PDF(Pubmed)
Abstract：
Retrospective cohort studies in Cameroon found an association between Onchocerca volvulus microfilarial load in childhood (measured in 1991-1993) and risk of developing epilepsy later in life (measured in 2017). We parameterised and integrated this relationship (across children aged 3-15 years) into the previously published, stochastic transmission model, EPIONCHO-IBM, for Simulium damnosum sensu lato-transmitted onchocerciasis. We simulated 19 years (1998-2017) of annual ivermectin mass drug administration (MDA) reflecting coverage in the study area, and modelled epilepsy prevalence and incidence. Scenario-based simulations of 25 years of (annual and biannual) MDA in hyper- and holoendemic settings, with 65% and 80% therapeutic coverage, were also conducted. EPIONCHO-IBM predicted 7.6% epilepsy prevalence (compared to 8.2% in the Cameroon study) and incidence of 317 cases/100,000 person-years (compared to 350). In hyperendemic areas, 25 years of biannual MDA (80% coverage) eliminated onchocerciasis-associated epilepsy (OAE) and protected untreated under-fives from its development. Strengthening onchocerciasis programmes, implementing alternative strategies, and evaluating treatment for under-fives and school-age children are crucial to prevent OAE in highly-endemic settings.
摘要：
喀麦隆的回顾性队列研究发现，儿童期Onchocerca扭转微丝虫负荷（1991-1993年测量）与以后生活中发生癫痫的风险（2017年测量）之间存在关联。我们将这种关系（在3-15岁的儿童中）参数化并整合到以前发表的文章中，随机传输模型，EPIONCHO-IBM,由雷木香传播的盘尾丝虫病。我们模拟了19年（1998-2017）的年度伊维菌素大规模药物管理（MDA），反映了研究区域的覆盖率，并模拟了癫痫的患病率和发病率。在高流行和全流行环境中，基于场景的25年（年度和半年）MDA模拟，65%和80%的治疗覆盖率，也进行了。EPIONCHO-IBM预测癫痫患病率为7.6％（喀麦隆研究中为8.2％），发病率为317例/100,000人年（350）。在高流行地区，25年两次的MDA（覆盖率80％）消除了盘尾丝虫病相关的癫痫（OAE），并保护了未经治疗的五岁以下儿童的发展。加强盘尾丝虫病方案，实施替代战略，评估五岁以下儿童和学龄儿童的治疗对于在高流行环境中预防OAE至关重要。
