在单次大规模阿兹罗米辛治疗后,再进行向治疗后,的复发:一项纵向研究
Oriol Mitjà1, Charmie Godornes2, Wendy Houinei3
1Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Lihir Medical Center, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea.
Lancet (London, England)
|February 12, 2018
概括
世卫组织的根除策略在短期内取得了成功,但在长期内失败,原因是再次出现和对产生抗性. 可能需要重复大量处理以消除.
科学领域:
- 热带医学
- 传染病流行病学
- 抗菌药物耐药性
背景情况:
- 在热带地区,
- 世界卫生组织 (WHO) 通过大规模的阿齐思罗米辛治疗采取了一项消除的策略.
- 试点研究表明,短时间内发病率有所降低.
研究的目的:
- 评估世卫组织灭策略的长期有效性.
- 评估大规模处理后的复发情况.
- 确定导致治疗失败和耐药性的因素.
主要方法:
- 在巴布亚新几内亚的岛上进行了一项纵向研究.
- 在42个月内进行了临床,血清和PCR调查.
- 用基因型和旅行史来追踪感染的进口和传播.
主要成果:
- 在18个月的时间里,大量的阿兹罗米辛治疗使活跃的从1. 8%降低到0. 1%,但在42个月后又重新出现了0. 4%.
- 在菌株中检测到抗阿兹罗米辛突变,在某些情况下观察到临床失败.
- 潜在的和菌株遗传多样性的减少表明传播减少,但没有消除.
结论:
- 世卫组织的策略没有在一个高度流行的社区中实现长期消除.
- 在群体治疗期间缺席的个体和随后的重新出现是关键的挑战.
- 需要加强监测和重复大量治疗的可能性.
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