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首页> 外文期刊>PLOS Neglected Tropical Diseases >Predicted Impact of Mass Drug Administration on the Development of Protective Immunity against Schistosoma haematobium
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Predicted Impact of Mass Drug Administration on the Development of Protective Immunity against Schistosoma haematobium

机译：预期的大规模药物管理对血吸虫血吸虫保护性免疫发展的影响

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Previous studies suggest that protective immunity against Schistosoma haematobium is primarily stimulated by antigens from dying worms. Praziquantel treatment kills adult worms, boosting antigen exposure and protective antibody levels. Current schistosomiasis control efforts use repeated mass drug administration (MDA) of praziquantel to reduce morbidity, and may also reduce transmission. The long-term impact of MDA upon protective immunity, and subsequent effects on infection dynamics, are not known. A stochastic individual-based model describing levels of S. haematobium worm burden, egg output and protective parasite-specific antibody, which has previously been fitted to cross-sectional and short-term post-treatment egg count and antibody patterns, was used to predict dynamics of measured egg output and antibody during and after a 5-year MDA campaign. Different treatment schedules based on current World Health Organisation recommendations as well as different assumptions about reductions in transmission were investigated. We found that antibody levels were initially boosted by MDA, but declined below pre-intervention levels during or after MDA if protective immunity was short-lived. Following cessation of MDA, our models predicted that measured egg counts could sometimes overshoot pre-intervention levels, even if MDA had had no effect on transmission. With no reduction in transmission, this overshoot occurred if protective immunity was short-lived. This implies that disease burden may temporarily increase following discontinuation of treatment, even in the absence of any reduction in the overall transmission rate. If MDA was additionally assumed to reduce transmission, a larger overshoot was seen across a wide range of parameter combinations, including those with longer-lived protective immunity. MDA may reduce population levels of immunity to urogenital schistosomiasis in the long-term (3–10 years), particularly if transmission is reduced. If MDA is stopped while S. haematobium is still being transmitted, large rebounds (up to a doubling) in egg counts could occur.
机译：先前的研究表明，针对血吸虫血吸虫的保护性免疫主要是由垂死蠕虫的抗原刺激的。吡喹酮治疗杀死成虫，增加抗原暴露和保护性抗体水平。当前的血吸虫病控制工作使用吡喹酮的反复大规模药物管理（MDA）来降低发病率，还可能减少传播。 MDA对保护性免疫的长期影响以及对感染动态的后续影响尚不清楚。基于随机个体的模型来描述沙门氏菌的蠕虫负荷，卵产量和保护性寄生虫特异性抗体的水平，该模型先前已适应于横截面和短期治疗后的卵数和抗体模式，用于预测5年MDA运动期间和之后测得的卵产量和抗体的动态变化。根据世界卫生组织当前的建议，对不同的治疗方案以及减少传播的不同假设进行了调查。我们发现抗体水平最初是由MDA增强的，但如果保护性免疫是短暂的，则在MDA期间或之后降至干预前水平以下。在MDA停止后，我们的模型预测，即使MDA对传播没有影响，测得的卵数有时仍可能超过干预前的水平。在不降低传输的情况下，如果保护性免疫力很短，则会发生超调。这意味着即使不降低总传播率，疾病的负担也可能在治疗中断后暂时增加。如果另外假设使用MDA来减少传输，则在各种参数组合（包括具有较长保护性免疫的参数组合）中都会看到较大的过冲。长期（3-10年），MDA可能会降低人群对泌尿生殖道血吸虫病的免疫力，特别是如果传播减少。如果在尚在传播沙门氏菌的情况下停止MDA，则鸡蛋计数可能会出现较大的反弹（最多翻倍）。

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