Current soil-transmitted helminth (STH) control guidelines endorse the use of albendazole or mebendazole for school-based targeted preventive chemotherapy (PC), yet their reduced efficacy against Strongyloides stercoralis and Trichuris trichiura presents significant limitations. Emerging evidence indicates that community-wide PC [or mass drug administration (MDA)] using ivermectin, commonly used in other neglected tropical disease (NTD) control programs, may play an important role in controlling these parasites. We conducted a systematic review and meta-analysis to evaluate the effectiveness of ivermectin PC in reducing STH prevalence in endemic populations. We searched Pubmed, EMBASE, and Web of Science on February 14, 2023, for studies that investigated the effectiveness of ivermectin PC, either alone or in combination with other anthelmintic drugs, on STH infections, and provided a measure of STH prevalence before and after PC. We calculated pooled prevalence reductions for each STH using random-effects meta-analyses. Our protocol is available on PROSPERO (registration number CRD42023401219). A total of 21 were eligible for the systematic review, of which 15 were eligible for meta-analysis. All studies delivered ivermectin through MDA. The pooled prevalence reduction of S. stercoralis following MDA with ivermectin alone was 84.49% (95% CI 54.96–94.66) across five studies and 81.37% (95% CI 61.62–90.96) across seven studies with or without albendazole. The prevalence reduction of T. trichiura was 49.93% (95% CI 18.23–69.34) across five studies with ivermectin alone, and 89.40% (95% CI 73.66–95.73) across three studies with the addition of albendazole. There was high heterogeneity for all syntheses (I2 > 65%). This study underscores the key role of ivermectin-based MDA in addressing limitations in current global STH guidelines in terms of limited efficacy against S. stercoralis and T. trichiura. Based on these findings, revising international STH guidelines to include ivermectin is a promising option to progress the control and eventual elimination of STHs and other NTDs.

中文翻译：

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伊维菌素大规模给药在控制流行人群土源性蠕虫感染中的有效性：系统评价和荟萃分析

目前的土源性蠕虫（STH）控制指南支持使用阿苯达唑或甲苯达唑进行学校针对性预防性化疗（PC），但它们对粪类圆线虫和鞭毛虫的疗效较低，存在很大的局限性。新出现的证据表明，使用伊维菌素进行社区范围的 PC [或大规模药物管理 (MDA)]（常用于其他被忽视的热带病 (NTD) 控制计划）可能在控制这些寄生虫方面发挥重要作用。我们进行了系统回顾和荟萃分析，以评估伊维菌素 PC 在降低流行人群中 STH 患病率方面的有效性。我们于 2023 年 2 月 14 日检索了 Pubmed、EMBASE 和 Web of Science，查找了调查伊维菌素 PC（单独使用或与其他驱虫药联合使用）对 STH 感染的有效性的研究，并提供了治疗前后 STH 患病率的衡量标准个人电脑。我们使用随机效应荟萃分析计算了每种 STH 的汇总患病率降低情况。我们的协议可在 PROSPERO 上使用（注册号 CRD42023401219）。共有 21 项符合系统评价资格，其中 15 项符合荟萃分析资格。所有研究均通过 MDA 递送伊维菌素。在五项研究中，仅使用伊维菌素进行 MDA 后，粪圆线虫的总体患病率降低了 84.49% (95% CI 54.96–94.66)，而在使用或不使用阿苯达唑的七项研究中，粪圆线虫患病率降低了 81.37% (95% CI 61.62–90.96)。在单独使用伊维菌素的五项研究中，毛毛虫的患病率降低了 49.93% (95% CI 18.23–69.34)，而在添加阿苯达唑的三项研究中，毛虫患病率降低了 89.40% (95% CI 73.66–95.73)。所有合成均存在高度异质性 (I2 > 65%)。这项研究强调了基于伊维菌素的 MDA 在解决当前全球 STH 指南中对粪圆线虫和毛毛虫功效有限方面的局限性方面的关键作用。基于这些发现，修订国际 STH 指南以纳入伊维菌素是推进控制和最终消除 STH 和其他 NTD 的一个有希望的选择。