Q1。请您解释一下伊维菌素如何减少疟疾传播？

A few years ago, the New York Times ran a piece about this concept and entitled it: “Human Swallows Pill. Mosquito Bites Human. Mosquito Dies”.伊维菌素因其在与河盲和象症的斗争中的巨大成功而受到认可，但很少有人知道它也杀死了蚊子以吸收的蚊子。

Female mosquitoes bite because they need the proteins in the blood to produce eggs. If enough people in an area take ivermectin, this could result in massive mortality of the mosquito population. Fewer mosquitos usually equal less malaria.

There is however more complexity as ivermectin can also affect mosquito behaviour and fertility, expanding the impact beyond what could be expected based on mortality alone. All is tightly associated with the time the drug remains in the blood above a certain “mosquito-killing” threshold.

Q2. Don’t we have insecticides that kill mosquitoes already? Why would ivermectin be needed?

Insecticides do not impede evolution. Our current anti-mosquito interventions are mostly used within the home Treated bednets and Indoor Residual Spraying have had enormous success in reducing malaria deaths. This has however put selective pressure on mosquitoes and led to increase biting in areas or times not protected by these measures remarkably outdoors. This behavioural adaptation allows mosquitoes to forage on humans and avoid insecticides.

这种药物杀死了咬人的蚊子。如果在社区层面适当地使用，那么在某个地区，大量喂食蚊子将独立于时间或咬人地点死亡。

Q3. How widespread is the use of ivermectin?

为了目前在被忽视的热带疾病中的迹象，在过去30年中分配了超过25亿剂的剂量。2015年约有2亿美元。目前不用于疟疾。

Q4。您已经广泛审查了伊维菌素的使用，请总结您的发现吗？

伊维菌素应设想为complementarytool, not as a stand alone measure.

Ivermectin kills all malaria vectors against it has been tested, although there can be differences in susceptibility between species. The lethal effect is quick, most mosquitoes die within a few days of imbibing ivermectin containing-blood. The mosquito mortality is directly related to the amount of drug in the blood at the time of biting. To maximize impact against malaria, two factors will be key (a) the treatment scheme used and (b) the proportion of the population that is treated.

伊维菌素应设想为complementarytool, not as a stand alone measure.

Q5. What are your recommendations for the future use of ivermectin?

…data from the field is what will drive ultimate decisions.

Our recommendation is that the right data needs to be collected to allow WHO and countries to decide how such a drug would be used by communities, where it would best be deployed, and the overall risk-benefit. While it is a potential valuable addition to the malaria toolbox, data from the field is what will drive ultimate decisions.