世界卫生组织(世卫组织)承认血吸虫病是《2030年可持续发展目标议程》中旨在全球消除的被忽视的热带病之一。在巴西,曼氏血吸虫病被认为是一个公共卫生问题,生活在环境和卫生条件差地区的弱势群体中尤为普遍。2022年,世卫组织发布了一份指南,其中包括协助流行国家的国家计划实现发病率控制的建议。消除血吸虫病作为一个公共卫生问题,并朝着中断传输的方向前进。这里提出的观点,由OswaldoCruz基金会(Fiocruz)血吸虫病转化计划(FioSchisto)的成员集体编写,以及受邀的专家,检查世卫组织对巴西环境的建议的可行性,为适用于巴西流行病学现实的公共卫生政策提供适当的建议,并建议未来研究解决相关问题。在巴西,提供安全的水和卫生设施应该是实现消除血吸虫病目标的关键行动。参与措施实施的机构应与初级保健小组一起采取行动进行规划,执行,监测,并根据其流行病学指标评估优先城市的行动。寄主蜗牛的控制应优先考虑在繁殖地点采取明智的生态干预措施。信息,教育,和通信(IEC)战略应与水和卫生以及其他控制行动相关联,积极参与学校社区。为了识别受感染的携带者,FioSchisto建议采用免疫和分子测试的两阶段方法,以验证干预期间及以后的传播中断。吡喹酮的管理应在初级保健级别的医疗监督下进行。MDA应该在特殊环境中考虑,作为衡量地方性高的地区初始攻击策略的指标,始终与水和卫生设施融为一体,IEC,蜗牛控制。协助决策,以及对战略行动的监测和评估,我们需要一个信息系统。FioSchisto认为,这种系统化对于投资于战略研究以支持改善血吸虫病控制行动至关重要。巴西消除血吸虫病的努力将从垂直规范框架向涉及部门间和跨学科合作的以社区为中心的方法转变,从而取得成功。
The World Health Organization (WHO) recognizes schistosomiasis as one of the Neglected Tropical Diseases targeted for global elimination in the 2030 Agenda of the Sustainable Development Goals. In Brazil, schistosomiasis mansoni is considered a public health problem, particularly prevalent among vulnerable populations living in areas with poor environmental and sanitary conditions. In 2022, the WHO published a
Guideline encompassing recommendations to assist national programs in endemic countries in achieving morbidity control, eliminating schistosomiasis as a public health problem, and advancing towards interrupting transmission. The perspectives presented here, collectively prepared by members of the Oswaldo Cruz Foundation\'s (Fiocruz) Schistosomiasis Translational Program (FioSchisto), along with invited experts, examine the feasibility of the WHO recommendations for the Brazilian settings, providing appropriate recommendations for public health policies applicable to the epidemiological reality of Brazil, and suggests future research to address relevant issues. In Brazil, the provision of safe water and sanitation should be the key action to achieve schistosomiasis elimination goals. The agencies involved in measures implementation should act together with the Primary Care teams for planning, executing, monitoring, and evaluating actions in priority municipalities based on their epidemiological indicators. Host snails control should prioritize judicious ecological interventions at breeding sites. The Information, Education, and Communication (IEC) strategy should be associated with water and sanitation and other control actions, actively involving school community. To identify infected carriers, FioSchisto recommends a two-stage approach of immunological and molecular tests to verify transmission interruption during the intervention and beyond.
Praziquantel administration should be done under medical supervision at the Primary Care level. MDA should be considered in exceptional settings, as a measure of initial attack strategy in locations presenting high endemicity, always integrated with water and sanitation, IEC, and snail control. To assist decision-making, as well as the monitoring and evaluation of strategic actions, there is a need for an Information System. FioSchisto considers this systematization essential to make investments in strategic research to support the improvement of schistosomiasis control actions. Efforts toward schistosomiasis elimination in Brazil will succeed with a paradigm shift from the vertical prescriptive framework to a community-centered approach involving intersectoral and interdisciplinary collaboration.