1
|
Burniston S, Okello AL, Khamlome B, Inthavong P, Gilbert J, Blacksell SD, Allen J, Welburn SC. Cultural drivers and health-seeking behaviours that impact on the transmission of pig-associated zoonoses in Lao People's Democratic Republic. Infect Dis Poverty 2015; 4:11. [PMID: 25973203 PMCID: PMC4430026 DOI: 10.1186/2049-9957-4-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/19/2015] [Indexed: 11/10/2022] Open
Abstract
Pig rearing is an important income source in the Lao People's Democratic Republic (PDR), with many smallholder farmers using traditional free-range pig production systems. Despite the potentially significant health risks posed by pig production regarding pig-associated zoonoses, information on the sociocultural drivers of these zoonoses is significantly lacking. This review summarises the existing sociocultural knowledge on eight pig-associated zoonoses suspected to be endemic in Southeast Asia: brucellosis, Q fever (Coxiella burnetii), trichinellosis, hepatitis E virus, leptospirosis, Japanese encephalitis, Streptococcus suis and Taenia solium taeniasis-cysticercosis. It summarises current knowledge on these diseases grouped according to their clinical manifestations in humans to highlight the propensity for underreporting. A literature search was conducted across multiple databases for publications from 1990 to the present day related to the eight pig-associated zoonoses and the risk and impact connected with them, with Lao PDR as a case study. Many of these pig-associated zoonoses have similar presentations and are often diagnosed as clinical syndromes. Misdiagnosis and underreporting are, therefore, substantial and emphasise the need for more robust diagnostics and appropriate surveillance systems. While some reports exist in other countries in the region, information is significantly lacking in Lao PDR with existing information coming mainly from the capital, Vientiane. The disease burden imposed by these zoonoses is not only characterised by morbidity and mortality, but directly impacts on livelihoods through income reduction and production losses, and indirectly through treatment costs and lost work opportunities. Other factors crucial to understanding and controlling these diseases are the influence of ethnicity and culture on food-consumption practices, pig rearing and slaughter practices, hygiene and sanitation, health-seeking behaviours and, therefore, risk factors for disease transmission. Published information on the knowledge, attitudes and beliefs of people regarding pig zoonoses and their risk factors is also extremely limited in Lao PDR and the broader Southeast Asian region. The need for more transdisciplinary research, using a One Health approach, in order to understand the underlining social determinants of health and their impacts on health-seeking behaviours, disease transmission and, ultimately, disease reporting, cannot be more emphasized.
Collapse
Affiliation(s)
- Stephanie Burniston
- Division of Infection and Pathway Medicine, College of Medicine and Veterinary, Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Anna L Okello
- Division of Infection and Pathway Medicine, College of Medicine and Veterinary, Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB UK ; CSIRO Animal Food and Health Sciences, Australian Animal Health Laboratory (AAHL), Regional Programme, 5 Portarlington Road, East Geelong, Victoria 3219 Australia
| | - Boualam Khamlome
- Department for Communicable Disease Control (DCDC), Ministry of Health, Thadeua Road, Vientiane, Lao PDR
| | - Phouth Inthavong
- Department of Livestock and Fisheries, Ministry of Agriculture and Forestry, Ban Sithan Nua, Luang Prabang Road, Sikhottabong District, Vientiane, 7042 Lao PDR
| | - Jeffrey Gilbert
- International Livestock Research Institute (ILRI), Asia Programme, Kabete, Naivasha Road, Nairobi, 30709-00100 Kenya
| | - Stuart D Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, 10400 Bangkok, Thailand ; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LJ UK
| | - John Allen
- CSIRO Animal Food and Health Sciences, Australian Animal Health Laboratory (AAHL), Regional Programme, 5 Portarlington Road, East Geelong, Victoria 3219 Australia
| | - Susan C Welburn
- Division of Infection and Pathway Medicine, College of Medicine and Veterinary, Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| |
Collapse
|
2
|
Prevalence and predictors of over-the-counter medication use among pregnant women: a cross-sectional study in the Netherlands. BMC Public Health 2013; 13:185. [PMID: 23452432 PMCID: PMC3662163 DOI: 10.1186/1471-2458-13-185] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 02/08/2013] [Indexed: 11/28/2022] Open
Abstract
Background Over-the-counter-medication (OTC-medication) use during pregnancy can be potentially harmful for the fetus. To successfully counsel the patient it is important to know if the patient is at risk. In this study possible predictors for OTC-medication use were identified and a model was designed to predict OTC-medication use during pregnancy. Methods We performed a post-hoc analysis on data collected for a clustered clinical trial to study a screening strategy for Query fever. Pregnant women under supervision of a midwife were eligible for inclusion. These women filled out questionnaires during their pregnancy and post-partum. These questionnaires were used to determine the prevalence and to select possible predictors for OTC-medication use. These predictors were included in a prediction model using multivariate analysis. The discrimination and calibration of the model were assessed with Receiver Operating Characteristic analysis and the Hosmer and Lemeshow test. Results Of the 1348 women enrolling in the clustered clinical trial, we included 1246 women in this analysis. The prevalence of OTC-medication use was 12.5%. The predictors for OTC-medication use in our cohort were: nulliparity, use of prescription medication, the presence of a comorbidity, Body Mass Index between 26 and 30 kg/m2 and General Practitioner visits. These predictors were used to design a prediction model for OTC-medication use. The area under the Receiver Operating Characteristic-curve of the prediction model was 0.667 (95% CI 0.620-0.714 P<0.001) and the predictive probabilities ranged from 6.6% to 57.4%. The Hosmer and Lemeshow goodness-of-fit test indicated good calibration of the model (P = 0.640). Conclusion It is possible to indicate women at risk for OTC-medication use during pregnancy, using five maternal characteristics that independently contribute to the prediction model. The predictors are easy to estimate and the model is easy to implement in daily practice.
Collapse
|
3
|
Abstract
Q fever is an ubiquitous zoonosis caused by Coxiella burneti, an intracellular bacterium that can produce acute or chronic infections in humans. These forms are characterized by different evolution, serological profile and treatment that must be very long to achieve a cure in chronic forms. However, the serological profile for diagnosis and the real value of serology for predicting outcome are controversial, and management dilemmas for many patients with Q fever infection are continuously emerging. In this article, we describe in a comprehensive manner the different clinical presentations of the disease, making a critical overview of the evidence for serological predictions. We also take a broad view of new available diagnostic techniques and finally, we give recommendations for treatment.
Collapse
Affiliation(s)
- Arístides de Alarcón
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Manuel Siurot s/n, Sevilla, 41013, Spain,
| |
Collapse
|
4
|
Kampschreur LM, Dekker S, Hagenaars JCJP, Lestrade PJ, Renders NHM, de Jager-Leclercq MGL, Hermans MHA, Groot CAR, Groenwold RHH, Hoepelman AIM, Wever PC, Oosterheert JJ. Identification of risk factors for chronic Q fever, the Netherlands. Emerg Infect Dis 2012; 18:563-70. [PMID: 22469535 PMCID: PMC3309671 DOI: 10.3201/eid1804.111478] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Since 2007, the Netherlands has experienced a large Q fever outbreak. To identify and quantify risk factors for development of chronic Q fever after Coxiella burnetii infection, we performed a case-control study. Comorbidity, cardiovascular risk factors, medications, and demographic characteristics from 105 patients with proven (n = 44), probable (n = 28), or possible (n = 33) chronic Q fever were compared with 201 patients who had acute Q fever in 2009 but in whom chronic Q fever did not develop (controls). Independent risk factors for development of proven chronic Q fever were valvular surgery, vascular prosthesis, aneurysm, renal insufficiency, and older age.
Collapse
|
5
|
Dijkstra F, van der Hoek W, Wijers N, Schimmer B, Rietveld A, Wijkmans CJ, Vellema P, Schneeberger PM. The 2007–2010 Q fever epidemic in the Netherlands: characteristics of notified acute Q fever patients and the association with dairy goat farming. ACTA ACUST UNITED AC 2012; 64:3-12. [DOI: 10.1111/j.1574-695x.2011.00876.x] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
6
|
Epidemic Q fever in humans in the Netherlands. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 984:329-64. [PMID: 22711640 DOI: 10.1007/978-94-007-4315-1_17] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 2005, Q fever was diagnosed on two dairy goat farms and 2 years later it emerged in the human population in the south of the Netherlands. From 2007 to 2010, more than 4,000 human cases were notified with an annual seasonal peak. The outbreaks in humans were mainly restricted to the south of the country in an area with intensive dairy goat farming. In the most affected areas, up to 15% of the population may have been infected. The epidemic resulted in a serious burden of disease, with a hospitalisation rate of 20% of notified cases and is expected to result in more cases of chronic Q fever among risk groups in the coming years. The most important risk factor for human Q fever is living close (<5 km) to an infected dairy goat farm. Occupational exposure plays a much smaller role. In 2009 several veterinary control measures were implemented including mandatory vaccination of dairy goats and dairy sheep, improved hygiene measures, and culling of pregnant animals on infected farms. The introduction of these drastic veterinary measures has probably ended the Q fever outbreak, for which the Netherlands was ill-prepared.
Collapse
|
7
|
Munster JM, Leenders ACAP, Hamilton CJCM, Hak E, Aarnoudse JG, Timmer A. Placental histopathology after Coxiella burnetii infection during pregnancy. Placenta 2011; 33:128-31. [PMID: 22142774 DOI: 10.1016/j.placenta.2011.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/17/2011] [Indexed: 11/16/2022]
Abstract
Symptomatic and asymptomatic Coxiella burnetii infection during pregnancy have been associated with obstetric complications. We described placental histopathology and clinical outcome of five cases with asymptomatic C. burnetii infection during pregnancy and compared these cases with four symptomatic cases from the literature. In contrast with the symptomatic cases, we did not observe necrosis or active inflammation in the placentas of the asymptomatic women. Obstetrical outcome was more favourable in the asymptomatic cases than in the symptomatic cases. Asymptomatic and symptomatic C. burnetii infection during pregnancy are different entities with respect to placental histopathology and the risk of obstetric complications.
Collapse
Affiliation(s)
- J M Munster
- University of Groningen, University Medical Centre Groningen, Department of Obstetrics and Gynaecology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
8
|
Breteler JK, Oudhoff JP, Munster JM, Aarnoudse JG, van Steenbergen JE, Beaujean DJMA. Risks, trust and knowledge: determinants of pregnant women's decisions regarding participation in a future Q fever screening and treatment program during a large epidemic in The Netherlands. Prenat Diagn 2011; 31:814-20. [PMID: 21717482 DOI: 10.1002/pd.2772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/05/2011] [Accepted: 03/15/2011] [Indexed: 11/05/2022]
Affiliation(s)
- Janna Klein Breteler
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | | | | | | | | |
Collapse
|
9
|
van der Hoek W, Meekelenkamp JCE, Leenders ACAP, Wijers N, Notermans DW, Hukkelhoven CWPM. Antibodies against Coxiella burnetii and pregnancy outcome during the 2007-2008 Q fever outbreaks in The Netherlands. BMC Infect Dis 2011; 11:44. [PMID: 21314933 PMCID: PMC3042933 DOI: 10.1186/1471-2334-11-44] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 02/11/2011] [Indexed: 11/14/2022] Open
Abstract
Background Q fever has become a major public health problem in the Netherlands. Infection with Coxiella burnetii (Q fever) during pregnancy has resulted in adverse pregnancy outcome in the majority of reported cases. Therefore, we aimed to quantify this risk by examining the earliest periods corresponding to the epidemic in the Netherlands. Methods Serum samples that had been collected from the area of highest incidence by an existing national prenatal screening programme and data from the Netherlands Perinatal Registry (PRN) on diagnosis and outcome were used. We performed indirect immunofluorescence assay to detect the presence of IgM and IgG antibodies against C. burnetii in the samples. The serological results were analyzed to determine statistical association with recorded pregnancy outcome. Results Evaluation of serological results for 1174 women in the PRN indicated that the presence of IgM and IgG antibodies against phase II of C. burnetii was not significantly associated with preterm delivery, low birth weight, or several other outcome measures. Conclusion The present population-based study showed no evidence of adverse pregnancy outcome among women who had antibodies to C. burnetii during early pregnancy.
Collapse
Affiliation(s)
- Wim van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands.
| | | | | | | | | | | |
Collapse
|