Infectious Diseases of Poverty最新文献

Background: Echinococcosis is an infectious parasitic disease that is extremely harmful to human health. Albendazole is provided free of charge to patients requiring medication under the central government finance transfer payment scheme for echinococcosis control and prevention in China. Our aim is to monitor the state of patient medication and its therapeutic impact, which will help improve medication compliance and the therapeutic effect.

Methods: Random cluster sampling was used to select 10 echinococcosis-endemic counties in China, and all albendazole-treated patients in these counties were investigated. The chi-square and Kruskal-Wallis tests were used to compare two or more rates or constituent ratios, and multiple logistic regression analysis was used to identify the influencing factors. The records of patients were reviewed to obtain the initial diagnosis results as well as the most recent follow-up results and time, and efficacy was assessed.

Results: We examined 899 patient files treated with albendazole in 10 endemic counties. Of the 582 evaluable files, 7.9% did not take albendazole, and 69.2% did not take albendazole regularly. Only 22.9% took albendazole regularly. Of the 536 patients who took albendazole, 242 exhibited adverse reactions. Patients who were Tibetan, herdsmen, received no formal education, used emulsion, and exhibited adverse reactions demonstrated poor compliance. A total of 174 patients with cystic echinococcosis received their most recent imaging follow-up results within one year of the investigation date. Among them, 9 patients met the criteria for cure, accounting for 5.2%; 56 patients showed effectiveness, accounting for 32.2%; 105 patients were deemed ineffective, accounting for 59.8%; 5 patients experienced recurrence, accounting for 2.9%.

Conclusions: Albendazole medication compliance in patients with echinococcosis is not ideal. We must prioritize health education and promotion for Tibetans, herdsmen, and those without formal education. Patients who adhered to their medication regimen achieved higher rates of cure and effectiveness. To improve medication compliance and efficacy, it is particularly important to improve communication and medication guidance for patients receiving emulsions and those with adverse reactions after taking albendazole. Simultaneously strengthen patients' attention to follow-up and re-examination.

Background: Traditional Chinese medicine (TCM) has developed a rich theoretical system and practical experience in fighting to infectious diseases over the past thousands of years, and has played an important role in controlling the spread owing to its unique advantages. In particular, its significant contribution to the prevention and control of Corona Virus Disease 2019 (COVID-19) is widely recognized. COVID-19 infection is mainly non-severe with a favorable overall outcome, but patients with comorbidities tend to have a poor prognosis. However, a comprehensive review of TCM for preventing and treating COVID-19 with comorbidities across various systems is still lacking. Hence, this scoping review aims to conduct a comprehensive investigation on treatment outcome of TCM for treating COVID-19 with comorbidities across various systems.

Methods: The scoping review was conducted by searching English databases including PubMed and Web of Science, and Chinese databases including China National Knowledge Infrastructure and Wanfang between January 2020 and January 2024. We followed the inclusion and exclusion criteria to identify relevant literature. Information for inclusion in the literature were subsequently extracted and consolidated.

Results: We enrolled 13 literature that met the inclusion criteria in the review finally. Our analysis revealed that research on COVID-19 with comorbidities was mostly focused on circulatory diseases, including hypertension, heart failure, and cerebrovascular diseases, most common comorbidities were hypertension. Followed by endocrine and metabolic diseases such as diabetes, respiratory diseases including pulmonary tuberculosis and chronic obstructive pulmonary disease have been also addressed. However, there were few studies on co-infectious urogenital system disease, and no studies on the rheumatic, immune, hematological, nervous, reproductive, and skin systems diseases. Based on existing studies, TCM has significantly improved the clinical symptoms of COVID-19 with comorbidities such as fever, fatigue, dry cough, anorexia and asthma, the absorption of lung lesions, shortened the duration of viral shedding and the course of disease.

Conclusions: TCM has great application prospects in treating COVID-19 with comorbidities. These findings could provide important evidence for clinicians to treat COVID-19 with comorbidities. Multi-center studies are required to confirm our results in the future.

Background: Food-borne trematodiases (FBTs), mainly encompassing clonorchiasis, fascioliasis, fasciolopsiasis, opisthorchiasis, and paragonimiasis, is a neglected public health problem, particularly in the WHO South-East Asia and the Western Pacific regions. This study evaluates the global, regional, and national disease burden of FBTs from 1990 to 2021 and projects trends to 2030, underscore the need for targeted prevention and control.

Methods: Using the Global Burden of Disease 2021 database, the crude and the age-standardized prevalence rate (ASPR) and age-standardized prevalence disability-adjusted life years rate (ASDR) of FBTs at the global, regional and national level from 1990 to 2021 were described. The pivotal years of trend changes were identified using joinpoint regression analysis. The effects of age, period, cohort on FBTs prevalence and correlation with the sociodemographic index (SDI) was analyzed. Finally, the worldwide disability-adjusted life years (DALYs) for FBTs, projected up to 2030 using the Bayesian age-period-cohort model, were analyzed.

Results: In 2021, 44,466,329 FBTs cases [95% uncertainty interval (UI): 40,017,217, 50,034,921], and 998,028 DALYs [95% UI: 569,766, 1,638,112] were estimated across 17 countries. The Western Pacific region exhibited the highest ASPR and ASDR, with the values of 1649.26 (95% UI: 1461.95, 1881.64) and 36.54 (95% UI: 19.77, 64.16), respectively. From 1990 to 2021, Lao PDR, Thailand, and the Philippines showed the most substantial declines in FBTs, while Kazakhstan had the largest average annual percentage change in DALYs (- 6.60, 95% UI: - 7.10, - 6.10). High-middle and middle SDI countries exhibited higher burden, with ASDR values of 28.03 (95% UI: 15.41, 48.73) and 16.63 (95% UI: 9.32, 27.68), respectively. The disease burden was greater among males, peaking in the 50-59 age group. The projected ASDR in 2030 is 13.10 for males and 8.40 for females.

Conclusions: FBTs remain a public health threat, with the global ASDR projected to remain stable, showing only a slight decrease by 2030. Low-income countries face ambiguous mortality rates and underestimated disease burdens, highlighting the need for improved surveillance. To achieve the 2030 NTD goal, comprehensive surveillance and integrated strategies derived using a One Health approach should be prioritized to control FBTs effectively.

Background: Vector-borne parasitic infectious diseases associated with poverty (referred to as vb-pIDP), such as malaria, leishmaniasis, lymphatic filariasis, African trypanosomiasis, Chagas disease, and onchocerciasis, are highly prevalent in many regions around the world. This study aims to characterize the recent burdens of and changes in these vb-pIDP globally and provide a comprehensive and up-to-date analysis of geographical and temporal trends.

Methods: Data on the prevalence and disability-adjusted life years (DALYs) of the vb-pIDP were retrieved from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021 for 21 geographical regions and 204 countries worldwide, from 1990-2021. The age-standardized prevalence rate and DALYs rate by age, sex, and sociodemographic index (SDI) were calculated to quantify temporal trends. Correlation analysis was performed to examine the relationship between the age-standardized rate and the SDI.

Results: Over the past 30 years, the age-standardized prevalence rate and DALYs rate of these vb-pIDP have generally decreased, with some fluctuations. The distribution of vb-pIDP globally is highly distinctive. Except for Chagas disease, the age-standardized prevalence rate and DALYs rate of other vb-pIDP were highest in low-SDI regions by 2021. Malaria had the highest age-standardized prevalence rate (2336.8 per 100,000 population, 95% UI: 2122.9, 2612.2 per 100,000 population) and age-standardized DALYs rate (806.0 per 100,000 population, 95% UI: 318.9, 1570.2 per 100,000 population) among these six vb-pIDP globally. Moreover, significant declines in the age-standardized prevalence rate and DALYs rate have been observed in association with an increase in the SDI . Globally, 0.14% of DALYs related to malaria are attributed to child underweight, and 0.08% of DALYs related to malaria are attributed to child stunting.

Conclusions: The age-standardized prevalence rate and DALY rates for the vb-pIDP showed pronounced decreasing trends from 1990-2021. However, the vb-pIDP burden remains a substantial challenge for vector-borne infectious disease control globally and requires effective control strategies and healthcare systems. The findings provide scientific evidence for designing targeted health interventions and contribute to improving the prevention and control of infectious diseases.

Background: Toxoplasma gondii oocysts, excreted in cat feces, pose a significant health risk to humans through contaminated soil and water. Rapid and accurate detection of T. gondii in environmental samples is essential for public health protection.

Methods: We developed a novel, single-tube detection method that integrates loop-mediated isothermal amplification (LAMP), the clustered regularly interspaced short palindromic repeats (CRISPR)/Cas12b system, and lateral flow immunoassay strips for rapid, visual identification of T. gondii. This method targets the T. gondii B1 gene, initially amplifies it with LAMP, directed by a single-guide RNA (sgRNA). It then recognizes the amplified target gene and activates trans-cleavage, cutting nearby single-stranded DNA (ssDNA) reporters. Fluorescence detection was performed using a 6-Carboxyfluorescein (FAM)-12N-Black Hole Quencher-1 (BHQ1) reporter, while Fluorescein Isothiocyanate (FITC)-12N-Biotin enabled visual detection on lateral flow strips. The method was tested for its ability to detect various T. gondii genotypes and related parasites, assessing its specificity and broad-spectrum applicability. It was further applied to real-world environmental samples to evaluate its practicality.

Results: The LAMP-CRISPR/Cas12b method exhibited high specificity and broad-spectrum detection capability, successfully identifying nine T. gondii genotypes and distinguishing them from 11 other parasitic species. Sensitivity testing at both molecular (plasmid) and practical (oocyst) levels showed detection limits of 10  copies/μL and 0.1 oocyst, respectively. When applied to 112 environmental samples (soil, water, and cat feces), the method demonstrated 100% sensitivity, accurately reflecting known infection rates.

Conclusions: This LAMP-CRISPR/Cas12b single-tube method offers a robust, innovative approach for monitoring zoonotic T. gondii in environmental samples, with significant implications for public health surveillance.

Background: Despite consecutive decades of success in reducing malaria transmission, Ethiopia went off track towards its goal of malaria elimination by 2030, as outlined in the NMCP malaria strategy. Recent malaria outbreaks in Ethiopia are attributed to the emergence and spread of diagnostic and drug-resistant Plasmodium falciparum, increased insecticide resistance in major vectors and the spread of invasive Anopheles stephensi. The effects of the COVID-19 pandemic, environmental anomalies and internal conflicts have also potentially played a role in increasing malaria transmission. This study aimed to evaluate the contribution of environmental factors and An. stephensi to the spatiotemporal trends of recent malaria cases in Ethiopia.

Methods: Clinical malaria case data reported weekly between January 2013 and January 2023 were obtained from the Ethiopian Public Health Institute (EPHI), Addis Ababa. A negative binomial regression model was used to explain the variability and potential overdispersion in the weekly number of malaria cases reported across Ethiopian administrative zones. This model incorporated fixed effects for selected environmental factors and random effects to capture temporal trends, zone specific seasonal patterns, spatial trends at the zone level, and the presence of An. stephensi and its impact.

Results: Our negative binomial regression model highlighted 56% variability in the data and slightly more than half (55%) was due to environmental factors, while the remainder was captured by random effects. A significant nationwide decline in malaria risk was observed between 2013 and 2018, followed by a sharp increase in early 2022. Malaria risk was higher in western and northwestern zones of Ethiopia compared to other zones. Zone-specific seasonal patterns, not explained by environmental factors, were grouped into four clusters of seasonal behaviours. The presence of An. stephensi was not shown to have any significant impact on malaria risk.

Conclusions: Understanding the spatial and temporal drivers of malaria transmission and therefore identifying more appropriate malaria control strategies are key to the success of any malaria elimination and eradication programmes in Ethiopia. Our study found that approximately 50% of malaria risk variability could be explained by environmental, temporal, and spatial factors included in the analysis, while the remaining variation was unexplained and may stem from other factors not considered in this study. This highlights the need for a better understanding of underlying factors driving local malaria transmission and outbreaks, to better tailor regional programmatic responses.

Background: Reactive case detection (RACD) for malaria control has been found effective in low transmission settings, but its impact and cost-effectiveness in moderate-to-high transmission settings are unknown. We conducted an economic evaluation alongside an empirical trial of a modified RACD strategy (1,7-mRCTR) in three moderate-to-high malaria transmission districts in Tanzania.

Methods: The costs and cost savings associated with the intervention relative to passive case detection alone were estimated in the study sites of Kilwa, Kibiti, and Rufiji districts in Tanzania from 2019-2021. Empirical cost data were collected using household surveys. The incremental costs of the intervention were calculated from under a societal perspective. Costs are reported in 2022 US dollars. Trial data and malaria registers from health facilities were used to calculate the number of malaria cases detected. We simulated unobserved and distal health effects of the intervention to assess cost-effectiveness in terms of incremental cost-effectiveness ratios (ICERs). Propagated uncertainty was assessed via second-order Monte Carlo simulation, including bootstrapping of empirical data distributions. Incremental costs per disability-adjusted life year (DALY) averted were compared to a willingness-to-pay threshold based on estimated opportunity costs of healthcare spending in Tanzania.

Results: The programmatic cost of the 1,7-mRCTR intervention was 5327 United States Dollars (USD) per 1000 population. The combination of reactive and passive case detection in the intervention arm resulted in an additional 445 malaria cases detected per 1000 compared to passive detection alone, yielding an incremental cost per additional case detected of 12.0 USD. Based on modelling results, for every percentage point decline in malaria prevalence, the intervention averted 95.2 cases and 0.04 deaths per 1000 population. On average, the 1,7-mRCTR intervention averted 19.1 DALYs per 1000 population. Compared to passive malaria detection, the ICERs for the 1,7-mRCTR intervention were 7.3 USD per case averted, 16,884 USD per death averted, and 163 USD per DALY averted.

Conclusions: Our analysis demonstrates that the 1,7-mRCTR intervention appears to be cost-effective under a willingness-to-pay threshold of 417 USD per DALY averted, showing that modified RACD strategies can provide value for money in moderate-to-high transmission settings.

Background: Stigma experienced by people with infectious diseases impedes access to care, leading to adverse psychosocial consequences. Community-based interventions could prevent or mitigate these consequences but lack robust evidence. This scoping review aimed to identify and critically appraise community-based psychosocial support interventions to reduce stigma and improve mental health for people affected by stigmatizing infectious diseases including tuberculosis (TB), HIV/AIDS, and leprosy.

Methods: This was a scoping review of literature indexed in PubMed, Web of Science, Elton B. Stephens Company (EBSCO) database, as well as reports in the World Health Organization repository, published from January 2000 to June 2023. We included research articles and reports addressing stigma and mental health disorders among individuals with TB, HIV/AIDS, or leprosy and/or their household members in low- and middle-income and/or high TB burden countries. We extracted information regarding types of psychosocial interventions and their reported impact on health and psychosocial indicators.

Results: Thirty studies were included in this review: 21 (70%) related to HIV/AIDS, seven (23%) leprosy, and two (7%) TB. Of these, eleven were quantitative studies, nine qualitative, and ten mixed-methods. Eleven community-based interventions were reported to reduce infectious disease-related stigma, predominantly internalized and enacted stigma, and improve adherence to medication, quality of life, health-related knowledge, depression symptoms, and psychosocial wellbeing. Most studies involved lay people in the community as supporters of those affected. The predominant reported mechanism of intervention effect was the ability of supporters to enable those affected to feel seen and listened to, to accept their diagnosis, to improve their self-esteem, and to facilitate continuation of their daily lives, and thereby reducing anticipated stigma, self-stigma, and mental illness. Adequate training for lay people was reported to be essential to ensure success of interventions.

Conclusions: This review identified a paucity of high-quality evidence relating to community-based interventions to reduce stigma for infectious diseases. However, such interventions have been reported to reduce stigma and improve mental health among people with HIV/AIDS, leprosy, and TB. Engaging affected communities and peers, through the conception, planning, training, implementation, and evaluation phases, was reported to be essential to optimise intervention uptake, impact, and sustainability.

Background: Aedes mosquitoes pose a significant global threat as vectors for several debilitating arboviruses, including dengue, Zika, yellow fever, and chikungunya. Their unique breeding habits, behavior, and daytime activity complicate control efforts, prompting the search for innovative solutions. The sterile insect technique (SIT) and incompatible insect technique (IIT) are promising new techniques under investigation. This review synthesizes findings from field trials on SIT and/or IIT for Aedes mosquito control.

Methods: A scoping review was conducted through comprehensive searches on Scopus, Web of Science, MEDLINE, PubMed, and preprint repositories up to April 25, 2024. Studies were initially screened for relevance based on their titles and abstracts, followed by a full-text review conducted by two independent extractors. Only field trials with control groups were included, with the final assessment focusing on trials reporting epidemiological outcomes. Data were abstracted into templates, emphasizing study design, intervention details, and outcomes. The review adhered to the PRISMA-ScR guidelines.

Results: The search identified 21 field trials in various countries against Aedes mosquitoes. These trials employed diverse methodologies and mosquito release strategies, achieving varying levels of mosquito population suppression. Notably, two SIT and two Wolbachia-based IIT trials reported epidemiological outcomes, including reductions in dengue incidence and associated risk ratios. However, the reliance on national surveillance data for assessing dengue incidence suggests caution due to the potential underreporting of subclinical cases.

Conclusions: The review underscores the promise of SIT and IIT for controlling Aedes mosquito populations, citing successful reductions in mosquito densities and dengue transmission. However, it calls for more rigorous study designs and standardized methodologies, as well as the adoption of comprehensive frameworks to accurately assess the effectiveness of these interventions. Future research should focus on bridging gaps in real-world effectiveness by addressing factors such as feasibility, acceptability, scalability, and cost, which are crucial for guiding their successful large-scale deployment in any country.

Background: Detection of infection with Mycobacterium leprae allows timely prophylactic treatment, thereby reducing transmission as well as the risk of permanent, leprosy-associated nerve damage. However, since there is no worldwide-implemented standard test for M. leprae infection, detection of infection in asymptomatic individuals remains a major challenge for control programs in endemic areas. In previous studies, we developed and field-tested a lateral flow assay (LFA) quantitatively detecting human IgM against M. leprae-specific phenolic glycolipid I (anti-PGL-I), a marker for both active and past infection. This rapid test utilizes luminescent, background-free, up-converting reporter particles (UCP) and immunochromatography (i.e. the UCP-LF test platform) for accurate quantitation of anti-PGL-I IgM without operator bias. The aim of this study was to evaluate the final version of this quantitative UCP-based rapid test (i.e. PGL-I QURapid), using serum and fingerstick blood (FSB).

Methods: The test comprises a lateral flow strip, in a standard plastic or biodegradable cassette. It can be provided with a humanized, recombinant control to monitor test performance and calculate accurate anti-PGL-I IgM levels. The performance of this QUR-test was assessed using serum and FSB from patients with leprosy (n = 214), tuberculosis (n = 20), buruli ulcer (n = 19), leishmaniasis (n = 14), non-tuberculous mycobacterial (n = 35) infections, as well as healthy Dutch individuals (n = 710) and humanized, recombinant anti-PGL-I IgM antibodies. Plot receiver operating characteristic curves were created and sensitivity (Sn), specificity (Sp) and the area under the curve were calculated to evaluate test performance.

Results: Test results classified multibacillary leprosy patients with 95.0% Sn and 100% Sp using serum and 91.5% Sn and 99.8% Sp using FSB. Qualitative test results could be read after 2 min flow time, with accurate quantitation from 10 min onwards. The new anti-PGL-I IgM control supports production of batches with predetermined seropositivity thresholds and monitoring of the PGL-I QUR-test in various settings.

Conclusion: The operational version of the PGL-I QURapid with point-of-care applicability, meets the WHO target product profile criteria. Thus, this QUR-test is ready for public health implementations.