PDF(Pubmed)
Abstract：
BACKGROUND: The Dual-Active Ingredient long-lasting insecticidal nets (Dual-AI LLIN) have been developed to counteract the reduced efficacy of pyrethroid (PY)-only nets due to widespread pyrethroid insecticide resistance in malaria vector mosquitoes. They constitute half of the nets distributed in sub-Saharan Africa between 2022 and 2024. However, their effectiveness once they develop holes is unclear, particularly in pyrethroid-resistant settings. This study evaluates the textile integrity of three dual- AI LLINs compared to standard PY LLN, over 3 years of use in a community in Tanzania and the associated impact on malaria prevalence and incidence.
METHODS: A secondary analysis of data from a randomized controlled trial (RCT) in North-western Tanzania was conducted to evaluate the effectiveness of α-cypermethrin only; pyriproxyfen and α-cypermethrin (PPF-PY); chlorfenapyr and α-cypermethrin (chlorfenapyr-PY); and the synergist piperonyl butoxide and permethrin (PBO-PY) LLINs on malaria infection prevalence and case incidence. The association between the net textile condition and 1/malaria prevalence over 3 years of use between 2019 and 2022, and 2/malaria case incidence in a cohort of children over 2 years of follow-up was assessed between 2019 and 2021.
RESULTS: There was no significant association between damaged (OR 0.98, 95% CI 0.71-1.37, p-value = 0.655) and too-torn (OR 1.07, 95% CI 0.77-1.47, p-value = 0.694) compared to intact nets on malaria prevalence for all net types. However, there were reduced rates of malaria case incidence in children sleeping under a net in good condition compared to too-torn nets (incidence rate ratio (IRR) 0.76 [95% CI 0.63-0.92], p = 0.005). Malaria incidence was also consistently lower in too-torn PBO-PY LLIN (IRR = 0.37 [95% CI 0.19-0.72], p = 0.003) and chlorfenapyr-PY LLIN (IRR = 0.45 [95% CI 0.33-0.97], p = 0.053) compared to an intact PY-only LLIN during the first year of follow up. In year 2, the incidence was only significantly lower in intact chlorfenapyr-PY LLIN (IRR = 0.49 [95% CI 0.29-0.81], p = 0.006) compared to intact PY LLIN.
CONCLUSIONS: The study confirmed that sleeping under a chlorfenapyr-PY LLIN or PBO-PY LLIN offered superior protection to pyrethroid-only nets even when torn. Preventing the development of holes is essential as they impact the level of protection offered against malaria infection.
BACKGROUND: ClinicalTrials.gov, number (NCT03554616).
METHODS: A secondary analysis of data from a randomized controlled trial (RCT) in North-western Tanzania was conducted to evaluate the effectiveness of α-cypermethrin only; pyriproxyfen and α-cypermethrin (PPF-PY); chlorfenapyr and α-cypermethrin (chlorfenapyr-PY); and the synergist piperonyl butoxide and permethrin (PBO-PY) LLINs on malaria infection prevalence and case incidence. The association between the net textile condition and 1/malaria prevalence over 3 years of use between 2019 and 2022, and 2/malaria case incidence in a cohort of children over 2 years of follow-up was assessed between 2019 and 2021.
RESULTS: There was no significant association between damaged (OR 0.98, 95% CI 0.71-1.37, p-value = 0.655) and too-torn (OR 1.07, 95% CI 0.77-1.47, p-value = 0.694) compared to intact nets on malaria prevalence for all net types. However, there were reduced rates of malaria case incidence in children sleeping under a net in good condition compared to too-torn nets (incidence rate ratio (IRR) 0.76 [95% CI 0.63-0.92], p = 0.005). Malaria incidence was also consistently lower in too-torn PBO-PY LLIN (IRR = 0.37 [95% CI 0.19-0.72], p = 0.003) and chlorfenapyr-PY LLIN (IRR = 0.45 [95% CI 0.33-0.97], p = 0.053) compared to an intact PY-only LLIN during the first year of follow up. In year 2, the incidence was only significantly lower in intact chlorfenapyr-PY LLIN (IRR = 0.49 [95% CI 0.29-0.81], p = 0.006) compared to intact PY LLIN.
CONCLUSIONS: The study confirmed that sleeping under a chlorfenapyr-PY LLIN or PBO-PY LLIN offered superior protection to pyrethroid-only nets even when torn. Preventing the development of holes is essential as they impact the level of protection offered against malaria infection.
BACKGROUND: ClinicalTrials.gov, number (NCT03554616).
摘要：
背景：已经开发了双活性成分长效杀虫蚊帐（Dual-AILLIN），以抵消由于疟疾病媒蚊子普遍存在的拟除虫菊酯杀虫剂耐药性而导致的仅拟除虫菊酯（PY）蚊帐的功效降低。它们占2022年至2024年间撒哈拉以南非洲分布的蚊帐的一半。然而,一旦它们出现漏洞，它们的有效性就不清楚了，特别是在抗拟除虫菊酯的环境中。本研究评估了三种双AILLINs与标准PYLLN相比的纺织品完整性，在坦桑尼亚的一个社区使用超过3年，以及对疟疾流行和发病率的相关影响。
方法：对来自坦桑尼亚西北部的一项随机对照试验（RCT）的数据进行了二次分析，以评估仅使用α-氯氰菊酯的有效性；吡丙醚和α-氯氰菊酯（PPF-PY）；氯非那霉素和α-氯氰菊酯（氯非那霉素-PY）；以及协同剂胡椒基丁醚的发病率和疟疾（PBPY）在2019年至2022年期间，净纺织品状况与使用3年以上的1/疟疾患病率之间的关联，以及在2019年至2021年期间评估了2/疟疾病例发病率。
结果：与完整的蚊帐相比，所有蚊帐类型的疟疾患病率在受损（OR0.98，95％CI0.71-1.37，p值=0.655）和过度撕裂（OR1.07，95％CI0.77-1.47，p值=0.694）之间没有显着关联。然而,与被撕裂的蚊帐相比，睡在状况良好的蚊帐下的儿童的疟疾发病率降低(发病率比率(IRR)0.76[95%CI0.63-0.92]，p=0.005)。过度撕裂的PBO-PYLLIN的疟疾发病率也一直较低(IRR=0.37[95%CI0.19-0.72]，p=0.003）和氯非那普利LLIN（IRR=0.45[95%CI0.33-0.97]，p=0.053）与随访第一年中完整的仅PYLLIN相比。在第2年，在完整的氯杀非菌灵-PYLLIN中，发病率仅显著降低（IRR=0.49[95%CI0.29-0.81]，p=0.006）与完整的PYLLIN相比。
结论：该研究证实，即使撕裂，在氯非虫子碱-PYLLIN或PBO-PYLLIN下睡觉也比仅有拟除虫菊酯的蚊帐具有更好的保护作用。防止漏洞的发展至关重要，因为它们会影响针对疟疾感染的保护水平。
背景：ClinicalTrials.gov，编号（NCT03554616）。
方法：对来自坦桑尼亚西北部的一项随机对照试验（RCT）的数据进行了二次分析，以评估仅使用α-氯氰菊酯的有效性；吡丙醚和α-氯氰菊酯（PPF-PY）；氯非那霉素和α-氯氰菊酯（氯非那霉素-PY）；以及协同剂胡椒基丁醚的发病率和疟疾（PBPY）在2019年至2022年期间，净纺织品状况与使用3年以上的1/疟疾患病率之间的关联，以及在2019年至2021年期间评估了2/疟疾病例发病率。
结果：与完整的蚊帐相比，所有蚊帐类型的疟疾患病率在受损（OR0.98，95％CI0.71-1.37，p值=0.655）和过度撕裂（OR1.07，95％CI0.77-1.47，p值=0.694）之间没有显着关联。然而,与被撕裂的蚊帐相比，睡在状况良好的蚊帐下的儿童的疟疾发病率降低(发病率比率(IRR)0.76[95%CI0.63-0.92]，p=0.005)。过度撕裂的PBO-PYLLIN的疟疾发病率也一直较低(IRR=0.37[95%CI0.19-0.72]，p=0.003）和氯非那普利LLIN（IRR=0.45[95%CI0.33-0.97]，p=0.053）与随访第一年中完整的仅PYLLIN相比。在第2年，在完整的氯杀非菌灵-PYLLIN中，发病率仅显著降低（IRR=0.49[95%CI0.29-0.81]，p=0.006）与完整的PYLLIN相比。
结论：该研究证实，即使撕裂，在氯非虫子碱-PYLLIN或PBO-PYLLIN下睡觉也比仅有拟除虫菊酯的蚊帐具有更好的保护作用。防止漏洞的发展至关重要，因为它们会影响针对疟疾感染的保护水平。
背景：ClinicalTrials.gov，编号（NCT03554616）。
