Mass drug administration (MDA) program of albendazole to at-risk populations as preventive chemotherapy is the core public health intervention to control soil-transmitted helminths (STHs). Achieving this goal relies on drug effectiveness in reducing the parasite reservoirs in the community and preventing reinfection. We assessed the efficacy of albendazole against STH parasite infection and reinfection status after cure. A total of 984 schoolchildren infected with at least one type of STH parasite (hookworm, Ascaris lumbricoides, Trichuris trichiura) in southern Ethiopia were enrolled and received albendazole and praziquantel in MDA campaign conducted from January to March 2019. Stool exams at week-4 and at week-8 of post-MDA were done using Kato Katz technique. The primary outcome was efficacy assessed by cure rate (CR) and fecal egg reduction rates (ERRs) at four weeks of post-MDA. The secondary outcome was reinfection status defined as parasite egg positivity at eight weeks among those who were cured at 4 weeks of post-MDA. Group comparisons in CR and related factors were assessed with chi-square or Fisher’s exact tests. Predictors of CR were examined through univariate and multivariate regression analyses. The overall CR and ERR for hookworm infection were 97.2% (95% CI 94.6–99.4) and 97.02%, respectively. The overall CR and ERR for A. lumbricoides were 71.5% (95% CI 68.3–74.6) and 84.5% respectively. The overall CR and ERR and for T. trichiura were 49.5% (95% CI 44.8–54.2) and 68.3%, respectively. The CR among moderate T. trichiura infection intensity was 28.6%. Among children cured of hookworm, A. lumbricoides and T. trichiura at week 4 post-MDA, 4.6%, 18.3% and 52.4% became reinfected at week-8 post-MDA, respectively. Significantly lower CR (36.6%) and higher reinfection after cure (60.6%) among A. lumbricoides and T. trichiura coinfected children than A. lumbricoides only (CR = 69.6%, reinfection rate = 15.1%) or T. trichiura only infected children (CR = 55.6%, reinfection rate = 47.1%) was observed. Pre-treatment coinfection with ≥ two types of STH parasites was significantly associated with re-infection after cure. Albendazole MDA is efficacious against hookworm but has reduced efficacy against A. lumbricoides and is not effective against T. trichiura. The low drug efficacy and high reinfection rate after cure underscore the need for alternative treatment and integration of other preventive measures to achieve the target of eliminating STHs as a public health problem by 2030.

中文翻译：

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单剂量阿苯达唑对蛔虫和毛虫的疗效降低，埃塞俄比亚南部学童治愈后再感染率较高：一项前瞻性队列研究

对高危人群进行阿苯达唑大规模药物管理（MDA）计划作为预防性化疗是控制土源性蠕虫（STH）的核心公共卫生干预措施。实现这一目标取决于药物在减少社区寄生虫储存库和防止再次感染方面的有效性。我们评估了阿苯达唑对 STH 寄生虫感染的疗效以及治愈后的再感染状态。2019 年 1 月至 3 月开展的 MDA 运动中，埃塞俄比亚南部共有 984 名感染至少一种 STH 寄生虫（钩虫、蛔虫、鞭毛虫）的学童入组并接受了阿苯达唑和吡喹酮治疗。第 4 周和第 4 周进行了粪便检查。 MDA 后第 8 周使用 Kato Katz 技术完成。主要结局是通过 MDA 后 4 周的治愈率 (CR) 和粪卵减少率 (ERR) 评估疗效。次要结果是在 MDA 后 4 周治愈的患者中，再感染状态定义为 8 周时寄生虫卵呈阳性。CR 和相关因素的组间比较通过卡方检验或 Fisher 精确检验进行评估。通过单变量和多变量回归分析检查 CR 的预测因子。钩虫感染的总体 CR 和 ERR 分别为 97.2% (95% CI 94.6–99.4) 和 97.02%。蚓螈的总体 CR 和 ERR 分别为 71.5% (95% CI 68.3–74.6) 和 84.5%。T. trichiura 的总体 CR 和 ERR 分别为 49.5% (95% CI 44.8–54.2) 和 68.3%。中度毛虫感染强度的 CR 为 28.6%。在 MDA 后第 4 周治愈钩虫、蚓状线虫和毛线虫的儿童中，分别有 4.6%、18.3% 和 52.4% 在 MDA 后第 8 周再次感染。与仅感染蚓螈（CR = 69.6%，再感染率 = 15.1%）或仅感染鞭毛虫的儿童相比，蛔虫和毛虫合并感染的儿童的 CR（36.6%）显着较低（36.6%），治愈后再感染率较高（60.6%）。观察到（CR = 55.6%，再感染率 = 47.1%）。治疗前同时感染≥两种类型的STH寄生虫与治愈后的再次感染显着相关。阿苯达唑 MDA 对钩虫有效，但对线虫的效力降低，对毛毛虫无效。低药效和治愈后高再感染率强调需要替代治疗和整合其他预防措施，以实现到 2030 年消除 STH 作为公共卫生问题的目标。