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• W1520662430 abstract "Background: Schistosomiasis is a water-based disease, endemic in over 70 countries in thetropics and subtropics. At present, the bulk of the global burden is concentrated in sub-Saharan Africa. Some important foci exist in South America, the Middle East, Southeast Asiaand in China. We reviewed the literature, used the latest population statistics and estimate thatglobally, 207 million people are infected and 779 millions are at risk of infection. Soiltransmittedhelminthiasis caused by Ascaris lumbricoides, hookworms and Trichuris trichiura,is highly endemic throughout the tropics and elsewhere, particularly in resource-constraintsettings. At least 1 billion people worldwide are infected, many of whom harbour multiplespecies concurrently. Strongyloides stercoralis is a far less recognized and researched soiltransmittedhelminth. Taenia spp. is transmitted via raw and undercooked meat dishes and isendemic globally but, similar to S. stercoralis, accurate statistics and distribution maps arelacking. All these parasites belong to the group of the so-called neglected tropical diseases. Inrecent years, different programmes have been launched with an aim to providing regularanthelminthic treatment to millions of people worldwide. However, only a handful of safe andefficacious drugs are available, but none of them covers the entire parasite spectrum. Whilechemotherapy is a key strategy to reduce morbidity, other measures are necessary to achievesustainable control.Schistosoma japonicum, soil-transmitted helminths, Taenia spp. and other helminths arecommon throughout China. In view of the profound demographic, ecological and socioeconomictransformations China has gone through over the past 30 years, the distribution andfrequency of many parasites has changed. Shifts have been attributed to regional variations incontrol efforts, socio-economic development and changing customs.Objectives: This Ph.D. thesis pursued five specific objectives. First, to systematically reviewthe literature with regard to the effects of water resources development on the localepidemiology of schistosomiasis. Second, to study the epidemiology of S. japonicum andother helminth infections across Eryuan county, Yunnan province, China. Third, to identifyrisk factors for S. japonicum seropositivity in Eryuan county, and to put forward predictiverisk maps. Fourth, to study intestinal multiparasitism, the local endemicity of S. stercoralisand the performance of diagnostic tools in Menghai county, Yunnan province. Fifth, to assessthe safety and efficacy of tribendimidine against S. stercoralis and Taenia spp.Methods: The available data regarding the number and spatial extent of large dam reservoirsand surface-irrigation in schistosome-endemic areas were compiled and multiplied withcountry-specific rural population density estimates. We systematically reviewed the literatureto identify studies pertaining to the effect of water resources development projects onschistosomiasis, and carried out a meta-analysis and calculated risk ratios.The cross-sectional survey in Eryuan county involved 3220 individuals from 35 villages.They were screened by parasitological (S. japonicum, intestinal helminths) and serologicalmethods (schistosomiasis, cysticercosis, trichinellosis). Questionnaires were administered toobtain demographic, behavioural, and socio-economic data. Geographical, remotely-sensedenvironmental, demographic, and epidemiological data were used in a spatially-explicitBayesian model to predict the risk of schistosomiasis japonica seroprevalence across thecounty. The endemic spectrum of intestinal parasites was assessed in Nongyang village insouthern Yunnan province where 2-3 stool samples were collected from 215 individuals, andanalysed by four different diagnostic approaches, i.e. Kato-Katz, Baermann, Koga agar plateand ether-concentration after conservation of the stool sample in sodium acetate-acetic acidformalinesolution. The effect of the sampling effort on the measured prevalence, and thediagnostic performance of the different techniques were assessed. The safety and efficacy oftribendimidine for treating S. stercoralis and Taenia spp. infections was investigated inNanweng village. A single oral dose of tribendimidine was administered to 57 individuals,and results were compared to the effect of a single oral dose of albendazole given to 66individuals. The efficacy was assessed 2-3 weeks post-treatment based on 2-3 stool samplesscreened before and after treatment using different methods.Results: A predicted 106 million people at risk of schistosomiasis live adjacent (≤5 km) tolarge dam reservoirs or in irrigated areas. We identified 58 studies, mainly from Africansettings, and included a subset of 24 studies containing 35 datasets to calculate pooled randomrisk ratios. People living in close proximity to large dam reservoirs were at a 2.4-fold (95%confidence interval [CI]: 1.4-3.9) higher risk of S. haematobium and at a 2.6-fold (95% CI:1.4-5.0) risk of S. mansoni. In irrigated areas, the pooled random risk ratios were 1.1 (95% CI:0.02-7.3) for S. haematobium and 4.7 (95% CI: 0.49-23.0) for S. mansoni.The most common helminth in Eryuan county was A. lumbricoides (15.4%), followed byTaenia spp. (3.5%) and S. japonicum (2.7%) in known schistosome-endemic villages.Seroprevalences were high; 58.8% for trichinellosis, 49.5% for schistosomiasis japonica inknown S. japonicum-endemic villages, and 18.5% for cysticercosis. Prevalences as well as thesocio-economic status of the families showed strong spatial heterogeneity; most helminthswere more prevalent among the poor in mountainous areas but S. japonicum and trichinellosiswere mainly found among the better-off inhabitants of plain areas. Being Han and growingtobacco were additional risk factors for S. japonicum. Sero- and egg-positive individuals werealso found outside the recognized S. japonicum-endemic villages. The spatially-explicitBayesian model identified demographic (age and sex) and geographical (slope and elevation)risk factors, and predicted higher S. japonicum seroprevalences for the plain areas whencompared to mountainous regions.Fifteen parasite species were identified in Nongyang village, eight helminths and sevenprotozoa. The prevalence of the three common soil-transmitted helminth exceeded 85% each.We found a S. stercoralis prevalence of 11.7% with a predominance among adult males. Theprevalence of intestinal protozoa was lower; the most common was Blastocystis hominis(20.0%). Most study participants harboured three intestinal parasites concurrently (range 1-6).Infection intensities were mainly light for T. trichiura and hookworm, but moderate forA. lumbricoides. The collection of multiple stool samples resulted in higher prevalences, mostnotably for S. stercoralis and hookworms. Pooling results from multiple methods consistentlyincreased the overall sensitivity.A single oral dose of tribendimidine (200 mg for those 5-14 years old; 400 mg for those≥15 years old) reduced the S. stercoralis prevalence from 19.3% to 8.8% (cure rate: 54.5%,P = 0.107) and the Taenia spp. prevalence from 26.3% to 8.8% (cure rate: 66.7%, P = 0.014).Albendazole treatment resulted in comparable prevalence reductions. At treatment evaluation,additional infections were discovered among those previously declared uninfected. Theseinfections were most likely missed before due to lack of diagnostic sensitivity. Consideringthese “new” infections reduced the net cure rate, most notably for Taenia spp. among thealbendazole group. For Taenia spp., the difference between the tribendimidine andalbendazole-specific cure rates became significant (P = 0.001).Conclusions/significance: The distribution map of human helminth infections in Yunnanprovince, China still has many white spots and important shifts in the spectrum andprevalence of endemic parasites are expected in the face of the ongoing socio-economicdevelopment. New survey approaches, diagnostic tools and risk profiling techniques havebeen introduced, and the local epidemiology of S. japonicum and further parasites includinghelminths and intestinal protozoa has been elucidated. S. stercoralis is endemic in Yunnanprovince. The safety and efficacy of a potentially additional tool in future control efforts fortreating S. stercoralis and Taenia spp. – i.e. tribendimidine – was studied. The studiesconducted in the frame of this Ph.D. thesis document the current situation pertaining tovarious currently neglected parasites and in hitherto unexplored settings, thus providing abase for the articulation of much needed control programmes which respond to local needs." @default.
• W1520662430 created "2016-06-24" @default.
• W1520662430 creator A5001303535 @default.
• W1520662430 date "2008-01-01" @default.
• W1520662430 modified "2023-09-23" @default.
• W1520662430 title "Epidemiology and diagnosis of Schistosoma japonicum, other helminth infections and multiparasitism in Yunnan province, People's Republic of China" @default.
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• W1520662430 doi "https://doi.org/10.5451/unibas-004493318" @default.
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