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Qian MB, Keiser J, Utzinger J, Zhou XN. Clonorchiasis and opisthorchiasis: epidemiology, transmission, clinical features, morbidity, diagnosis, treatment, and control. Clin Microbiol Rev 2024; 37:e0000923. [PMID: 38169283 PMCID: PMC10938900 DOI: 10.1128/cmr.00009-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/18/2023] [Indexed: 01/05/2024] Open
Abstract
Clonorchis sinensis, Opisthorchis viverrini, and Opisthorchis felineus are important liver flukes that cause a considerable public health burden in eastern Asia, southeastern Asia, and eastern Europe, respectively. The life cycles are complex, involving humans, animal reservoirs, and two kinds of intermediate hosts. An interplay of biological, cultural, ecological, economic, and social factors drives transmission. Chronic infections are associated with liver and biliary complications, most importantly cholangiocarcinoma. With regard to diagnosis, stool microscopy is widely used in epidemiologic surveys and for individual diagnosis. Immunologic techniques are employed for screening purposes, and molecular techniques facilitate species differentiation in reference laboratories. The mainstay of control is preventive chemotherapy with praziquantel, usually combined with behavioral change through information, education and communication, and environmental control. Tribendimidine, a drug registered in the People's Republic of China for soil-transmitted helminth infections, shows potential against both C. sinensis and O. viverrini and, hence, warrants further clinical development. Novel control approaches include fish vaccine and biological control. Considerable advances have been made using multi-omics which may trigger the development of new interventions. Pressing research needs include mapping the current distribution, disentangling the transmission, accurately estimating the disease burden, and developing new diagnostic and treatment tools, which would aid to optimize control and elimination measures.
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Affiliation(s)
- Men-Bao Qian
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai, People’s Republic of China
- NHC Key Laboratory of Parasite and Vector Biology, Shanghai, People’s Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People’s Republic of China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai, People’s Republic of China
- NHC Key Laboratory of Parasite and Vector Biology, Shanghai, People’s Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People’s Republic of China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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He YT, Huang XH, Fang YY, Zeng QS, Li LD, Luo L, Lai YS. Cost-effectiveness evaluation of different control strategies for Clonorchis sinensis infection in a high endemic area of China: A modelling study. PLoS Negl Trop Dis 2022; 16:e0010429. [PMID: 35605030 PMCID: PMC9166357 DOI: 10.1371/journal.pntd.0010429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/03/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022] Open
Abstract
Clonorchiasis is an important food-borne parasitic disease caused by Clonorchis sinensis infection. The evaluation of long-term cost-effectiveness of control strategies is important for disease control and prevention. The present study aimed to assess the cost-effectiveness of the three recommended strategies (i.e., WHO, Chinese and Guangdong strategies) and different combinations of commonly used measures (i.e., preventive chemotherapy, information, education, and communication (IEC) and environmental improvement) on clonorchiasis. The study area, Fusha town in Guangdong Province, was a typical high endemic area in China. The analysis was based on a multi-group transmission model of C. sinensis infection. We set the intervention duration for 10 years and post-intervention period for 50 years. The corresponding costs and DALYs were estimated. Strategies with incremental cost-effectiveness ratios (ICERs) less than 1/5 of the willingness-to-pay threshold were identified as highly cost-effective strategies. The optimal control strategy was obtained using the next best comparator method. The ICERs of Guangdong strategy were $172 (95% CI: $143-$230) US for praziquantel and $106 (95% CI: $85-$143) US for albendazole, suggesting the highest cost-effectiveness among the three recommended strategies. For praziquantel, 470 sets of control strategies were identified as highly cost-effective strategies for achieving infection control (prevalence<5%). The optimal strategy consisted of chemotherapy targeted on at-risk population, IEC and environmental improvement, with coverages all being 100%, and with the ICER of $202 (95% CI: $168-$271) US. The results for transmission control (prevalence<1%) and albendazole were obtained with the same procedures. The findings may help to develop control policies for C. sinensis infection in high endemic areas. Moreover, the method adopted is applicable for assessment of optimal strategies in other endemic areas. Clonorchiasis, a food-borne trematodiases, affects millions of people in Asia. Highly cost-effective control strategies are critical for its control. Previous studies considering the economic evaluation of control strategies were rare, mostly based on interventions in practical, and not capable of evaluating long-term cost-effectiveness of strategies with possible combinations of control measures or under various coverages. Based on a dynamic, multi-group transmission model, we simulated different control strategies in a high clonorchiasis endemic area, and evaluated their cost-effectiveness. Among the three recommended strategies (i.e., WHO, Chinese and Guangdong strategies), the Guangdong strategy was the most cost-effective. For praziquantel, 470 sets of control strategies were identified as highly cost-effective strategies for achieving infection control (prevalence<5%) among the strategies of possible combinations of the three common measures (i.e., preventive chemotherapy, information, education, and communication (IEC) and environmental modification). The optimal strategy consisted of chemotherapy targeted on at-risk population, IEC and environmental improvement, with coverages all being 100%. The results for transmission control (prevalence<1%) and albendazole were obtained with the same procedures. The numerical results may help to develop control strategies for C. sinensis infection in high endemic areas. The methodology is applicable for other different endemic areas.
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Affiliation(s)
- Yun-Ting He
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xiao-Hong Huang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- Statistics Office of network data information department, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Yue-Yi Fang
- Institute of Parasitic Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province, People’s Republic of China
| | - Qing-Sheng Zeng
- Xinhui District Center for Disease Control and Prevention, Jiangmen City, Guangdong Province, People’s Republic of China
| | - Lai-De Li
- Xinhui District Center for Disease Control and Prevention, Jiangmen City, Guangdong Province, People’s Republic of China
| | - Le Luo
- Zhongshan Center for Disease Control and Prevention, Zhongshan, Guangdong Province, People’s Republic of China
| | - Ying-Si Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- * E-mail:
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Qian MB, Zhou CH, Zhu HH, Chen YD, Zhou XN. Cost yield of different treatment strategies against Clonorchis sinensis infection. Infect Dis Poverty 2021; 10:136. [PMID: 34933693 PMCID: PMC8693485 DOI: 10.1186/s40249-021-00917-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Clonorchiasis is attributed to the ingestion of raw freshwater fish harboring Clonorchis sinensis. Morbidity control is targeted through the administration of antihelminthics. This study modelled the cost yield indicated by effectiveness and utility of different treatment strategies against clonorchiasis. METHODS About 1000 participants were enrolled from each of 14 counties selected from four provincial-level administrative divisions namely Guangxi, Guangdong, Heilongjiang and Jilin in 2017. Fecal examination was adopted to detect C. sinensis infection, while behavior of ingesting raw freshwater fish was enquired. Counties were grouped into four categories based on prevalence, namely low prevalence group (< 1%), moderate prevalence group (1-9.9%), high prevalence group (10-19.9%) and very high prevalence group (≥ 20%), while population were divided into three subgroups, namely children aged below 14 years old, adult female and adult male both aged over 14 years old. The average of cost effectiveness indicated by the cost to treat single infected cases with C. sinensis and of cost utility indicated by the cost to avoid per disability-adjusted life years (DALYs) caused by C. sinensis infection was calculated. Comparisons were performed between three treatment schedules, namely individual treatment, massive and selective chemotherapy, in which different endemic levels and populations were considered. RESULTS In selective chemotherapy strategy, the cost to treat single infected case in very high prevalence group was USD 10.6 in adult male, USD 11.6 in adult female, and USD 13.2 in children. The cost increased followed the decrease of endemic level. In massive chemotherapy strategy, the cost per infected case in very high prevalence group was USD 14.0 in adult male, USD 17.1 in adult female, USD 45.8 in children, which were also increased when the endemic level decreased. In individual treatment strategy, the cost was USD 12.2 in adult male, USD 15.0 in adult female and USD 41.5 in children in very high prevalence group; USD 19.2 in adult male, USD 34.0 in adult female, and USD 90.1 in children in high prevalence group; USD 30.4 in adult male, USD 50.5 in adult female and over USD 100 in children in moderate prevalence group; and over USD 400 in any population in low prevalence group. As to cost utility, the differences by treatment strategies, populations and endemic levels were similar to those in cost effectiveness. CONCLUSIONS Both cost effectiveness and cost utility indicators are highly impacted by the prevalence and population, as well as the treatment schedules. Adults especially men in the areas with a prevalence over 10% should be prioritized, in which selective chemotherapy was best and massive chemotherapy was also cost effective. In moderate endemic areas, the yield is not ideal, but selective chemotherapy for adult male may also be adopted. In low endemic areas, all strategies were high costly and new strategies need to be developed.
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Affiliation(s)
- Men-Bao Qian
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China.,Chinese Center for Tropical Diseases Research, Shanghai, China.,Key Laboratory of Parasite and Vector Biology, National Health Commission, Shanghai, China.,National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, China.,WHO Collaborating Center for Tropical Diseases, Shanghai, China.,School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Hai Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China.,Chinese Center for Tropical Diseases Research, Shanghai, China.,Key Laboratory of Parasite and Vector Biology, National Health Commission, Shanghai, China.,National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, China.,WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Hui-Hui Zhu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China.,Chinese Center for Tropical Diseases Research, Shanghai, China.,Key Laboratory of Parasite and Vector Biology, National Health Commission, Shanghai, China.,National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, China.,WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Ying-Dan Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China.,Chinese Center for Tropical Diseases Research, Shanghai, China.,Key Laboratory of Parasite and Vector Biology, National Health Commission, Shanghai, China.,National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, China.,WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China. .,Chinese Center for Tropical Diseases Research, Shanghai, China. .,Key Laboratory of Parasite and Vector Biology, National Health Commission, Shanghai, China. .,National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, China. .,WHO Collaborating Center for Tropical Diseases, Shanghai, China. .,School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Qian MB, Jiang ZH, Ge T, Wang X, Zhou CH, Zhu HH, Zhou XN. Rapid screening of Clonorchis sinensis infection: Performance of a method based on raw-freshwater fish-eating practice. Acta Trop 2020; 207:105380. [PMID: 32007446 DOI: 10.1016/j.actatropica.2020.105380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 01/09/2023]
Abstract
Clonorchis sinensis infection is caused by ingestion of raw freshwater fish containing the infective larvae of Clonorchis sinensis. It is highly endemic in East Asia, especially in China. Selective chemotherapy of people who report habitual eating of raw freshwater fish is a control measure. As the performance of this screening technique has not yet been fully evaluated in China, a cross-sectional study was conducted, covering 17 counties in four major clonorchiasis-endemic provinces. About 1 000 participants were enrolled from each county. Fecal samples were collected and examined for helminth eggs and each person enrolled was asked about their practice with respect to eating raw freshwater fish. In total, 16 230 participants from 16 counties were finally included. The overall prevalence of C. sinensis infection was 10.8%, ranging from 0 to 53.7% in the 16 counties, while the percentage of inhabitants eating raw freshwater fish was 26.5%, ranging from 0 to 79.1%. The overall sensitivity and specificity of screening for C. sinensis infection in this approach was 82.3% and 80.3%, respectively, yielding a Youden's index of 0.6. The overall positive and negative likelihood ratios were 4.2 and 0.2, respectively, while the overall positive and negative predictive values were 33.5% and 97.4%, respectively. Furthermore, the sensitivity was higher with regard to high-intensity infections compared to light infections.
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Park DS, Na SJ, Cho SH, June KJ, Cho YC, Lee YH. Prevalence and risk factors of clonorchiasis among residents of riverside areas in Muju-gun, Jeollabuk-do, Korea. THE KOREAN JOURNAL OF PARASITOLOGY 2014; 52:391-7. [PMID: 25246718 PMCID: PMC4170035 DOI: 10.3347/kjp.2014.52.4.391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 06/29/2014] [Accepted: 07/15/2014] [Indexed: 11/23/2022]
Abstract
We evaluated the status of Clonorchis sinensis infection and potential risk factors among residents of riverside areas (Geumgang) in Muju-gun, Jeollabuk-do (Province), Korea. From January to February 2010, a total of 349 (171 males, 178 females) stool samples were collected and examined by the formalin-ether concentration technique. Also, village residents were interviewed using questionnaires to obtain information about C. sinensis infection-related risk factors. Overall egg-positive rate of C. sinensis was 13.2%. Egg-positive rates were significantly higher in males, farmers, and residents who had lived there more than 20 years, and in residents who had eaten raw freshwater fish than in opposite groups, respectively. However, there was no significant difference between age groups, education levels, cigarette smoking, alcohol drinking, health status, past history of infection, and experience of clonorchiasis medication and examination. Logistic regression analysis was performed to determine risk factors for clonorchiasis. On univariate analysis, the odds ratios for males, farmers, those who had lived there more than 20 years, and who had eaten raw freshwater fish were 2.41, 4.44, 3.16, and 4.88 times higher than those of the opposites, respectively. On multivariate analysis, the odds ratio of residents who had eaten raw freshwater fish was 3.2-fold higher than that of those who had not. These results indicate that residents living in Muju-gun, along the Geum River, Korea, have relatively high C. sinensis egg-positive rates, and the habit of eating raw freshwater fish was the major factor for the maintenance of clonorchiasis.
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Affiliation(s)
- Do-Soon Park
- Graduate School of Public Health, Chungnam National University, Daejeon 301-131, Korea
| | - Sung-Jin Na
- Department of Infection Biology, School of Medicine, Chungnam National University, Daejeon 301-131, Korea
| | - Shin Hyeong Cho
- Division of Malaria and Parasitic Diseases, Korea National Institute of Health, Osong 363-951, Korea
| | - Kyung Ja June
- Department of Nursing, Soonchunhyang University, Chonan 330-090, Korea
| | - Young-Chae Cho
- Graduate School of Public Health, Chungnam National University, Daejeon 301-131, Korea
| | - Young-Ha Lee
- Department of Infection Biology, School of Medicine, Chungnam National University, Daejeon 301-131, Korea
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Lier T, Do DT, Johansen MV, Nguyen TH, Dalsgaard A, Asfeldt AM. High reinfection rate after preventive chemotherapy for fishborne zoonotic trematodes in Vietnam. PLoS Negl Trop Dis 2014; 8:e2958. [PMID: 24945411 PMCID: PMC4063704 DOI: 10.1371/journal.pntd.0002958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 05/07/2014] [Indexed: 12/19/2022] Open
Abstract
Background The World Health Organization aims for complete morbidity control of fishborne zoonotic trematodes (FZT) in endemic areas by 2020. The main intervention tool for achieving this goal is regular use of preventive chemotherapy by offering praziquantel to those at risk in endemic areas. The purpose of this study was to investigate the effectiveness of preventive chemotherapy to control FZT in an endemic area in Northern Vietnam. Methodology and principle findings We followed a cohort of 396 people who fulfilled the criteria for receiving preventive chemotherapy. Stool samples were examined by Kato-Katz technique for the presence of trematode eggs before, and two, 16, 29 and 60 weeks after preventive chemotherapy. The prevalence of trematode eggs in stool was 40.2% before, 2.3% two weeks after and increased to a cumulative prevalence of 29.8% sixty weeks after preventive chemotherapy. Conclusions The effectiveness of preventive chemotherapy as a main component in control of FZT is not well documented in most endemic areas. We found a high reinfection rate within the first year after preventive chemotherapy. Since these trematodes are zoonoses, preventive chemotherapy may not have sufficient impact alone on the transmission to have a lasting effect on the prevalence. Animal reservoirs and farm management practices must be targeted to achieve sustainable control of fishborne zoonotic trematode infections, hence control programs should consider a One Health approach. Fishborne zoonotic trematodes (FZT) are small parasitic flatworms (flukes) living either in the intrahepatic bile ducts or in the intestines of humans and many species of animals and birds. Transmission occurs by eating infected raw freshwater fish. FZT are especially common in Southeast and East Asia. WHO suggests using preventive chemotherapy in the control of these parasites by providing an effective drug, praziquantel, once a year to either all inhabitants in the endemic areas or selectively to those who are at special risk because they eat raw fish. Preventive chemotherapy has been used for some years in Northern Vietnam, but the effectiveness has not been thoroughly examined. We followed a group of 396 people who had eaten raw fish and examined the stool for the presence of trematode eggs before preventive chemotherapy and two, 16, 29 and 60 weeks after. The proportions of egg positive persons were 40.2% before, 2.3% two weeks after and increased to 29.8% sixty weeks after preventive chemotherapy. We found a high rate of reinfection. Contribution from animals to the transmission implies that preventive chemotherapy of humans alone will most likely be insufficient to control the FZT infections.
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Affiliation(s)
- Tore Lier
- Department for Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- * E-mail:
| | - Dung Trung Do
- Department for Parasitology, National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Maria Vang Johansen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thi Hop Nguyen
- Department for Parasitology, National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Anders Dalsgaard
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Mette Asfeldt
- Department for Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
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Phan VT, Ersbøll AK, Do DT, Dalsgaard A. Raw-fish-eating behavior and fishborne zoonotic trematode infection in people of northern Vietnam. Foodborne Pathog Dis 2010; 8:255-60. [PMID: 21117922 DOI: 10.1089/fpd.2010.0670] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Raw fish consumption in restaurants, for example, Sashimi style, is popular worldwide. In Vietnam, raw fish dishes are also traditionally prepared and consumed in private households. However, the habits of eating raw or otherwise inadequately cooked fish can be associated with risks of acquiring fishborne zoonotic trematode (FZT) infection. The present study was done in a fish-farming community in Nam Dinh, Vietnam, to obtain information about habits of eating raw fish dishes and risks for human FZT infection. Discussions were held in different groups divided by gender and age on raw-fish-eating behavior. A total of 180 household members were interviewed and their stool samples analyzed to identify risk factors of FZT infection. There was awareness about the risk of liver fluke infections from eating raw fish. However, many older people accepted these risks and continued eating raw fish, as they know effective drug treatment is available. Raw fish dishes are consumed at social gatherings from shared plates and dipping sauces using the same chop sticks. This is likely to pose risks of crosscontamination with FZT metacercariae to different food items as indicated by the finding that 25.8% of household members that stated not to have eaten raw fish were infected. In total, 32.2% fish farm household members were infected with FZT. The odds of FZT infection was 2.3 times higher (p = 0.013) for those eating raw fish than for those who did not eat raw fish. Among the people eating raw fish, those eating raw fish in restaurants had 3.6 times higher odds of FZT infection (p = 0.009) than people eating raw fish at home. A successful program to control FZT must be based on in-depth knowledge on the social and anthropological determinants of people's raw-fish-eating behavior and hygiene practices as well as production of FZT-free fish for human consumption.
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Affiliation(s)
- Van Thi Phan
- Centre for Environment and Disease Monitoring in Aquaculture, Research Institute for Aquaculture No. 1, Tu Son, Bac Ninh, Vietnam.
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