The hygiene hypothesis is thought to be a significant contributor to the growing incidence of inflammatory bowel disease (IBD) around the world, although the evidence for specific factors that underlie the hygiene hyp...The hygiene hypothesis is thought to be a significant contributor to the growing incidence of inflammatory bowel disease (IBD) around the world, although the evidence for specific factors that underlie the hygiene hypothesis in IBD is unclear. We aimed to systematically review the literature to determine which hygiene-related factors are associated with the development of IBD. Publications identified from a broad based MEDLINE and Current Contents search between 1966 and 2007 on key terms relevant to the 'hygiene hypothesis' and IBD including H pylori exposure, helminths, cold chain hypothesis, measles infection and vaccination, antibiotic use, breastfeeding, family size, sibship, urban upbringing, day care attendance and domestic hygiene were reviewed. The literature suggests that the hygiene hypothesis and its association with decreased microbial exposure in childhood probably plays an important role in the development of IBD, although the strength of the supporting data for each of the factors varies considerably. The most promising factors that may potentially be associated with development of IBD include H pylori exposure, helminths, breastfeeding and sibship. However, the vast majority of studies in this area are plagued by serious methodological shortcomings, particularly the reliance on retrospective recall of information making it difficult to truly ascertain the importance of a 'hygiene hypothesis' in IBD. The 'hygiene hypothesis' in IBD is an important area of research that may give clues to the aetiology of this disease. Directions for future research are recommended.展开更多
Evidence from epidemiological studies indicates an inverse correlation between the incidence of certain immune-mediated diseases, including inflammatory bowel diseases (IBD), and exposure to helminths. Helminth parasi...Evidence from epidemiological studies indicates an inverse correlation between the incidence of certain immune-mediated diseases, including inflammatory bowel diseases (IBD), and exposure to helminths. Helminth parasites are the classic inducers of Th2 responses. The Th2-polarized T cell response driven by helminth infection has been linked to the attenuation of some damaging Th1 driven inflammatory responses, preventing some Th1-mediated autoimmune diseases in the host, including experimentally induced colitis. Helminth parasites (the porcine whipworm, Trichuris suis ) have been tested for treating IBD patients, resulting in clinical amelioration of the disease. As a result, there is a great deal of interest in the research community in exploring the therapeutic use of helminth parasites for the control of immune-mediated diseases, including IBD. However, recent studies have provided evidence indicating the exacerbating effects of helminths on bacterial as well as non-infectious colitis in animal models. Therefore, a better understanding of mechanisms by which helminths modulate host immune responses in the gut may reveal novel, more effective and safer approaches to helminth-based therapy of IBD.展开更多
Background Current soil-transmitted helminth(STH)control guidelines endorse the use of albendazole or meben-dazole for school-based targeted preventive chemotherapy(PC),yet their reduced efficacy against Strongyloides...Background Current soil-transmitted helminth(STH)control guidelines endorse the use of albendazole or meben-dazole for school-based targeted preventive chemotherapy(PC),yet their reduced efficacy against Strongyloides sterc-oralis 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.Methods 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 infec-tions,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).Results 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 ivermec-tin 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(I^(2)>65%).Conclusions 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 inter-national STH guidelines to include ivermectin is a promising option to progress the 展开更多
The Millennium Development Goals(MDGs)made a marked transformation for neglected and vulnerable communities in the developing countries from the start,but infectious diseases of poverty(IDoPs)continue to inflict a dis...The Millennium Development Goals(MDGs)made a marked transformation for neglected and vulnerable communities in the developing countries from the start,but infectious diseases of poverty(IDoPs)continue to inflict a disproportionate global public health burden with associated consequences,thereby contributing to the vicious cycle of poverty and inequity.However,the effectiveness and large-scale coverage of artemisinin combination therapy(ACT)have revolutionized malaria treatment just as the control of lymphatic filariasis(LF)and onchocerciasis have benefitted from harnessing the broad-spectrum effect of avermectin-based derivatives.The paradigm shift in therapeutic approach,effected by these two drugs and their impact on community-based interventions of parasitic diseases plaguing the endemic low-and middle-income countries(LIMCs),led to the Nobel Prize in Physiology or Medicine in 2015.However,the story would not be complete without mentioning praziquantel.The huge contribution of this drug in modernizing the control of schistosomiasis and also some intestinal helminth infections had already shifted the focus from control to potential elimination of this disease.Together,these new drugs have provided humankind with powerful new tools for the alleviation of infectious diseases that humans have lived with since time immemorial.These drugs all have broad-spectrum effects,yet they are very safe and can even be packaged together in various combinations.The strong effect on so many of the great infectious scourges in the developing countries has not only had a remarkable influence on many endemic diseases,but also contributed to improving the cost structure of healthcare.Significant benefits include improved quality of preventive and curative medicine,promotion of community-based interventions,universal health coverage and the fostering of global partnerships.The laudable progress and benefits achieved are indispensable in championing,strengthening and moving forward elimination of the IDoPs.However,there is an urgent n展开更多
Background Mass drug administration(MDA)program of albendazole to at-risk populations as preventive chemo-therapy is the core public health intervention to control soil-transmitted helminths(STHs).Achieving this goal ...Background Mass drug administration(MDA)program of albendazole to at-risk populations as preventive chemo-therapy 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 effcacy of albendazole against STH parasite infection and reinfection status after cure.Methods A total of 984 schoolchildren infected with at least one type of STH parasite(hookworm,Ascaris lumbri-coides,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 effcacy 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 multi-variate regression analyses.Results 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 infec-tion 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 展开更多
Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these c...Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between 展开更多
Objective:To assess the epidemiology of urinary schistosomiasis and soil-transmitted helminthiasis among women of reproductive age in Mwaluphamba,Kwale County,Kenya.Methods:A community-based cross-sectional study desi...Objective:To assess the epidemiology of urinary schistosomiasis and soil-transmitted helminthiasis among women of reproductive age in Mwaluphamba,Kwale County,Kenya.Methods:A community-based cross-sectional study design was employed to randomly sample 422 women of reproductive age(15-<50 years)from four villages in Mwaluphamba location.Stool specimens were collected and examined using the Kato-Katz method,while filtration technique was used to analyze urine specimens.Participants’sociodemographic details were obtained using a standardized questionnaire.Results:Urinary schistosomiasis prevalence was at 4.7%(20/422,95%CI 2.8%-6.9%)while the prevalence of soil-transmitted helminthiasis infection was 4.5%(19/422,95%CI 2.6%-6.7%).The infection intensities of urinary schistosomiasis among the study participants ranged from 1 to 120 eggs/10 mL of urine with median egg count of 18.45 eggs/10 mL.The patients were diagnosed with light infection,of 56.16 egg/gram and 48.48 egg/gram for Trichuris trichiura and hookworms,respectively.Women without latrines had 15.7 times higher risk of having urinary schistosomiasis compared to those with a latrine.Similarly,use of surface water(aOR=1.0,95%CI 0.2-1.4,P=0.010)and crossing the river to go to a place(aOR=1.1,95%CI 0.3-1.6,P=0.009)were statistically significant risk factors for getting urinary schistosomiasis.In bivariable regression analysis,defecating around the water source(OR=4.3,95%CI 1.5-12.9)had a statistically significant association with the prevalence of soil-transmitted helminthiasis(P=0.008).Conclusions:This study has given an insight on the prevalence and intensity of urinary schistosomiasis and soil-transmitted helminthiasis in Mwaluphamba location that form a basis for strengthening the control and elimination programmes for these neglected tropical diseases.展开更多
Soil-transmitted helminth(STH)infections continue to be the most prevalent of the 20 neglected tropical diseases,affecting nearly a quarter of the world’s population and causing approximately 2.54 million disability-...Soil-transmitted helminth(STH)infections continue to be the most prevalent of the 20 neglected tropical diseases,affecting nearly a quarter of the world’s population and causing approximately 2.54 million disability-adjusted life years.1,2 Ascaris lumbricoides,Trichuris trichiuria,and multiple species of hookworms(ie,Ancylostoma duodenale,Necator americanus and Ancylostoma ceylanicum)are known to cause significant infections in humans.Approximately 70%of the infections are reportedly occurring in Asia,where nearly a quarter of the population is infected with at least one STHspecies.3,4 Infections are particularly deleterious among school-and preschool-aged children,women of reproductive age and immunocompromised populations.Impaired cognitive and motor development,stunting,malnutrition and other potentially life-long sequelae are the known adverse health effects of STH infections in children.5–7 Hence,control and elimination efforts have been directed at addressing the prevalence and burden of infections among at-risk populations.展开更多
Background Soil-transmitted helminths(STHs)were previously endemic in Shandong Province,China.This study aimed to analyze the STHs prevalence trend and the natural,social,and human cognitive and behavioural factors in...Background Soil-transmitted helminths(STHs)were previously endemic in Shandong Province,China.This study aimed to analyze the STHs prevalence trend and the natural,social,and human cognitive and behavioural factors infuencing the discrepancies between high and low infection levels from 2016 to 2020 in Shandong Province in eastern China.Methods STHs surveillance data of Shandong Province from 2016 to 2020 were obtained from China Information Management System for Prevention and Control of Parasitic Diseases.STHs infections were detected by modifed Kato–Katz method.Comprehensive information on the natural and social factors,STHs-related knowledge and behaviours were collected through questionnaire surveys.Retrospective spatial scan analysis was performed using SaTScan v10.1 to evaluate any identifed spatial clusters of STHs infection for statistical signifcance and Bayes discriminant analysis was used to discriminate the high or low infection groups of the villages.Results In total,72,160 participants were involved in our survey from 2016 to 2020.The overall STHs prevalence rate was 1.13%,with the eastern region of Shandong Province having the highest rate(2.02%).The predominant species was T.trichiura,with the prevalence rate of 0.99%and the≥70-year age group possessed the highest rate of 2.21%.The STHs prevalence rate showed an annual linear downward trend from 2016 to 2020(χ_(trend)^(2) =127.600,P<0.001).Respondents aged≥60 years had the lowest awareness level of STHs-related prevention knowledge(all P<0.05),and were the most likely to adopt the practice of fertilizing with fresh stool(χ^(2)=28.354,P<0.001).Furthermore,the southern region demonstrated the highest temperature and rainfall level and the lowest GNP and annual net income per capita(all P<0.05).Conclusions There is a remarkable declining in STHs prevalence in Shandong Province from 2016 to 2020.However,the prevalence rates of STHs especially T.trichiura in the southern and eastern regions were still high,and the elderly were more susceptible 展开更多
Background:With more than two billion people infected worldwide,soil-transmitted helminths(STH)are the most widespread infections.To date,STH control efforts rely predominantly on recurrent mass drug administration(MD...Background:With more than two billion people infected worldwide,soil-transmitted helminths(STH)are the most widespread infections.To date,STH control efforts rely predominantly on recurrent mass drug administration(MDA),which does not prevent reinfection.Additional public health measures including novel health educational tools are required for more sustained integrated control of STH.We describe the development of an educational cartoon video(The Magic Glasses)targeting STH infections in Chinese schoolchildren and its pilot testing in China.We applied an extensive community-based mixed methods approach involving input from the target group of 9–10 year old schoolchildren and key informants,such as teachers,doctors and parents,in order to identify potential STH infection risks in the study area and to formulate key messages for the cartoon.The development of the educational cartoon included three major steps:formative research,production,and pilot testing and revision.Results:We found that most adults and approximately 50%of the schoolchildren were aware of roundworm(Ascaris)infection,but knowledge of transmission,prevention and treatment of STH was poor.Observations in the study area showed that unhygienic food practices,such as eating raw and unwashed fruit or playing in vegetable gardens previously fertilised with human faeces,posed major STH infection risks.Conclusions:It was crucial to assess the intellectual,emotional,social and cultural background of the target population prior to video production in order to integrate the key messages of the cartoon into everyday situations.Overall,our strategy for the development of the cartoon and its incorporation into a health education package proved successful,and we provide a summary of recommendations for the development of future educational videos based on our experiences in China.展开更多
Background:Given the restricted distribution of Schistosoma mekongi in one province in Lao People’s Democratic Republic(Lao PDR)and two provinces in Cambodia,together with progress of the national control programmes ...Background:Given the restricted distribution of Schistosoma mekongi in one province in Lao People’s Democratic Republic(Lao PDR)and two provinces in Cambodia,together with progress of the national control programmes aimed at reducing morbidity and infection prevalence,the elimination of schistosomiasis mekongi seems feasible.However,sensitive diagnostic tools will be required to determine whether elimination has been achieved.We compared several standard and novel diagnostic tools in S.mekongi-endemic areas.Methods:The prevalence and infection intensity of S.mekongi were evaluated in 377 study participants from four villages in the endemic areas in Lao PDR and Cambodia using Kato-Katz stool examination,antibody detection based on an enzyme-linked immunosorbent assay(ELISA)and schistosome circulating antigen detection by lateral-flow tests.Two highly sensitive test systems for the detection of cathodic and anodic circulating antigens(CCA,CAA)in urine and serum were utilized.Results:Stool microscopy revealed an overall prevalence of S.mekongi of 6.4%(one case in Cambodia and 23 cases in Lao PDR),while that of Opisthorchis viverrini,hookworm,Trichuris trichiura,Ascaris lumbricoides and Taenia spp.were 50.4%,28.1%,3.5%,0.3%and 1.9%,respectively.In the urine samples,the tests for CCA and CAA detected S.mekongi infections in 21.0%and 38.7%of the study participants,respectively.In the serum samples,the CAA assay revealed a prevalence of 32.4%,while a combination of the CAA assay in serum and in urine revealed a prevalence of 43.2%.There was a difference between the two study locations with a higher prevalence reached in the samples from Lao PDR.Conclusions:The CCA,CAA and ELISA results showed substantially higher prevalence estimates for S.mekongi compared to Kato-Katz thick smears.Active schistosomiasis mekongi in Lao PDR and Cambodia might thus have been considerably underestimated previously.Hence,sustained control efforts are still needed to break transmission of S.mekongi.The pivotal role of highly sensitive diag展开更多
文摘The hygiene hypothesis is thought to be a significant contributor to the growing incidence of inflammatory bowel disease (IBD) around the world, although the evidence for specific factors that underlie the hygiene hypothesis in IBD is unclear. We aimed to systematically review the literature to determine which hygiene-related factors are associated with the development of IBD. Publications identified from a broad based MEDLINE and Current Contents search between 1966 and 2007 on key terms relevant to the 'hygiene hypothesis' and IBD including H pylori exposure, helminths, cold chain hypothesis, measles infection and vaccination, antibiotic use, breastfeeding, family size, sibship, urban upbringing, day care attendance and domestic hygiene were reviewed. The literature suggests that the hygiene hypothesis and its association with decreased microbial exposure in childhood probably plays an important role in the development of IBD, although the strength of the supporting data for each of the factors varies considerably. The most promising factors that may potentially be associated with development of IBD include H pylori exposure, helminths, breastfeeding and sibship. However, the vast majority of studies in this area are plagued by serious methodological shortcomings, particularly the reliance on retrospective recall of information making it difficult to truly ascertain the importance of a 'hygiene hypothesis' in IBD. The 'hygiene hypothesis' in IBD is an important area of research that may give clues to the aetiology of this disease. Directions for future research are recommended.
基金Grant DK 074727 (R21) from the National Institutes of HealthAn unrestricted educational grant from Wyeth NutritionA research fellowship from the Research Center for High Altitude Medicine, Qinghai University Medical School, China
文摘Evidence from epidemiological studies indicates an inverse correlation between the incidence of certain immune-mediated diseases, including inflammatory bowel diseases (IBD), and exposure to helminths. Helminth parasites are the classic inducers of Th2 responses. The Th2-polarized T cell response driven by helminth infection has been linked to the attenuation of some damaging Th1 driven inflammatory responses, preventing some Th1-mediated autoimmune diseases in the host, including experimentally induced colitis. Helminth parasites (the porcine whipworm, Trichuris suis ) have been tested for treating IBD patients, resulting in clinical amelioration of the disease. As a result, there is a great deal of interest in the research community in exploring the therapeutic use of helminth parasites for the control of immune-mediated diseases, including IBD. However, recent studies have provided evidence indicating the exacerbating effects of helminths on bacterial as well as non-infectious colitis in animal models. Therefore, a better understanding of mechanisms by which helminths modulate host immune responses in the gut may reveal novel, more effective and safer approaches to helminth-based therapy of IBD.
文摘Background Current soil-transmitted helminth(STH)control guidelines endorse the use of albendazole or meben-dazole for school-based targeted preventive chemotherapy(PC),yet their reduced efficacy against Strongyloides sterc-oralis 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.Methods 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 infec-tions,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).Results 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 ivermec-tin 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(I^(2)>65%).Conclusions 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 inter-national STH guidelines to include ivermectin is a promising option to progress the
基金We are grateful of the funding support received from National Institute of Parasitic Diseases,China,Chinese Center for Disease and Control and Prevention,Shanghai on this project,through China-UK Global Health Support Programme(GHSP OP302).
文摘The Millennium Development Goals(MDGs)made a marked transformation for neglected and vulnerable communities in the developing countries from the start,but infectious diseases of poverty(IDoPs)continue to inflict a disproportionate global public health burden with associated consequences,thereby contributing to the vicious cycle of poverty and inequity.However,the effectiveness and large-scale coverage of artemisinin combination therapy(ACT)have revolutionized malaria treatment just as the control of lymphatic filariasis(LF)and onchocerciasis have benefitted from harnessing the broad-spectrum effect of avermectin-based derivatives.The paradigm shift in therapeutic approach,effected by these two drugs and their impact on community-based interventions of parasitic diseases plaguing the endemic low-and middle-income countries(LIMCs),led to the Nobel Prize in Physiology or Medicine in 2015.However,the story would not be complete without mentioning praziquantel.The huge contribution of this drug in modernizing the control of schistosomiasis and also some intestinal helminth infections had already shifted the focus from control to potential elimination of this disease.Together,these new drugs have provided humankind with powerful new tools for the alleviation of infectious diseases that humans have lived with since time immemorial.These drugs all have broad-spectrum effects,yet they are very safe and can even be packaged together in various combinations.The strong effect on so many of the great infectious scourges in the developing countries has not only had a remarkable influence on many endemic diseases,but also contributed to improving the cost structure of healthcare.Significant benefits include improved quality of preventive and curative medicine,promotion of community-based interventions,universal health coverage and the fostering of global partnerships.The laudable progress and benefits achieved are indispensable in championing,strengthening and moving forward elimination of the IDoPs.However,there is an urgent n
文摘Background Mass drug administration(MDA)program of albendazole to at-risk populations as preventive chemo-therapy 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 effcacy of albendazole against STH parasite infection and reinfection status after cure.Methods A total of 984 schoolchildren infected with at least one type of STH parasite(hookworm,Ascaris lumbri-coides,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 effcacy 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 multi-variate regression analyses.Results 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 infec-tion 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
文摘Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between
文摘Objective:To assess the epidemiology of urinary schistosomiasis and soil-transmitted helminthiasis among women of reproductive age in Mwaluphamba,Kwale County,Kenya.Methods:A community-based cross-sectional study design was employed to randomly sample 422 women of reproductive age(15-<50 years)from four villages in Mwaluphamba location.Stool specimens were collected and examined using the Kato-Katz method,while filtration technique was used to analyze urine specimens.Participants’sociodemographic details were obtained using a standardized questionnaire.Results:Urinary schistosomiasis prevalence was at 4.7%(20/422,95%CI 2.8%-6.9%)while the prevalence of soil-transmitted helminthiasis infection was 4.5%(19/422,95%CI 2.6%-6.7%).The infection intensities of urinary schistosomiasis among the study participants ranged from 1 to 120 eggs/10 mL of urine with median egg count of 18.45 eggs/10 mL.The patients were diagnosed with light infection,of 56.16 egg/gram and 48.48 egg/gram for Trichuris trichiura and hookworms,respectively.Women without latrines had 15.7 times higher risk of having urinary schistosomiasis compared to those with a latrine.Similarly,use of surface water(aOR=1.0,95%CI 0.2-1.4,P=0.010)and crossing the river to go to a place(aOR=1.1,95%CI 0.3-1.6,P=0.009)were statistically significant risk factors for getting urinary schistosomiasis.In bivariable regression analysis,defecating around the water source(OR=4.3,95%CI 1.5-12.9)had a statistically significant association with the prevalence of soil-transmitted helminthiasis(P=0.008).Conclusions:This study has given an insight on the prevalence and intensity of urinary schistosomiasis and soil-transmitted helminthiasis in Mwaluphamba location that form a basis for strengthening the control and elimination programmes for these neglected tropical diseases.
文摘Soil-transmitted helminth(STH)infections continue to be the most prevalent of the 20 neglected tropical diseases,affecting nearly a quarter of the world’s population and causing approximately 2.54 million disability-adjusted life years.1,2 Ascaris lumbricoides,Trichuris trichiuria,and multiple species of hookworms(ie,Ancylostoma duodenale,Necator americanus and Ancylostoma ceylanicum)are known to cause significant infections in humans.Approximately 70%of the infections are reportedly occurring in Asia,where nearly a quarter of the population is infected with at least one STHspecies.3,4 Infections are particularly deleterious among school-and preschool-aged children,women of reproductive age and immunocompromised populations.Impaired cognitive and motor development,stunting,malnutrition and other potentially life-long sequelae are the known adverse health effects of STH infections in children.5–7 Hence,control and elimination efforts have been directed at addressing the prevalence and burden of infections among at-risk populations.
文摘Background Soil-transmitted helminths(STHs)were previously endemic in Shandong Province,China.This study aimed to analyze the STHs prevalence trend and the natural,social,and human cognitive and behavioural factors infuencing the discrepancies between high and low infection levels from 2016 to 2020 in Shandong Province in eastern China.Methods STHs surveillance data of Shandong Province from 2016 to 2020 were obtained from China Information Management System for Prevention and Control of Parasitic Diseases.STHs infections were detected by modifed Kato–Katz method.Comprehensive information on the natural and social factors,STHs-related knowledge and behaviours were collected through questionnaire surveys.Retrospective spatial scan analysis was performed using SaTScan v10.1 to evaluate any identifed spatial clusters of STHs infection for statistical signifcance and Bayes discriminant analysis was used to discriminate the high or low infection groups of the villages.Results In total,72,160 participants were involved in our survey from 2016 to 2020.The overall STHs prevalence rate was 1.13%,with the eastern region of Shandong Province having the highest rate(2.02%).The predominant species was T.trichiura,with the prevalence rate of 0.99%and the≥70-year age group possessed the highest rate of 2.21%.The STHs prevalence rate showed an annual linear downward trend from 2016 to 2020(χ_(trend)^(2) =127.600,P<0.001).Respondents aged≥60 years had the lowest awareness level of STHs-related prevention knowledge(all P<0.05),and were the most likely to adopt the practice of fertilizing with fresh stool(χ^(2)=28.354,P<0.001).Furthermore,the southern region demonstrated the highest temperature and rainfall level and the lowest GNP and annual net income per capita(all P<0.05).Conclusions There is a remarkable declining in STHs prevalence in Shandong Province from 2016 to 2020.However,the prevalence rates of STHs especially T.trichiura in the southern and eastern regions were still high,and the elderly were more susceptible
文摘Background:With more than two billion people infected worldwide,soil-transmitted helminths(STH)are the most widespread infections.To date,STH control efforts rely predominantly on recurrent mass drug administration(MDA),which does not prevent reinfection.Additional public health measures including novel health educational tools are required for more sustained integrated control of STH.We describe the development of an educational cartoon video(The Magic Glasses)targeting STH infections in Chinese schoolchildren and its pilot testing in China.We applied an extensive community-based mixed methods approach involving input from the target group of 9–10 year old schoolchildren and key informants,such as teachers,doctors and parents,in order to identify potential STH infection risks in the study area and to formulate key messages for the cartoon.The development of the educational cartoon included three major steps:formative research,production,and pilot testing and revision.Results:We found that most adults and approximately 50%of the schoolchildren were aware of roundworm(Ascaris)infection,but knowledge of transmission,prevention and treatment of STH was poor.Observations in the study area showed that unhygienic food practices,such as eating raw and unwashed fruit or playing in vegetable gardens previously fertilised with human faeces,posed major STH infection risks.Conclusions:It was crucial to assess the intellectual,emotional,social and cultural background of the target population prior to video production in order to integrate the key messages of the cartoon into everyday situations.Overall,our strategy for the development of the cartoon and its incorporation into a health education package proved successful,and we provide a summary of recommendations for the development of future educational videos based on our experiences in China.
基金We are grateful to financial support of the Task Force for Global Health,Neglected Tropical Diseases Support Centre,the Department of Parasitology,Leiden University Medical Center and the Swiss Tropical and Public Health Institute.
文摘Background:Given the restricted distribution of Schistosoma mekongi in one province in Lao People’s Democratic Republic(Lao PDR)and two provinces in Cambodia,together with progress of the national control programmes aimed at reducing morbidity and infection prevalence,the elimination of schistosomiasis mekongi seems feasible.However,sensitive diagnostic tools will be required to determine whether elimination has been achieved.We compared several standard and novel diagnostic tools in S.mekongi-endemic areas.Methods:The prevalence and infection intensity of S.mekongi were evaluated in 377 study participants from four villages in the endemic areas in Lao PDR and Cambodia using Kato-Katz stool examination,antibody detection based on an enzyme-linked immunosorbent assay(ELISA)and schistosome circulating antigen detection by lateral-flow tests.Two highly sensitive test systems for the detection of cathodic and anodic circulating antigens(CCA,CAA)in urine and serum were utilized.Results:Stool microscopy revealed an overall prevalence of S.mekongi of 6.4%(one case in Cambodia and 23 cases in Lao PDR),while that of Opisthorchis viverrini,hookworm,Trichuris trichiura,Ascaris lumbricoides and Taenia spp.were 50.4%,28.1%,3.5%,0.3%and 1.9%,respectively.In the urine samples,the tests for CCA and CAA detected S.mekongi infections in 21.0%and 38.7%of the study participants,respectively.In the serum samples,the CAA assay revealed a prevalence of 32.4%,while a combination of the CAA assay in serum and in urine revealed a prevalence of 43.2%.There was a difference between the two study locations with a higher prevalence reached in the samples from Lao PDR.Conclusions:The CCA,CAA and ELISA results showed substantially higher prevalence estimates for S.mekongi compared to Kato-Katz thick smears.Active schistosomiasis mekongi in Lao PDR and Cambodia might thus have been considerably underestimated previously.Hence,sustained control efforts are still needed to break transmission of S.mekongi.The pivotal role of highly sensitive diag
