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la Cruz-Saldana TD, Bustos JA, Requena-Herrera MP, Martinez-Merizalde N, Ortiz-Cam L, Cáceres AL, Guzman C, Gavidia CM, Ugarte-Gil C, Castillo-Neyra R. A scoping review on control strategies for Echinococcus granulosus sensu lato. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.21.24312335. [PMID: 39228722 PMCID: PMC11370509 DOI: 10.1101/2024.08.21.24312335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Background Cystic echinococcosis (CE) is a widespread neglected zoonotic disease caused by Echinococcus granulosus sensu lato (EG) with a global burden of control in the billions of dollars. E. granulosus' life cycle involves definitive, intermediate, and humans as dead-end hosts. Echinococcosis control programs use strategies that focus on any of these hosts. We aimed to provide a comprehensive and up-to-date overview of the EG control interventions worldwide. Methods We conducted a scoping review by mapping all studies on interventions for EG control following the Arksey and O'Malley Framework. We screened identified articles, and charted and coded selected papers. We classified the data based on target host, type of study, and control mechanism. We described the efficacy or safety outcomes, and the associated barriers/facilitators for the intervention. Critical appraisal was conducted. Results From 7,853 screened studies, we analyzed 45: seven centered on human interventions, 21 on animals, and 17 on both. Studies on humans focused on educational strategies and human CE monitoring. The studies on animals were field trials and most were based on Praziquantel (PZQ) for dogs. Studies focused on both animals and humans had, in general, more participants, lasted longer, and covered larger geographical areas. Overall, the quality of studies was moderate to low. Conclusions Available evidence suggests that long-term interventions aimed at both animals and humans can achieve significant reduction in EG transmission, particularly when PZQ treatment for dogs is included. Higher quality evidence, standardization of methodologies, and better reporting on post-intervention outcomes are necessary for drawing stronger conclusions. Further evidence is needed to assess the sustainability and scalability of control measures. Nonetheless, an integrative One Health approach is essential for overcoming the multiple challenges associated with sustaining long-term control efforts for Echinococcosis.
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Affiliation(s)
- Tania De la Cruz-Saldana
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Center for Global Health, School of Health Sciences, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú
| | - Javier A Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Center for Global Health, School of Health Sciences, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú
| | - Maria P Requena-Herrera
- One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Lizzie Ortiz-Cam
- One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana Lucía Cáceres
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carolina Guzman
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar M Gavidia
- Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Cesar Ugarte-Gil
- Department of Epidemiology. School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ricardo Castillo-Neyra
- One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sykes AL, Larrieu E, Poggio TV, Céspedes MG, Mujica GB, Basáñez MG, Prada JM. Modelling diagnostics for Echinococcus granulosus surveillance in sheep using Latent Class Analysis: Argentina as a case study. One Health 2022; 14:100359. [PMID: 34977321 PMCID: PMC8683760 DOI: 10.1016/j.onehlt.2021.100359] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022] Open
Abstract
Echinococcus granulosus sensu lato is a globally prevalent zoonotic parasitic cestode leading to cystic echinococcosis (CE) in both humans and sheep with both medical and financial impacts, whose reduction requires the application of a One Health approach to its control. Regarding the animal health component of this approach, lack of accurate and practical diagnostics in livestock impedes the assessment of disease burden and the implementation and evaluation of control strategies. We use of a Bayesian Latent Class Analysis (LCA) model to estimate ovine CE prevalence in sheep samples from the Río Negro province of Argentina accounting for uncertainty in the diagnostics. We use model outputs to evaluate the performance of a novel recombinant B8/2 antigen B subunit (rEgAgB8/2) indirect enzyme-linked immunosorbent assay (ELISA) for detecting E. granulosus in sheep. Necropsy (as a partial gold standard), western blot (WB) and ELISA diagnostic data were collected from 79 sheep within two Río Negro slaughterhouses, and used to estimate individual infection status (assigned as a latent variable within the model). Using the model outputs, the performance of the novel ELISA at both individual and flock levels was evaluated, respectively, using a receiver operating characteristic (ROC) curve, and simulating a range of sample sizes and prevalence levels within hypothetical flocks. The estimated (mean) prevalence of ovine CE was 27.5% (95%Bayesian credible interval (95%BCI): 13.8%-58.9%) within the sample population. At the individual level, the ELISA had a mean sensitivity and specificity of 55% (95%BCI: 46%-68%) and 68% (95%BCI: 63%-92%), respectively, at an optimal optical density (OD) threshold of 0.378. At the flock level, the ELISA had an 80% probability of correctly classifying infection at an optimal cut-off threshold of 0.496. These results suggest that the novel ELISA could play a useful role as a flock-level diagnostic for CE surveillance in the region, supplementing surveillance activities in the human population and thus strengthening a One Health approach. Importantly, selection of ELISA cut-off threshold values must be tailored according to the epidemiological situation.
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Key Words
- Argentina
- BCI, Bayesian Credible Interval
- Bayesian inference
- CE, Cystic Echinococcosis
- CI, Confidence Interval
- DALY, Disability-adjusted life year
- Diagnostics
- ELISA, Enzyme-Linked Immunosorbent Assay
- Echinococcosis
- JAGS, Just Another Gibbs Sampler
- LCA, Latent class analysis
- Latent class analysis
- MCAR, Missing completely at random
- MCMC, Markov Chain Monte Carlo
- OD, Optical density
- ROC, Receiver Operating Characteristic
- SD, Standard deviation
- Surveillance
- USD, United States Dollar
- WB, Western blot
- WHO, World Health Organization.
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Affiliation(s)
- Abagael L. Sykes
- London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Edmundo Larrieu
- Facultad de Ciencias Veterinarias, Universidad Nacional de La Pampa, General Pico, Argentina
- Escuela de Veterinaria, Universidad Nacional de Río Negro, Choele Choel, Argentina
| | | | | | | | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Joaquin M. Prada
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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3
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Uchiumi L, Mujica G, Araya D, Salvitti JC, Sobrino M, Moguillansky S, Solari A, Blanco P, Barrera F, Lamunier J, Arezo M, Seleiman M, Yadon ZE, Tamarozzi F, Casulli A, Larrieu E. Prevalence of human cystic echinococcosis in the towns of Ñorquinco and Ramos Mexia in Rio Negro Province, Argentina, and direct risk factors for infection. Parasit Vectors 2021; 14:262. [PMID: 34011406 PMCID: PMC8136178 DOI: 10.1186/s13071-021-04753-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/28/2021] [Indexed: 01/02/2023] Open
Abstract
Background Cystic echinococcosis (CE) is a parasitic zoonosis caused by infection with the larval stage of Echinococcus granulosus (s.l.). This study investigated the prevalence and potential risk factors associated with human CE in the towns and rural areas of Ñorquinco and Ramos Mexia, Rio Negro province, Argentina. Methods To detect abdominal CE cysts, we screened 892 volunteers by ultrasound and investigated potential risk factors for CE using a standardized questionnaire. Prevalence ratio (PR) with 95% confidence intervals (CI) was used to measure the association between CE and the factors investigated, applying bivariate and multivariate analyses. Results Abdominal CE was detected in 42/892 screened volunteers (4.7%, 95% CI 3.2–6.1), only two of whom were under 15 years of age. Thirteen (30.9%) CE cases had 25 cysts in active stages (CE1, CE2, CE3a, according to the WHO Informal Working Group on Echinococcosis [WHO-IWGE] classification). The most relevant risk factors identified in the bivariate analysis included: living in rural areas (P = 0.003), age > 40 years (P = 0.000), always drinking water from natural sources (P = 0.007), residing in rural areas during the first 5 years of life (P = 0.000) and having lived more than 20 years at the current address (P = 0.013). In the multivariate final model, the statistically significant risk factors were: frequently touching dogs (P = 0.012), residing in rural areas during the first 5 years of life (P = 0.004), smoking (P = 0.000), age > 60 years (P = 0.002) and living in rural areas (P = 0.017). Conclusions Our results point toward infection with CE being acquired since childhood and with constant exposure throughout life, especially in rural areas with a general environmental contamination. Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04753-y.
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Affiliation(s)
- Leonardo Uchiumi
- Hospital "Artémides Zatti", Viedma, Provincia de Río Negro, Argentina
| | - Guillermo Mujica
- Coordinación de Salud Ambiental, Ministerio de Salud, Viedma, Provincia de Rio Negro, Argentina
| | - Daniel Araya
- Coordinación de Salud Ambiental, Ministerio de Salud, Viedma, Provincia de Rio Negro, Argentina
| | - Juan Carlos Salvitti
- Hospital "Ramón Carrillo", San Carlos de Bariloche, Provincia de Río Negro, Argentina
| | - Mariano Sobrino
- Hospital "Ramón Carrillo", San Carlos de Bariloche, Provincia de Río Negro, Argentina
| | - Sergio Moguillansky
- Facultad de Medicina, Universidad del Comahue, Cipolletti, Provincia de Río Negro, Argentina
| | - Alejandro Solari
- Hospital "Raul Fernicola", Valcheta, Provincia de Rio Negro, Argentina
| | - Patricia Blanco
- Coordinación de Salud Ambiental, Ministerio de Salud, Viedma, Provincia de Rio Negro, Argentina
| | - Fabiana Barrera
- Hospital Area Programa de Ramos Mexia, Ministro Ramos Mexía, Argentina
| | | | - Marcos Arezo
- Coordinación de Salud Ambiental, Ministerio de Salud, Viedma, Provincia de Rio Negro, Argentina
| | - Marcos Seleiman
- Coordinación de Salud Ambiental, Ministerio de Salud, Viedma, Provincia de Rio Negro, Argentina
| | - Zaida E Yadon
- Instituto de Investigaciones Epidemiológicas, Academia Nacional de Medicina, Buenos Aires, Argentina
| | - Francesca Tamarozzi
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Adriano Casulli
- WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy.,European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Edmundo Larrieu
- Facultad de Ciencias Veterinarias, Universidad Nacional de La Pampa, General Pico, Provincia de La Pampa, Argentina. .,Escuela de Veterinaria, Universidad Nacional de Rio Negro, Choele Choel, Provincia de Rio Negro, Argentina.
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Lawson A, Boaz R, Corberán-Vallet A, Arezo M, Larrieu E, Vigilato MA, Del Rio Vilas VJ. Integration of animal health and public health surveillance sources to exhaustively inform the risk of zoonosis: An application to echinococcosis in Rio Negro, Argentina. PLoS Negl Trop Dis 2020; 14:e0008545. [PMID: 32841252 PMCID: PMC7473527 DOI: 10.1371/journal.pntd.0008545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/04/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
The analysis of zoonotic disease risk requires the consideration of both human and animal geo-referenced disease incidence data. Here we show an application of joint Bayesian analyses to the study of echinococcosis granulosus (EG) in the province of Rio Negro, Argentina. We focus on merging passive and active surveillance data sources of animal and human EG cases using joint Bayesian spatial and spatio-temporal models. While similar spatial clustering and temporal trending was apparent, there appears to be limited lagged dependence between animal and human outcomes. Beyond the data quality issues relating to missingness at different times, we were able to identify relations between dog and human data and the highest ‘at risk’ areas for echinococcosis within the province. This work focuses on utilizing animal disease data to try and inform our understanding of the spread of diseases in humans. We implement predictive models to estimate the relationship between the distribution of disease in animal populations and the distribution of disease in human populations. Development of a better understanding of this relationship could inform animal and public health interventions aiming to mitigate against human disease before it spreads. Missing data and limited data resources made discovery of these relationships difficult, but we fit multiple model types to try and identify any connection between these two populations. We found specific areas with elevated risk of human disease and changes in disease risk over time. Finally, there was some indication of an association between previous years’ levels of animal disease and human disease when using animals as covariables.
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Affiliation(s)
- Andrew Lawson
- Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
| | - R Boaz
- Medical University of South Carolina, Charleston, South Carolina, United States of America
| | | | - Marcos Arezo
- Ministerio de Salud, Viedma, Rio Negro, Argentina
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Irabedra P, Ferreira C, Sayes J, Elola S, Rodríguez M, Morel N, Segura S, Santos ED, Guisantes JA. Control programme for cystic echinococcosis in Uruguay. Mem Inst Oswaldo Cruz 2017; 111:372-7. [PMID: 27223652 PMCID: PMC4909035 DOI: 10.1590/0074-02760160070] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/12/2016] [Indexed: 11/22/2022] Open
Abstract
Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community's participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.
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Affiliation(s)
- Pilar Irabedra
- National Commission for Zoonoses, Ministry of Public Health, Montevideo , Uruguay, National Commission for Zoonoses, Ministry of Public Health, Montevideo, Uruguay
| | - Ciro Ferreira
- National Commission for Zoonoses, Ministry of Public Health, Montevideo , Uruguay, National Commission for Zoonoses, Ministry of Public Health, Montevideo, Uruguay
| | - Julio Sayes
- National Commission for Zoonoses, Ministry of Public Health, Tacuarembo , Uruguay, National Commission for Zoonoses, Ministry of Public Health, Tacuarembo, Uruguay
| | - Susana Elola
- National Commission for Zoonoses, Ministry of Public Health, Montevideo , Uruguay, National Commission for Zoonoses, Ministry of Public Health, Montevideo, Uruguay
| | - Miriam Rodríguez
- National Commission for Zoonoses, Ministry of Public Health, Rivera , Uruguay, National Commission for Zoonoses, Ministry of Public Health, Rivera, Uruguay
| | - Noelia Morel
- National Commission for Zoonoses, Ministry of Public Health, Montevideo , Uruguay, National Commission for Zoonoses, Ministry of Public Health, Montevideo, Uruguay
| | - Sebastian Segura
- National Commission for Zoonoses, Ministry of Public Health, Tacuarembo , Uruguay, National Commission for Zoonoses, Ministry of Public Health, Tacuarembo, Uruguay
| | - Estela Dos Santos
- National Commission for Zoonoses, Ministry of Public Health, Tacuarembo , Uruguay, National Commission for Zoonoses, Ministry of Public Health, Tacuarembo, Uruguay
| | - Jorge A Guisantes
- University of Basque Country, Faculty of Pharmacy, Department of Immunology, Microbiology and Parasitology, Vitoria , Spain, University of Basque Country, Faculty of Pharmacy, Department of Immunology, Microbiology and Parasitology, Vitoria, Spain
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6
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Abstract
Human cystic echinococcosis (CE) has been eliminated or significantly reduced as a public health problem in several previously highly endemic regions. This has been achieved by the long-term application of prevention and control measures primarily targeted to deworming dogs, health education, meat inspection, and effective surveillance in livestock and human populations. Human CE, however, remains a serious neglected zoonotic disease in many resource-poor pastoral regions. The incidence of human alveolar echinococcosis (AE) has increased in continental Europe and is a major public health problem in parts of Eurasia. Better understanding of wildlife ecology for fox and small mammal hosts has enabled targeted anthelmintic baiting of fox populations and development of spatially explicit models to predict population dynamics for key intermediate host species and human AE risk in endemic landscapes. Challenges that remain for echinococcosis control include effective intervention in resource-poor communities, better availability of surveillance tools, optimal application of livestock vaccination, and management and ecology of dog and wildlife host populations.
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Bingham GM, Larrieu E, Uchiumi L, Mercapide C, Mujica G, Del Carpio M, Hererro E, Salvitti JC, Norby B, Budke CM. The Economic Impact of Cystic Echinococcosis in Rio Negro Province, Argentina. Am J Trop Med Hyg 2016; 94:615-25. [PMID: 26787144 DOI: 10.4269/ajtmh.15-0304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/19/2015] [Indexed: 11/07/2022] Open
Abstract
Cystic echinococcosis (CE), a parasitic zoonosis with substantial human health and economic consequences, is highly endemic in Rio Negro Province, Argentina. The objective of this study was to estimate the direct and indirect human and livestock-associated monetary losses attributable to CE, in Rio Negro Province, for the year 2010. Human costs were estimated using data obtained from hospital chart reviews, patient interviews, and government reports. Livestock-associated losses were estimated using data from government reports and scientific publications. Spreadsheet models were developed utilizing Latin Hypercube sampling to account for uncertainty in the input parameters. In 2010, the estimated total cost of CE, in Rio Negro Province, ranged from US$4,234,000 (95% credible interval [CI]: US$2,709,000-US$6,226,000) to US$5,897,000 (95% CI: US$3,452,000-US$9,105,000), with livestock-associated losses representing between 80% and 94% of the total losses, depending on whether non-healthcare-seeking human cases were included and if livestock slaughter values were adjusted to account for underreporting. These estimates suggest that CE is responsible for considerable human and livestock-associated monetary losses in Rio Negro Province. Stakeholders and policymakers can use these data to better allocate public health and agricultural resources for this region.
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Affiliation(s)
- Glenda M Bingham
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Edmundo Larrieu
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Leonardo Uchiumi
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Carlos Mercapide
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Guillermo Mujica
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Mario Del Carpio
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Eduardo Hererro
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Juan Carlos Salvitti
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Bo Norby
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Christine M Budke
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas; Ministry of Health, Viedma, Rio Negro Province, Argentina; National University of La Pampa, General Pico, La Pampa Province, Argentina; Artemides Zatti Hospital, Viedma, Rio Negro Province, Argentina; Rogelio Cortizo Hospital, Ingeniero Jacobacci, Rio Negro Province, Argentina; Ramon Carrillo Hospital, Bariloche, Rio Negro Province, Argentina; Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
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A community-based study to examine the epidemiology of human cystic echinococcosis in Rio Negro Province, Argentina. Acta Trop 2014; 136:81-8. [PMID: 24742907 DOI: 10.1016/j.actatropica.2014.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/10/2014] [Accepted: 04/05/2014] [Indexed: 12/28/2022]
Abstract
Although cystic echinococcosis (CE) is an important public health problem in Rio Negro Province, current epidemiological data for CE, in this region of Argentina, are not available. Therefore, a community-based study, which incorporated diagnostic imaging and a questionnaire, was conducted in Ingeniero Jacobacci, a small town in southern Rio Negro Province. This study sought to assess the prevalence of human CE, in the study population, and to evaluate epidemiologic factors associated with CE transmission within the study area. Of the 560 individuals who volunteered to participate in the study, 189 (34%) were children and 371 (66%) were adults. All study participants were screened for CE using abdominal ultrasound scanning, with CE-positive or suspect individuals also receiving thoracic radiographs. The overall prevalence of CE was 7.1% (40/560), with 1.6% (3/189) of children, and 10% (37/371) of adults diagnosed as CE-positive. Although 92.5% (37/40) of the CE-positive individuals had only hepatic lesions, two participants had both hepatic and pulmonary lesions, and one participant had a single renal lesion. Approximately 92% (340/371) of the adult study participants completed the questionnaire, which was used to identify factors associated with an increased risk for human infection. Age, level of education, dog ownership, and contact with sheep were found to be significantly associated with CE status. This study demonstrated that CE continues to be highly endemic in this region of Rio Negro Province, Argentina. In addition, community-based ultrasound screening surveys are a noninvasive, effective approach to case detection at the community level.
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9
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Larrieu E, Herrero E, Mujica G, Labanchi JL, Araya D, Grizmado C, Calabro A, Talmon G, Ruesta G, Perez A, Gatti A, Santillán G, Cabrera M, Arezzo M, Seleiman M, Cavagión L, Cachau MG, Alvarez Rojas CA, Gino L, Gauci CG, Heath DD, Lamberti R, Lightowlers MW. Pilot field trial of the EG95 vaccine against ovine cystic echinococcosis in Rio Negro, Argentina: early impact and preliminary data. Acta Trop 2013; 127:143-51. [PMID: 23632258 DOI: 10.1016/j.actatropica.2013.04.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 04/14/2013] [Accepted: 04/15/2013] [Indexed: 11/17/2022]
Abstract
Cystic echinococcosis is endemic in the Rio Negro province of Argentina. After 30 years of control using praziquantel in dogs the transmission rate to humans and sheep has decreased significantly, however transmission persists. The objective of the study is to assess the impact of the inclusion of the EG95 vaccine for sheep in the control programme, including analysis of the vaccine's operative feasibility in field conditions. The vaccine was applied in an area comprising four communities of native people including 79 farms with 3146 lambs and 311 dogs in total. Seventy one farms were designated as control areas where no vaccinations were undertaken while vaccinations of lambs undertaken on 91 farms. Lambs received two vaccinations with the EG95 vaccine followed by a single booster injection when the animals were 1-1.5 years of age. Farm locations were defined using GPS coordinates for the houses. Evidence for Echinococcus granulosus transmission was monitored by coproantigen ELISA on samples of dog faeces, by E. granulosus-specific PCR using soil samples, and anti-E. granulosus antibody assessments in sera from 2 to 4 teeth lambs, purgation of dogs to detect E. granulosus worms and necropsy on adult sheep. Before the vaccine was introduced, 26.2% of sheep with 2-4 teeth were positive using ELISA/WB, the prevalence decreased to 7.8% at the third year following use of the vaccine. Necropsy of animals older than 6 years (not vaccinated) showed that 66.1% of animals were infected with E. granulosus. In dogs, 4% was found positive for E. granulosus using arecoline purgation and 24.7% of the farms were infected using coproELISA/WB. During the first year of vaccination 2721 lambs received the first vaccine dose and 2448 received a booster. In the second year 2138 lambs were initially vaccinated and 1745 received a booster, and 1308 animals received the third dose. During the third year 1110 lambs received the first dose from which 539 received a booster and 723 animals received the third dose. An analysis of advantages and limitations of the diagnostic techniques used and the ability of the geospatial analysis to detect risk area are included. Based in the immunodiagnostic techniques, the EG95 vaccine has been able to prevent the infection in animals up to 3 years old. Also, the difficulties in the field for the correct vaccine administration and the social features and habits that may impact on echinococcosis control are included in the analysis.
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Del Carpio M, Hugo Mercapide C, Salvitti JC, Uchiumi L, Sustercic J, Panomarenko H, Moguilensky J, Herrero E, Talmon G, Volpe M, Araya D, Mujica G, Calabro A, Mancini S, Chiosso C, Luis Labanchi J, Saad R, Goblirsch S, Brunetti E, Larrieu E. Early diagnosis, treatment and follow-up of cystic echinococcosis in remote rural areas in Patagonia: impact of ultrasound training of non-specialists. PLoS Negl Trop Dis 2012; 6:e1444. [PMID: 22253935 PMCID: PMC3254659 DOI: 10.1371/journal.pntd.0001444] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 11/01/2011] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Cystic echinococcosis (CE) is a chronic, complex and neglected disease caused by the larval stage of Echinococcus granulosus. The effects of this neglect have a stronger impact in remote rural areas whose inhabitants have no chances of being diagnosed and treated properly without leaving their jobs and travelling long distances, sometimes taking days to reach the closest referral center. BACKGROUND In 1980 our group set up a control program in endemic regions with CE in rural sections of Rio Negro, Argentina. Since 1997, we have used abdominopelvic ultrasound (US) as a screening method of CE in school children and determined an algorithm of treatment. OBJECTIVES To describe the training system of general practitioners in early diagnosis and treatment of CE and to evaluate the impact of the implementation of the field program. MATERIALS AND METHODS In 2000, to overcome the shortage of radiologists in the area, we set up a short training course on Focused Assessment with Sonography for Echinococcosis (FASE) for general practitioners with no previous experience with US. After the course, the trainees were able to carry out autonomous ultrasound surveys under the supervision of the course faculty. From 2000 to 2008, trainees carried out 22,793 ultrasound scans in children from 6 to 14 years of age, and diagnosed 87 (0.4%) new cases of CE. Forty-nine (56.4%) were treated with albendazole, 29 (33.3%) were monitored expectantly and 9 (10.3%) were treated with surgery. DISCUSSION The introduction of a FASE course for general practitioners allowed for the screening of CE in a large population of individuals in remote endemic areas with persistent levels of transmission, thus overcoming the barrier of the great distance from tertiary care facilities. The ability of local practitioners to screen for CE using US saved the local residents costly travel time and missed work and proved to be an efficacious and least expensive intervention tool for both the community and health care system.
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Affiliation(s)
- Mario Del Carpio
- Rogelio Cortizo Hospital, Ingeniero Jacobacci, Río Negro Province, Argentina
| | | | | | | | - José Sustercic
- Francisco López Lima Hospital, General Roca, Río Negro Province, Argentina
| | | | | | | | - Gabriel Talmon
- El Bolsón Hospital, El Bolsón, Río Negro Province, Argentina
| | - Marcela Volpe
- Ministry of Health, Viedma, Río Negro Province, Argentina
| | - Daniel Araya
- Ministry of Health, Viedma, Río Negro Province, Argentina
| | - Guillermo Mujica
- Rogelio Cortizo Hospital, Ingeniero Jacobacci, Río Negro Province, Argentina
| | | | - Sergio Mancini
- Ministry of Health, Viedma, Río Negro Province, Argentina
| | - Carlos Chiosso
- Ministry of Health, Viedma, Río Negro Province, Argentina
| | | | - Ricardo Saad
- “Prozome” Laboratory Viedma, Viedma, Río Negro Province, Argentina
| | - Sam Goblirsch
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Enrico Brunetti
- Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S. Matteo Hospital Foundation, and WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Edmundo Larrieu
- Ministry of Health, Viedma, Río Negro Province, Argentina
- Veterinary Faculty, National University of La Pampa, General Pico, La Pampa Province, Argentina
- * E-mail:
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Pierangeli NB, Soriano SV, Roccia I, Giménez J, Lazzarini LE, Grenóvero MS, Menestrina C, Basualdo JA. Heterogeneous distribution of human cystic echinococcosis after a long-term control program in Neuquén, Patagonia Argentina. Parasitol Int 2007; 56:149-55. [PMID: 17317277 DOI: 10.1016/j.parint.2007.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 01/15/2007] [Accepted: 01/17/2007] [Indexed: 11/19/2022]
Abstract
The present study is the first comprehensive analysis of human cystic echinococcosis (CE) epidemiological data carried out in the province of Neuquén, Patagonia Argentina, after 34 years of uninterrupted control program. A retrospective study of all the official records of confirmed human CE cases between 1995 and 2004 was carried out. A total of 1107 cases were reported. The overall mean annual incidence (MAI) was 24.4 per 100,000 inhabitants for the total population and 9.7/100,000 in the 0-14 year group. Distribution of cases by age and sex as well as frequency of cyst locations was analysed. Children accounted for 13.3% of total cases, indicating active transmission of the disease. Territorial distribution of cases was highly heterogeneous: MAI per 100,000 ranged from 7.9 in the Metropolitan Sanitary Area to 78.4 in the western rural areas. Higher values were recorded in small communities as Pilo Lil (800/100,000). MAI showed a significant decrease from 1995 to 1999 (43.9-18.8) but remains stable from 2000 to 2004 (15.9-15.5). These results suggest that standard control measures, despite long-term implementation, are not able to produce a sustained improvement of the epidemiological status of the disease. Further studies about local transmission cycles, definite and intermediate hosts present, Echinococcus granulosus strains or cultural behaviours in small communities are required in order to adequate the control actions in Neuquén.
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Affiliation(s)
- Nora B Pierangeli
- Cátedra de Microbiología y Parasitología, Escuela de Medicina, Universidad Nacional del Comahue, Buenos Aires 1400, 8300, Neuquén, Argentina.
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Moro PL, Lopera L, Bonifacio N, Gonzales A, Gilman RH, Moro MH. Risk factors for canine echinococcosis in an endemic area of Peru. Vet Parasitol 2005; 130:99-104. [PMID: 15893076 DOI: 10.1016/j.vetpar.2005.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2005] [Indexed: 10/25/2022]
Abstract
An epidemiological study was conducted in a highland rural community in Peru to determine risk factors for canine echinococcosis caused by Echinococcus granulosus. Dogs were diagnosed using a coproantigen enzyme-linked immunosorbent assay (ELISA). Dog owners were interviewed prior to stool collection and asked for attitudes, practices and beliefs likely to be associated with local patterns of E. granulosus transmission. Univariate and multivariate analysis were used to determine odds ratios (OR) and their 95% confidence intervals (CI). The main risk factors found to be significantly associated with canine echinococcosis by univariate analysis were dog age (3-25 months) (OR, 5.14; CI, 1.7-15.7), female sex (OR, 4.3; CI, 1.4-13.3) and having been fed hydatid infected offal (OR, 2.9; 95% CI, 1.0-8.6). There was complete lack of knowledge about echinococcosis transmission. In addition to periodic dog treatment, control programs need to emphasize education of the human population to increase knowledge of parasite transmission and to change human practices associated with high rates of infection.
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