麻风病的暴露后预防 (PEOPLE):一个集群随机试验
Epco Hasker1, Younoussa Assoumani2, Andriamira Randrianantoandro3
1Institute of Tropical Medicine, Antwerp, Belgium.
The Lancet. Global health
|May 18, 2024
概括
单剂量里法素暴露后预防 (SDDR-PEP) 显示出降低麻风病发病率的前景,特别是在广泛使用时. 针对受感染个体的查增强了它对Mycobacterium leprae传播的保护作用.
科学领域:
- 流行病学 流行病学
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
背景情况:
- 众所周知,使用单剂量里法素的暴露后预防 (PEP) 可以减少从Mycobacterium leprae感染到麻风病的进展.
- 这项研究研究了单剂双剂量里法素 (SDDR) -PEP的不同施用方式的有效性,包括更高的剂量 (20 mg/kg).
研究的目的:
- 为了比较各种SDDR-PEP管理策略在减少麻风病发病率方面的有效性.
- 评估SDDR-PEP的个体保护作用,并探索与麻风传播的空间关联.
主要方法:
- 在马达加斯加和科摩罗群岛进行了一项群集随机研究,持续了4年,涉及每年进行麻风查.
- 实施了四个研究臂:一个没有PEP的对照臂和三个具有不同SDDR-PEP分布的干预臂 (家庭接触者,在100米以内的接近,或与阳性血清学接近).
- 2岁及以上的参与者有资格参加,麻风患者接受多种药物治疗,无症状接触者接受SDDR-PEP.
主要成果:
- 总体而言,SDDR-PEP在干预组中显示,麻风病发病率的减少并不显著.
- 然而,在对基线流行率进行调整后,第3组 (在100米以内的SDDR-PEP) 显示出显著的减少 (IRR0.56,p=0.0030).
- 在个体上,SDDR-PEP具有保护性 (IRR为0.55,p=0.0050),对于居住在指数患者75米以内的人来说,麻风险显著增加.
结论:
- 虽然SDDR-PEP显示出对麻风的保护作用,但可能比最初预期的要小.
- 观察到麻风病例的强烈空间聚类,突出显示了接近受感染个体的重要性.
- 针对指数患者的门对门查和广泛的SDDR-PEP管理的联合策略可能会显著减少麻风的传播.
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