使用青蒿琥酯-吡咯那啶对森林居民进行定向给药和间歇性预防治疗以控制柬埔寨疟疾爆发的影响。

IF 3.6 Q1 TROPICAL MEDICINE Tropical Medicine and Health Pub Date : 2024-06-11 DOI:10.1186/s41182-024-00607-2
Dysoley Lek, Nguon Sokomar, Top Samphornarann, Jeanne Rideout, Saad El-Din Hassan, Tol Bunkea, Saing Sam Ath, Rothpisey Seng, John Hustedt, Thomas J Peto, Jayme Hughes, Ke Kimmen, Khoy Dy, Bipin Adhikari
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引用次数: 0

摘要

导言:柬埔寨国家疟疾计划的目标是到 2025 年迅速消灭所有人类疟疾。随着临床病例下降到接近消灭的水平,一项关键战略是迅速识别疟疾疫情,采取有效行动阻断当地传播。我们报告了柬埔寨西部 Kravanh 县为应对 2022 年恶性疟原虫疫情而采取的综合、多管齐下的管理方法:方法:菩萨省卫生厅与寄生虫学、昆虫学和疟疾控制中心(CNM)通过临床记录确定了发生传播的村庄,并启动了各种干预措施,包括分发驱虫蚊帐、开展宣传活动、实施发烧筛查和有针对性的药物治疗。在森林入口处设立了卫生站,随后在特定的村庄病灶实施了青蒿琥酯-吡咯那啶(Pyramax)靶向给药和森林居民间歇性预防治疗(IPTf)。收集了有关 IPTf 和 TDA 的依从性和不良事件的数据。计算了干预措施的覆盖率,并监测了当地的疟疾感染情况:结果:通过在开展 IPTf 和 TDA 的村庄进行发热监测,共筛查了 942 人。研究表明,目标村庄的覆盖率和坚持率都很高,第一轮覆盖率为 92%(553/600),第二轮覆盖率为 65%(387/600)。第一轮的坚持率为 99%(551/553),第二轮为 98%(377/387)。研究发现,与重复检测相比,森林居民更喜欢服用派瑞美,这与覆盖率一致:第一轮为 92%,第二轮为 65%。所有可通过保健站或流动小组接触到的人都报告完全服用了 IPTf。没有严重不良事件的报告。只有 6 人报告了轻微的不良反应,如体力不支、发烧、腹痛、腹泻和肌肉酸痛。有两人将症状归咎于预防后大量饮酒:有针对性的疟疾疫情应对措施表明,所选干预措施的可接受性、安全性和可行性都很高。利用现有的社区资源迅速控制了疟疾的传播。这一经验表明,在未来的疫情暴发中,该方案的应对措施是有效的。
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Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate-pyronaridine to control malaria outbreaks in Cambodia.

Introduction: The national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, a key strategy is the rapid identification of malaria outbreaks triggering effective action to interrupt local transmission. We report a comprehensive, multipronged management approach in response to a  2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia.

Methods: The provincial health department of Pursat in conjunction with the Center for Parasitology, Entomology and Malaria Control (CNM) identified villages where transmission was occurring using clinical records, and initiated various interventions, including the distribution of insecticide-treated bed nets, running awareness campaigns, and implementing fever screening with targeted drug administration. Health stations were set up at forest entry points, and later, targeted drug administrations with artesunate-pyronaridine (Pyramax) and intermittent preventive treatment for forest goers (IPTf) were implemented in specific village foci. Data related to adherence and adverse events from IPTf and TDA were collected. The coverage rates of interventions were calculated, and local malaria infections were monitored.

Results: A total of 942 individuals were screened through active fever surveillance in villages where IPTf and TDA were conducted. The study demonstrated high coverage and adherence rates in the targeted villages, with 92% (553/600) coverage in round one and 65% (387/600) in round two. Adherence rate was 99% (551/553) in round one and 98% (377/387) in round two. The study found that forest goers preferred taking Pyramax over repeated testing consistent with the coverage rates: 92% in round one compared to 65% in round two. All individuals reachable through health stations or mobile teams reported complete IPTf uptake. No severe adverse events were reported. Only six individuals reported mild adverse events, such as loss of energy, fever, abdominal pain, diarrhoea, and muscle aches. Two individuals attributed their symptoms to heavy alcohol intake following prophylaxis.

Conclusions: The targeted malaria outbreak response demonstrated high acceptability, safety, and feasibility of the selected interventions. Malaria transmission was rapidly controlled using the available community resources. This experience suggests the effectiveness of the programmatic response for future outbreaks.

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来源期刊
Tropical Medicine and Health
Tropical Medicine and Health TROPICAL MEDICINE-
CiteScore
7.00
自引率
2.20%
发文量
90
审稿时长
11 weeks
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