Disease Eradication

疾病根除
  • 文章类型: Journal Article
    霍乱仍然是埃塞俄比亚的一个重大公共卫生问题。超过1590万埃塞俄比亚人,占总人口的15%,生活在有霍乱反复爆发史的地区。过去9年的国家霍乱监测数据显示,该国每年都会爆发霍乱。目前的霍乱爆发,从2022年8月开始,影响了整个国家,2022年报告病例841例,病死率(CFR)为3.13%,2023年报告病例>3万例,CFR接近1.4%。根据“结束霍乱-到2030年的全球路线图”,埃塞俄比亚政府致力于消除该国的霍乱,并制定了“国家霍乱消除计划(NCP):2022-2028”,目标是到2028年实现霍乱热点地区的零本地传播,并比最近(2020-2022年)平均1.8%的CFR减少90%的死亡人数。该计划是多部门的,有明确的协调平台,包含所有干预措施,并进行深入的情境分析,符合现有的计划和战略,并在区域一级进行级联,并与现有的政府和公共结构一起实施。全国范围内,共确定了118个霍乱热点地区(区),并评估了现有霍乱疫情应对能力的全面情况分析。这个多部门和多年的NCP已经预测了约4.04亿美元的预算估计,其中>90%用于改善该国的水,卫生,卫生(2.22亿美元;占NCP总预算的55%)和病例管理(1.49亿美元;37%)。NCP中包含的霍乱疫苗接种策略在选定的霍乱热点地区展示了5年口服霍乱疫苗(OCV)引入计划,包括2剂(30604889剂)和单剂量(3031266剂)。然而,由于缺乏财政支持,其实施受到挑战,无法获得针对目标热点的疫苗(由于OCV全球库存中当前剂量不足),反复爆发霍乱,以及该国高度的人道主义需求。建议建立一个可持续的财务机制来支持实施,按照要求的疫苗剂量,重组计划协调平台,促进实施。
    Cholera remains a significant public health concern in Ethiopia. More than 15.9 million Ethiopians, constituting 15% of the total population, live in areas with a history of recurrent cholera outbreaks. The last 9 years of national cholera surveillance data show the country has been experiencing cholera outbreaks every year. The current cholera outbreak, starting in August 2022, has affected the entire country, with 841 reported cases and a 3.13% case fatality rate (CFR) in 2022, and >30 000 cases with nearly a 1.4% CFR in 2023. In line with \"Ending Cholera-A Global Roadmap to 2030,\" the government of Ethiopia is committed to eliminate cholera in the country and has prepared its \"National Cholera Elimination Plan (NCP): 2022-2028\" with aims to achieve zero local transmission in cholera hotspot areas by 2028 and 90% fatality reduction from the recent (2020-2022) average of 1.8% CFR. The plan is multisectoral, has a clear coordination platform, contains all interventions with in-depth situational analysis, is concordant with existing plans and strategies, and is cascaded at the regional level and implemented with existing government and public structures. Nationwide, total 118 cholera hotspot woredas (districts) were identified, and a comprehensive situation analysis of the existing cholera outbreak response capacity was assessed. This multisectoral and multiyear NCP has forecasted around US$404 million budget estimates with >90% allocated to improving the country\'s water, sanitation, and hygiene (US$222 million; 55% of total NCP budget) and case management (US$149 million; 37%). The cholera vaccination strategy included in the NCP exhibited a 5-year oral cholera vaccine (OCV) introduction plan with 2 doses (30 604 889 doses) and single dose (3 031 266 doses) in selected cholera hotspot areas. However, its implementation is challenged due to a lack of financial support, inability to get the requested vaccine for targeted hotspot woredas (due to the current shortage of doses in the OCV global stockpile), recurrent cholera outbreaks, and high humanitarian needs in the country. It is recommended to have a sustainable financial mechanism to support implementation, follow the requested vaccine doses, and reorganize the planned coordination platform to foster the implementation.
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  • 文章类型: Journal Article
    背景:尽管自2014年以来选择了治愈性治疗方案,但华盛顿州仅有12%的人诊断为丙型肝炎(HCV)在2018年接受了治疗。华盛顿州机构于2019年启动了一项消除计划,以促进获得和提供HCV筛查和治疗。这项研究的目的是评估提供者和卫生系统在华盛顿州成功实施HCV筛查和治疗的障碍。
    方法:这是一项针对547名医生的横断面在线调查,执业护士,医师助理,和为华盛顿州成年患者提供护理的临床药师于2022年进行。如果提供者在初级保健部门工作,他们就有资格,传染病,胃肠病学,或社区健康环境。问题评估了HCV筛查和治疗实践,实施障碍,提供者知识,观察到的污名,并愿意共同管理HCV和物质使用障碍。卡方或渔民精确测试比较了那些进行和未进行筛查或治疗的人的特征。
    结果:全州的HCV筛查提供者使用率很高(96%),确定最小的障碍。更少的提供者报告自己治疗HCV(28%);大多数(71%)将患者转介给另一个提供者。未治疗HCV的患者发现的障碍包括知识不足(64%)和缺乏组织支持(24%)。在治疗HCV的患者中最明显的障碍是缺乏治疗临床医生(18%)。很少(<10%)报告在HCV治疗的设置中观察到的污名。大多数临床医生(95%)愿意为使用酒精等药物的患者开处方治疗药物使用障碍。
    结论:尽管进行了广泛的筛查工作,在华盛顿州实施HCV治疗仍然存在障碍.缺乏治疗临床医生和临床医生知识缺陷是治疗HCV最常见的障碍。为了到2030年消除HCV,需要发展和教育治疗HCV的临床医生队伍。
    BACKGROUND: Despite curative treatment options since 2014, only 12% of individuals in Washington State diagnosed with Hepatitis C (HCV) received treatment in 2018. Washington State agencies launched an elimination plan in 2019 to promote access to and delivery of HCV screening and treatment. The purpose of this study is to evaluate provider and health system barriers to successful implementation of HCV screening and treatment across Washington State.
    METHODS: This is a cross-sectional online survey of 547 physicians, nurse practitioners, physician assistants, and clinical pharmacists who provide care to adult patients in Washington State conducted in 2022. Providers were eligible if they worked in a primary care, infectious disease, gastroenterology, or community health settings. Questions assessed HCV screening and treating practices, implementation barriers, provider knowledge, observed stigma, and willingness to co-manage HCV and substance use disorder. Chi-squared or fishers exact tests compared characteristics of those who did and did not screen or treat.
    RESULTS: Provider adoption of screening for HCV was high across the state (96%), with minimal barriers identified. Fewer providers reported treating HCV themselves (28%); most (71%) referred their patients to another provider. Barriers identified by those not treating HCV included knowledge deficit (64%) and lack of organizational support (24%). The barrier most identified in those treating HCV was a lack of treating clinicians (18%). There were few (< 10%) reports of observed stigma in settings of HCV treatment. Most clinicians (95%) were willing to prescribe medication for substance use disorders to those that were using drugs including alcohol.
    CONCLUSIONS: Despite widespread screening efforts, there remain barriers to implementing HCV treatment in Washington State. Lack of treating clinicians and clinician knowledge deficit were the most frequently identified barriers to treating HCV. To achieve elimination of HCV by 2030, there is a need to grow and educate the clinician workforce treating HCV.
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  • 文章类型: Journal Article
    背景:世界卫生组织(WHO)通过的消除被忽视的热带病的路线图旨在消除血吸虫病,作为公共卫生问题,到2030年。尽管撒哈拉以南非洲几个国家在减少血吸虫病发病率控制方面取得了进展,还有更多的事情需要做。使用具有可接受的灵敏度和特异性的准确诊断进行适当的监测对于评估所有针对血吸虫病的努力的成功至关重要。显微镜,尽管灵敏度低,仍然是诊断疾病的黄金标准方法。尽管已经做出了许多努力来开发基于循环寄生虫蛋白的新诊断方法,遗传标记,血吸虫卵形态,以及它们的顺磁性,没有一个足够强大,以取代显微镜。这篇综述重点介绍了在野外和临床环境中检测血吸虫病的常见诊断方法。重大挑战,并提供了新的和新颖的机会和诊断途径,这对于支持消除血吸虫病至关重要。
    方法:我们搜索了PubMed的相关和可靠的已发表文献,Scopus,谷歌学者,和Web的科学。搜索策略主要由子主题决定,因此使用了以下词语(schistosom*,诊断,Kato-Katz,抗体测试,循环抗原,POC-CCA,UCP-LF-CAA,分子诊断,核酸扩增试验,微流体,实验室-在磁盘上,实验室芯片,重组酶聚合酶扩增(RPA),LAMP,便携式音序器,纳米抗体测试,相同的多重复序列,诊断TPP,已确认,无提取),和布尔运算符AND和/OR用于优化搜索容量。由于血吸虫病的全球公共卫生性质,我们还搜索了可靠的文件,reports,和国际卫生组织发表的研究论文,世界卫生组织(世卫组织)和疾病控制和消除中心。
    BACKGROUND: The roadmap adopted by the World Health Organization (WHO) for eliminating neglected tropical diseases aims to eliminate schistosomiasis, as a public health concern, by 2030. While progress has been made towards reducing schistosomiasis morbidity control in several sub-Saharan African countries, there is still more that needs to be done. Proper surveillance using accurate diagnostics with acceptable sensitivity and specificity is essential for evaluating the success of all efforts against schistosomiasis. Microscopy, despite its low sensitivity, remains the gold standard approach for diagnosing the disease. Although many efforts have been made to develop new diagnostics based on circulating parasite proteins, genetic markers, schistosome egg morphology, and their paramagnetic properties, none has been robust enough to replace microscopy. This review highlights common diagnostic approaches for detecting schistosomiasis in field and clinical settings, major challenges, and provides new and novel opportunities and diagnosis pathways that will be critical in supporting elimination of schistosomiasis.
    METHODS: We searched for relevant and reliable published literature from PubMed, Scopus, google scholar, and Web of science. The search strategies were primarily determined by subtopic, and hence the following words were used (schistosom*, diagnosis, Kato-Katz, antibody test, circulating antigen, POC-CCA, UCP-LF-CAA, molecular diagnostics, nucleic acid amplification test, microfluidics, lab-on a disk, lab-on chip, recombinase polymerase amplification (RPA), LAMP, portable sequencer, nanobody test, identical multi-repeat sequences, diagnostic TPPs, REASSURED, extraction free), and Boolean operators AND and/OR were used to refine the searching capacity. Due to the global public health nature of schistosomiasis, we also searched for reliable documents, reports, and research papers published by international health organizations, World Health Organization (WHO), and Center for Disease control and Elimination.
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  • 文章类型: Journal Article
    背景:经过数十年的吡喹酮大规模给药(MDA),几个国家接近消除血吸虫病。在大部分未感染的人群中继续使用MDA似乎不再合理。需要采取替代干预措施来维持增益或加速传输中断。我们报告结果,优势,以及奔巴血吸虫低流行地区新型测试-治疗-追踪-测试-治疗(5T)干预措施的缺点,坦桑尼亚。
    方法:在2021年和2022年进行了基于学校和家庭的调查,以监测血链球菌和微血尿的患病率,并评估干预措施的影响。2021年,在15个低流行地区实施了5T干预措施,包括:(i)对小学和伊斯兰学校的学童进行微血尿测试,以代替血吸虫,(ii)治疗积极的儿童,(iii)将他们追踪到他们经常光顾的家庭和水体,(iv)在家庭和水体中测试个人,和(V)治疗阳性个体。此外,试验和治疗干预措施在研究区域的22个医疗机构实施.
    结果:在以学校为基础的15个低患病率实施单位的调查中,2021年和2022年分别为0.5%(7/1560)和0.4%(6/1645)。在以家庭为基础的调查中,在2021年和2022年,分别有0.5%(14/2975)和0.7%(19/2920)的参与者感染了S。微血尿患病率,不包括跟踪结果,在以学校为基础的调查中,2021年为1.4%(21/1560),2022年为1.5%(24/1645)。在以家庭为基础的调查中,2021年为3.3%(98/2975),2022年为5.4%(159/2920)。在5T干预期间,在小学和伊斯兰学校的儿童中,微血尿患病率分别为3.8%(140/3700)和5.8%(34/594),分别,家庭成员占17.1%(44/258),水体中的人占16.7%(10/60)。在卫生设施中,19.8%(70/354)的患者检测微血尿阳性。
    结论:有针对性的5T干预措施维持了极低的血吸虫流行率,并且被证明可以直接和可行地识别和治疗少数血吸虫感染的个体。未来的研究将显示5T干预措施是否可以长期维持收益并加快消除。
    背景:ISRCTN,ISCRCTN91431493。2020年2月11日注册,https://www。isrctn.com/ISRCTN91431493.
    BACKGROUND: After decades of praziquantel mass drug administration (MDA), several countries approach schistosomiasis elimination. Continuing MDA in largely uninfected populations no longer seems justified. Alternative interventions to maintain the gains or accelerate interruption of transmission are needed. We report results, strengths, and shortcomings of novel test-treat-track-test-treat (5T) interventions in low Schistosoma haematobium prevalence areas on Pemba, Tanzania.
    METHODS: School- and household-based surveys were conducted in 2021 and 2022 to monitor the S. haematobium and microhematuria prevalence and assess the impact of interventions. In 2021, 5T interventions were implemented in 15 low-prevalence areas and included: (i) testing schoolchildren in primary and Islamic schools for microhematuria as a proxy for S. haematobium, (ii) treating positive children, (iii) tracking them to their households and to water bodies they frequented, (iv) testing individuals at households and water bodies, and (v) treating positive individuals. Additionally, test-and-treat interventions were implemented in the 22 health facilities of the study area.
    RESULTS: The S. haematobium prevalence in the school-based survey in 15 low-prevalence implementation units was 0.5% (7/1560) in 2021 and 0.4% (6/1645) in 2022. In the household-based survey, 0.5% (14/2975) and 0.7% (19/2920) of participants were infected with S. haematobium in 2021 and 2022, respectively. The microhematuria prevalence, excluding trace results, in the school-based survey was 1.4% (21/1560) in 2021 and 1.5% (24/1645) in 2022. In the household-based survey, it was 3.3% (98/2975) in 2021 and 5.4% (159/2920) in 2022. During the 5T interventions, the microhaematuria prevalence was 3.8% (140/3700) and 5.8% (34/594) in children in primary and Islamic schools, respectively, 17.1% (44/258) in household members, and 16.7% (10/60) in people at water bodies. In health facilities, 19.8% (70/354) of patients tested microhematuria-positive.
    CONCLUSIONS: The targeted 5T interventions maintained the very low S. haematobium prevalence and proved straightforward and feasible to identify and treat many of the few S. haematobium-infected individuals. Future research will show whether 5T interventions can maintain gains in the longer-term and expedite elimination.
    BACKGROUND: ISRCTN, ISCRCTN91431493. Registered 11 February 2020, https://www.isrctn.com/ISRCTN91431493 .
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    Driven by international exchanges and climate changes, the invasion and spread of vector Anopheles mosquitoes posed a new challenge to achieving global malaria elimination. Taking the invasion of An. stephensi to exacerbate the malaria epidemic in Africa as an example, this article summarizes the current situation of global Anopheles invasion, and estimates the potential risk of vector Anopheles mosquitoes to unravel the difficulties and challenges in the global malaria elimination program, so as to provide insights into improved early earning and precision control of vector Anopheles mosquito invasion across the world.
    [摘要] 在国际交流与气候变化的驱动下, 媒介按蚊入侵与扩散 给全球疟疾消除目标的实现带来了新挑战。本文以斯氏按蚊入 侵加重非洲疟疾流行为例, 对全球按蚊入侵现状进行了梳理, 结 合媒介按蚊潜在入侵风险预估, 揭示全球疟疾消除的困难与挑 战, 为各国加强媒介按蚊入侵预警、媒介按蚊入侵的可持续精准 防控提供参考。.
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  • 文章类型: Journal Article
    Malaria is an infectious disease that seriously threatens human health. Currently, malaria control mainly depends on antimalarial chemotherapy. However, antimalarial drug resistance is becoming increasingly severe, which poses a great challenge to malaria control, notably treatment of Plasmodium falciparum malaria. To address this challenge, there is a need to facilitate development of novel antimalarial drugs and innovation of treatment strategies, as well as reinforce surveillance and research on antimalarial drug resistance. This article reviews the main categories and use guidelines of current antimalarial agents, summarizes the current status and monitoring methods of antimalarial drug resistance, and proposes the response to antimalarial drug resistance, so as to provide insights into the use of antimalarial drugs and response to antimalarial drug resistance, and contribute to global malaria elimination.
    [摘要] 疟疾是严重威胁人类健康的传染病之一, 目前疟疾 防控仍以药物治疗为主。然而, 抗疟药耐药性问题日益严峻, 给疟疾防控尤其是恶性疟治疗带来了严峻挑战。为应对这一 挑战, 需推动新型抗疟药物开发和治疗策略创新, 并加强抗疟 药耐药性监测与研究。本文梳理了当前抗疟药主要类别及使 用原则, 总结了抗疟药耐药性现状、监测手段及应对策略, 旨 在为抗疟药使用及耐药性应对提供科学参考、助力全球消除 疟疾。.
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  • 文章类型: Journal Article
    全球根除脊髓灰质炎倡议(GPEI)帮助全球开发了标准的急性弛缓性麻痹监测(AFP)系统,包括,知识,专业知识,技术援助,和训练有素的人员。AFP监测可以补充任何疾病监测系统。
    这项研究概述了孟加拉国的AFP监测演变,它的成功和挑战性因素,以及它促进其他健康目标的潜力。
    这项混合方法研究包括灰色文献综述,调查,和关键线人访谈(KIIs)。我们从在线网站收集灰色文献,并从GPEI利益相关者收集纸质文档。在孟加拉国的六个部门进行了在线和面对面调查,包括达卡,Rajshahi,Rangpur,吉大港,Sylhet,还有Khulna,映射隐性知识思想,方法,和经验。我们还进行了KIs,然后将数据结合在重点关注的新兴主题上,包括历史,挑战,和AFP监测计划的成功。
    根据灰色文献综述,调查,还有KII,AFP监测成功地减少了孟加拉国的脊髓灰质炎。主要的促进因素是多部门合作,监测免疫医疗干事(SIMO)网络活动,社会环境,基于社区的监测,有希望的政治承诺。另一方面,人口高速增长,难以到达的地区,居住在危险地区的人们,小儿麻痹症过渡规划是重大挑战。孟加拉国还利用这些脊髓灰质炎监测资产治疗其他疫苗可预防的疾病。
    世界已经接近消灭小儿麻痹症,知识,以及法新社监视的其他资产,可用于其他健康计划。此外,可以利用其优势来对抗新出现的疾病。
    主要发现:研究发现,孟加拉国已经实现了世界标准的监测系统,包括多部门合作在内的促进因素,GPEI合作伙伴,以及政治和社区支持。然而,人口高速增长,难以到达的地区和人们,小儿麻痹症过渡规划被认为是挑战。增加知识:此外,孟加拉国现在正在利用这些脊髓灰质炎监测资产来监测其他疫苗可预防的疾病。全球卫生对政策和行动的影响:由于脊髓灰质炎仍然对一些低收入国家构成威胁,从孟加拉国的AFP监测中获得的知识可以帮助这些国家从地球上根除脊髓灰质炎病例,并为VPD和其他卫生计划服务。
    UNASSIGNED: The Global Polio Eradication Initiative (GPEI) helped develop the standard acute flaccid paralysis surveillance (AFP) system worldwide, including, knowledge, expertise, technical assistance, and trained personnel. AFP surveillance can complement any disease surveillance system.
    UNASSIGNED: This study outlines AFP surveillance evolution in Bangladesh, its success and challenging factors, and its potential to facilitate other health goals.
    UNASSIGNED: This mixed-method study includes a grey literature review, survey, and key informant interviews (KIIs). We collected grey literature from online websites and paper documentation from GPEI stakeholders. Online and in-person surveys were conducted in six divisions of Bangladesh, including Dhaka, Rajshahi, Rangpur, Chittagong, Sylhet, and Khulna, to map tacit knowledge ideas, approaches, and experiences. We also conducted KIIs, and Data were then combined on focused emerging themes, including the history, challenges, and successes of AFP surveillance programme.
    UNASSIGNED: According to the grey literature review, survey, and KII, AFP surveillance successfully contributed to decreasing polio in Bangladesh. The major facilitating factors were multi-sectoral collaboration, Surveillance Immunization Medical Officer (SIMO) network activities, social environment, community-based surveillance, and promising political commitment. On the other hand, high population growth, hard-to-reach areas, people residing in risky zones, and polio transition planning were significant challenges. Bangladesh is also utilizing these polio surveillance assets for other vaccine-preventable diseases.
    UNASSIGNED: As the world is so close to eradicating polio, the knowledge, and other assets of the AFP surveillance, could be used for other health programmes. In addition, its strengths can be leveraged for combating new and emerging diseases.
    Main findings: The research found that Bangladesh has achieved a world-standard surveillance system, with facilitating factors including multi-sectoral collaboration, GPEI partners, and political and community support. However, high population growth, hard-to-reach areas and people, and polio transition planning were found to be challenges.Added knowledge: In addition, Bangladesh is now utilizing these polio surveillance assets to monitor other vaccine-preventable diseases.Global health impact for policy and action: Since polio is still a threat to some LMICs, the knowledge gained from AFP surveillance of Bangladesh could assist those countries in eradicating the cases of polio from the earth and serve VPDs and other health programmes as well.
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