背景:世卫组织提议到2030年消除盘尾丝虫病(河盲症)的传播。99%以上的盘尾丝虫病病例发生在撒哈拉以南非洲。伊维菌素的病媒控制和大量用药是多年来的主要干预措施,不同的成功。我们旨在确定与消除撒哈拉以南非洲盘尾丝虫病传播相关的因素。
方法:对于本系统综述和荟萃分析,我们搜索了报告撒哈拉以南非洲盘尾丝虫病传播状况的流行病学或昆虫学评估的已发表的文章,有或没有矢量控制。我们搜索了MEDLINE,PubMed,WebofScience,Embase,Cochrane中央控制试验登记册,非洲医学指数,和Google学术数据库,用于从数据库开始到2023年8月19日发布的所有文章,没有语言限制。使用的搜索词是“盘尾丝虫病”和“伊维菌素”和“大规模药物管理”。三个纳入标准是(1)焦点或位于非洲的焦点,(2)报告消除传播或至少10年伊维菌素大规模用药的重点或焦点,和(3)至少包括以下评估之一:微丝虫患病率,结节患病率,Ov16抗体血清阳性率,和黑蝇传染性患病率。排除了流行病学建模研究和综述。四名审稿人(NM,AJ,AM,和TNK)使用Excel中开发的数据提取工具从全文文章中提取数据,其中列记录了要提取的感兴趣数据,以及一个专栏,其中可以突出显示每个研究的重要评论。我们没有要求作者提供任何个人层面的数据。Foci被归类为实现消除传播,接近消除传播,或正在进行传输。我们使用混合效应元回归模型来识别与传播状态相关的因素。这项研究在PROSPERO注册,CRD42022338986。
结果:在删除重复项后筛选的1525篇文章中,75提供了来自撒哈拉以南非洲27个盘尾丝虫病流行国家中19个(70%)的238个不同病灶的282个记录。在24(9%)记录中报告了消除传播的情况,在86(30%)记录中接近消除传播,以及172条(61%)记录中的持续传播。I2为83·3%(95%CI79·7至86·3)。记录报告10年或10年以上连续大量药物给药,合格人群的治疗覆盖率为80%或更高,与未达到80%或更高覆盖率的患者相比,达到传播消除(对数赔率8·5[95%CI3·5至13·5])或消除并接近传播消除(42·4[18·7至66·1])的几率明显更高。报告15-19年伊维菌素大规模药物管理(22·7[17·2至28·2])和一年两次治疗(43·3[27·2至59·3])与消除和接近消除传播相比,不到15年,没有一年两次的大规模药物管理,分别。与没有病媒控制和低流行相比,没有病媒消除的病媒控制(-42·8[-59·1至-26·5])和基线全流行(-41·97[-60·6至-23·2])与持续传播风险增加相关。分别。由于媒介控制或环境变化而导致的黑蝇消失有助于消除传播。
结论:集体用药持续时间,频率,和覆盖率;基线流行;媒介消除或消失是消除撒哈拉以南非洲盘尾丝虫病传播的重要决定因素。我们的发现强调,如果各国要消除盘尾丝虫病的传播,则必须改善和维持高治疗覆盖率并增加治疗频率。
背景:比尔和梅琳达·盖茨基金会和被忽视的热带病模型协会,英国医学研究委员会,和全球卫生EDCTP3联合承诺。
■对于斯瓦希里语,法语,摘要的西班牙语和葡萄牙语翻译见补充材料部分。
BACKGROUND: WHO has proposed elimination of transmission of
onchocerciasis (river blindness) by 2030. More than 99% of cases of
onchocerciasis are in sub-Saharan Africa. Vector control and mass drug administration of ivermectin have been the main interventions for many years, with varying success. We aimed to identify factors associated with elimination of
onchocerciasis transmission in sub-Saharan Africa.
METHODS: For this systematic
review and meta-analysis we searched for published articles reporting epidemiological or entomological assessments of onchocerciasis transmission status in sub-Saharan Africa, with or without vector control. We searched MEDLINE, PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, African Index Medicus, and Google Scholar databases for all articles published from database inception to Aug 19, 2023, without language restrictions. The search terms used were \"
onchocerciasis\" AND \"ivermectin\" AND \"mass drug administration\". The three inclusion criteria were (1) focus or foci located in Africa, (2) reporting of elimination of transmission or at least 10 years of ivermectin mass drug administration in the focus or foci, and (3) inclusion of at least one of the following assessments: microfilarial prevalence, nodule prevalence, Ov16 antibody seroprevalence, and blackfly infectivity prevalence. Epidemiological modelling studies and reviews were excluded. Four reviewers (NM, AJ, AM, and TNK) extracted data in duplicate from the full-text articles using a data extraction tool developed in Excel with columns recording the data of interest to be extracted, and a column where important comments for each study could be highlighted. We did not request any individual-level data from authors. Foci were classified as achieving elimination of transmission, being close to elimination of transmission, or with ongoing transmission. We used mixed-effects meta-regression models to identify factors associated with transmission status. This study is registered in PROSPERO, CRD42022338986.
RESULTS: Of 1525 articles screened after the removal of duplicates, 75 provided 282 records from 238 distinct foci in 19 (70%) of the 27 onchocerciasis-endemic countries in sub-Saharan Africa. Elimination of transmission was reported in 24 (9%) records, being close to elimination of transmission in 86 (30%) records, and ongoing transmission in 172 (61%) records. I2 was 83·3% (95% CI 79·7 to 86·3). Records reporting 10 or more years of continuous mass drug administration with 80% or more therapeutic coverage of the eligible population yielded significantly higher odds of achieving elimination of transmission (log-odds 8·5 [95% CI 3·5 to 13·5]) or elimination and being close to elimination of transmission (42·4 [18·7 to 66·1]) than those with no years achieving 80% coverage or more. Reporting 15-19 years of ivermectin mass drug administration (22·7 [17·2 to 28·2]) and biannual treatment (43·3 [27·2 to 59·3]) were positively associated with elimination and being close to elimination of transmission compared with less than 15 years and no biannual mass drug administration, respectively. Having had vector control without vector elimination (-42·8 [-59·1 to -26·5]) and baseline holoendemicity (-41·97 [-60·6 to -23·2]) were associated with increased risk of ongoing transmission compared with no vector control and hypoendemicity, respectively. Blackfly disappearance due to vector control or environmental change contributed to elimination of transmission.
CONCLUSIONS: Mass drug administration duration, frequency, and coverage; baseline endemicity; and vector elimination or disappearance are important determinants of elimination of onchocerciasis transmission in sub-Saharan Africa. Our findings underscore the importance of improving and sustaining high therapeutic coverage and increasing treatment frequency if countries are to achieve elimination of onchocerciasis transmission.
BACKGROUND: The Bill & Melinda Gates Foundation and Neglected Tropical Diseases Modelling Consortium, UK Medical Research Council, and Global Health EDCTP3 Joint Undertaking.
UNASSIGNED: For the Swahili, French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.