse the use of albendazole or mebendazole for school-based targeted preventive chemotherapy (PC), yet their reduced efficacy against Strongyloides stercoralis and Trichuris trichiura presents significant limitations. Emerging evidence indicates that community-wide PC [or mass drug administration (MDA)] using ivermectin, commonly used in other neglected tropical disease (NTD) control programs, may play an important role in controlling these parasites. We conducted a systematic review and meta-analysis to evaluate the effectiveness of ivermectin PC in reducing STH prevalence in endemic populations.
METHODS: We searched Pubmed, EMBASE, and Web of Science on February 14, 2023, for studies that investigated the effectiveness of ivermectin PC, either alone or in combination with other anthelmintic drugs, on STH infections, and provided a measure of STH prevalence before and after PC. We calculated pooled prevalence reductions for each STH using random-effects meta-analyses. Our protocol is available on PROSPERO (registration number CRD42023401219).
RESULTS: A total of 21 were eligible for the systematic review, of which 15 were eligible for meta-analysis. All studies delivered ivermectin through MDA. The pooled prevalence reduction of S. stercoralis following MDA with ivermectin alone was 84.49% (95% CI 54.96-94.66) across five studies and 81.37% (95% CI 61.62-90.96) across seven studies with or without albendazole. The prevalence reduction of T. trichiura was 49.93% (95% CI 18.23-69.34) across five studies with ivermectin alone, and 89.40% (95% CI 73.66-95.73) across three studies with the addition of albendazole. There was high heterogeneity for all syntheses (I2 > 65%).
CONCLUSIONS: This study underscores the key role of ivermectin-based MDA in addressing limitations in current global STH guidelines in terms of limited efficacy against S. stercoralis and T. trichiura. Based on these findings, revising international STH guidelines to include ivermectin is a promising option to progress the control and eventual elimination of STHs and other NTDs.
METHODS: We searched Pubmed, EMBASE, and Web of Science on February 14, 2023, for studies that investigated the effectiveness of ivermectin PC, either alone or in combination with other anthelmintic drugs, on STH infections, and provided a measure of STH prevalence before and after PC. We calculated pooled prevalence reductions for each STH using random-effects meta-analyses. Our protocol is available on PROSPERO (registration number CRD42023401219).
RESULTS: A total of 21 were eligible for the systematic review, of which 15 were eligible for meta-analysis. All studies delivered ivermectin through MDA. The pooled prevalence reduction of S. stercoralis following MDA with ivermectin alone was 84.49% (95% CI 54.96-94.66) across five studies and 81.37% (95% CI 61.62-90.96) across seven studies with or without albendazole. The prevalence reduction of T. trichiura was 49.93% (95% CI 18.23-69.34) across five studies with ivermectin alone, and 89.40% (95% CI 73.66-95.73) across three studies with the addition of albendazole. There was high heterogeneity for all syntheses (I2 > 65%).
CONCLUSIONS: This study underscores the key role of ivermectin-based MDA in addressing limitations in current global STH guidelines in terms of limited efficacy against S. stercoralis and T. trichiura. Based on these findings, revising international STH guidelines to include ivermectin is a promising option to progress the control and eventual elimination of STHs and other NTDs.
摘要：
背景：当前的土壤传播蠕虫（STH）控制指南认可将阿苯达唑或甲苯达唑用于基于学校的靶向预防性化疗（PC），然而，它们对胸骨圆线虫和毛虫的疗效降低存在显著的局限性。新出现的证据表明，使用伊维菌素的全社区PC[或大规模药物管理（MDA）]，常用于其他被忽视的热带病(NTD)控制程序，可能在控制这些寄生虫方面发挥重要作用。我们进行了系统评价和荟萃分析，以评估伊维菌素PC在降低流行人群中STH患病率的有效性。
方法：我们搜索了Pubmed，EMBASE,和WebofScience于2023年2月14日发布，用于研究伊维菌素PC的有效性，单独或与其他驱虫药联合使用，关于STH感染，并提供了PC前后STH患病率的衡量标准。我们使用随机效应荟萃分析计算了每种STH的合并患病率降低。我们的协议可在PROSPERO上获得(注册号CRD42023401219)。
结果：共有21人符合系统评价的条件，其中15人符合荟萃分析的条件.所有研究均通过MDA递送伊维菌素。在5项研究中，仅使用伊维菌素的MDA后，胸骨链球菌的合并患病率降低为84.49％（95％CI54.96-94.66），在使用或不使用阿苯达唑的7项研究中，为81.37％（95％CI61.62-90.96）。在5项单独使用伊维菌素的研究中，TrichiuraT.trichiura的患病率降低为49.93％（95％CI18.23-69.34），在添加阿苯达唑的三项研究中，89.40%(95%CI73.66-95.73)。所有合成都存在高度异质性(I2>65%)。
结论：本研究强调了基于伊维菌素的MDA在解决当前全球STH指南中对胸骨链球菌和Trichiura疗效有限的局限性方面的关键作用。基于这些发现,修订国际STH准则以包括伊维菌素是一个有希望的选择，以促进对STH和其他NTD的控制和最终消除。
方法：我们搜索了Pubmed，EMBASE,和WebofScience于2023年2月14日发布，用于研究伊维菌素PC的有效性，单独或与其他驱虫药联合使用，关于STH感染，并提供了PC前后STH患病率的衡量标准。我们使用随机效应荟萃分析计算了每种STH的合并患病率降低。我们的协议可在PROSPERO上获得(注册号CRD42023401219)。
结果：共有21人符合系统评价的条件，其中15人符合荟萃分析的条件.所有研究均通过MDA递送伊维菌素。在5项研究中，仅使用伊维菌素的MDA后，胸骨链球菌的合并患病率降低为84.49％（95％CI54.96-94.66），在使用或不使用阿苯达唑的7项研究中，为81.37％（95％CI61.62-90.96）。在5项单独使用伊维菌素的研究中，TrichiuraT.trichiura的患病率降低为49.93％（95％CI18.23-69.34），在添加阿苯达唑的三项研究中，89.40%(95%CI73.66-95.73)。所有合成都存在高度异质性(I2>65%)。
结论：本研究强调了基于伊维菌素的MDA在解决当前全球STH指南中对胸骨链球菌和Trichiura疗效有限的局限性方面的关键作用。基于这些发现,修订国际STH准则以包括伊维菌素是一个有希望的选择，以促进对STH和其他NTD的控制和最终消除。
