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Lund AJ, Sokolow SH, Jones IJ, Wood CL, Ali S, Chamberlin A, Sy AB, Sam MM, Jouanard N, Schacht AM, Senghor S, Fall A, Ndione R, Riveau G, De Leo GA, López-Carr D. Exposure, hazard, and vulnerability all contribute to Schistosoma haematobium re-infection in northern Senegal. PLoS Negl Trop Dis 2021; 15:e0009806. [PMID: 34610025 PMCID: PMC8525765 DOI: 10.1371/journal.pntd.0009806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 10/19/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Infectious disease risk is driven by three interrelated components: exposure, hazard, and vulnerability. For schistosomiasis, exposure occurs through contact with water, which is often tied to daily activities. Water contact, however, does not imply risk unless the environmental hazard of snails and parasites is also present in the water. By increasing reliance on hazardous activities and environments, socio-economic vulnerability can hinder reductions in exposure to a hazard. We aimed to quantify the contributions of exposure, hazard, and vulnerability to the presence and intensity of Schistosoma haematobium re-infection. Methodology/Principal findings In 13 villages along the Senegal River, we collected parasitological data from 821 school-aged children, survey data from 411 households where those children resided, and ecological data from all 24 village water access sites. We fit mixed-effects logistic and negative binomial regressions with indices of exposure, hazard, and vulnerability as explanatory variables of Schistosoma haematobium presence and intensity, respectively, controlling for demographic variables. Using multi-model inference to calculate the relative importance of each component of risk, we found that hazard (Ʃwi = 0.95) was the most important component of S. haematobium presence, followed by vulnerability (Ʃwi = 0.91). Exposure (Ʃwi = 1.00) was the most important component of S. haematobium intensity, followed by hazard (Ʃwi = 0.77). Model averaging quantified associations between each infection outcome and indices of exposure, hazard, and vulnerability, revealing a positive association between hazard and infection presence (OR = 1.49, 95% CI 1.12, 1.97), and a positive association between exposure and infection intensity (RR 2.59–3.86, depending on the category; all 95% CIs above 1) Conclusions/Significance Our findings underscore the linkages between social (exposure and vulnerability) and environmental (hazard) processes in the acquisition and accumulation of S. haematobium infection. This approach highlights the importance of implementing both social and environmental interventions to complement mass drug administration. While the impacts of natural hazards tend to be described in terms of social determinants such as exposure and vulnerability, the risk for infectious disease is often expressed in terms of environmental determinants without fully considering the socio-ecological processes that put people in contact with infective agents of disease. In the case of schistosomiasis, risk is determined by human interactions with freshwater environments where schistosome parasites circulate between people and aquatic snails. In this study, we quantified the relative contributions of exposure, hazard, and vulnerability to schistosome re-infection among schoolchildren in an endemic region of northern Senegal. We find that hazard and vulnerability influence whether a child becomes infected, while exposure and hazard influence the burden of worms once infection is acquired. Increasing numbers of worms is known to be positively associated with increasing severity of disease. Our findings underscore the importance of evaluating social and environmental determinants of disease simultaneously; omitting measures of exposure, hazard or vulnerability may limit our understanding of risk.
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Affiliation(s)
- Andrea J. Lund
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Susanne H. Sokolow
- Hopkins Marine Station, Stanford University, Pacific Grove, California, United States of America
- Woods Institute for the Environment, Stanford University, Stanford, California, United States of America
| | - Isabel J. Jones
- Hopkins Marine Station, Stanford University, Pacific Grove, California, United States of America
| | - Chelsea L. Wood
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, Washington, United States of America
| | - Sofia Ali
- Stanford University, Stanford, California, United States of America
| | - Andrew Chamberlin
- Hopkins Marine Station, Stanford University, Pacific Grove, California, United States of America
| | - Alioune Badara Sy
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - M. Moustapha Sam
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - Nicolas Jouanard
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
- Station d’Innovation Aquacole, Saint Louis, Sénégal
| | - Anne-Marie Schacht
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
- University of Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
| | - Simon Senghor
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - Assane Fall
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - Raphael Ndione
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - Gilles Riveau
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
- University of Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
| | - Giulio A. De Leo
- Hopkins Marine Station, Stanford University, Pacific Grove, California, United States of America
- Woods Institute for the Environment, Stanford University, Stanford, California, United States of America
| | - David López-Carr
- Department of Geography, University of California, Santa Barbara, CA, United States of America
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Abstract
Transmissibility is the defining characteristic of infectious diseases. Quantifying transmission matters for understanding infectious disease epidemiology and designing evidence-based disease control programs. Tracing individual transmission events can be achieved by epidemiological investigation coupled with pathogen typing or genome sequencing. Individual infectiousness can be estimated by measuring pathogen loads, but few studies have directly estimated the ability of infected hosts to transmit to uninfected hosts. Individuals' opportunities to transmit infection are dependent on behavioral and other risk factors relevant given the transmission route of the pathogen concerned. Transmission at the population level can be quantified through knowledge of risk factors in the population or phylogeographic analysis of pathogen sequence data. Mathematical model-based approaches require estimation of the per capita transmission rate and basic reproduction number, obtained by fitting models to case data and/or analysis of pathogen sequence data. Heterogeneities in infectiousness, contact behavior, and susceptibility can have substantial effects on the epidemiology of an infectious disease, so estimates of only mean values may be insufficient. For some pathogens, super-shedders (infected individuals who are highly infectious) and super-spreaders (individuals with more opportunities to transmit infection) may be important. Future work on quantifying transmission should involve integrated analyses of multiple data sources.
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Guelbéogo WM, Gonçalves BP, Grignard L, Bradley J, Serme SS, Hellewell J, Lanke K, Zongo S, Sepúlveda N, Soulama I, Wangrawa DW, Yakob L, Sagnon N, Bousema T, Drakeley C. Variation in natural exposure to anopheles mosquitoes and its effects on malaria transmission. eLife 2018; 7:32625. [PMID: 29357976 PMCID: PMC5780040 DOI: 10.7554/elife.32625] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/30/2017] [Indexed: 11/25/2022] Open
Abstract
Variation in biting frequency by Anopheles mosquitoes can explain some of the heterogeneity in malaria transmission in endemic areas. In this study in Burkina Faso, we assessed natural exposure to mosquitoes by matching the genotype of blood meals from 1066 mosquitoes with blood from residents of local households. We observed that the distribution of mosquito bites exceeded the Pareto rule (20/80) in two of the three surveys performed (20/85, 76, and 96) and, at its most pronounced, is estimated to have profound epidemiological consequences, inflating the basic reproduction number of malaria by 8-fold. The distribution of bites from sporozoite-positive mosquitoes followed a similar pattern, with a small number of individuals within households receiving multiple potentially infectious bites over the period of a few days. Together, our findings indicate that heterogeneity in mosquito exposure contributes considerably to heterogeneity in infection risk and suggest significant variation in malaria transmission potential.
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Affiliation(s)
- Wamdaogo M Guelbéogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Bronner Pamplona Gonçalves
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lynn Grignard
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Bradley
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samuel S Serme
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Joel Hellewell
- MRC Centre for Outbreak Analysis & Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Kjerstin Lanke
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Soumanaba Zongo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Nuno Sepúlveda
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre of Statistics and Applications, University of Lisbon, Lisbon, Portugal
| | - Issiaka Soulama
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Dimitri W Wangrawa
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - N'Falé Sagnon
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ciddio M, Mari L, Sokolow SH, De Leo GA, Casagrandi R, Gatto M. The spatial spread of schistosomiasis: A multidimensional network model applied to Saint-Louis region, Senegal. ADVANCES IN WATER RESOURCES 2017; 108:406-415. [PMID: 29056816 PMCID: PMC5637889 DOI: 10.1016/j.advwatres.2016.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/13/2016] [Accepted: 10/10/2016] [Indexed: 05/06/2023]
Abstract
Schistosomiasis is a parasitic, water-related disease that is prevalent in tropical and subtropical areas of the world, causing severe and chronic consequences especially among children. Here we study the spatial spread of this disease within a network of connected villages in the endemic region of the Lower Basin of the Senegal River, in Senegal. The analysis is performed by means of a spatially explicit metapopulation model that couples local-scale eco-epidemiological dynamics with spatial mechanisms related to human mobility (estimated from anonymized mobile phone records), snail dispersal and hydrological transport of schistosome larvae along the main water bodies of the region. Results show that the model produces epidemiological patterns consistent with field observations, and point out the key role of spatial connectivity on the spread of the disease. These findings underline the importance of considering different transport pathways in order to elaborate disease control strategies that can be effective within a network of connected populations.
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Affiliation(s)
- Manuela Ciddio
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy
| | - Lorenzo Mari
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy
| | - Susanne H. Sokolow
- Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, United States
- Marine Science Institute, University of California, Santa Barbara, CA 93106, United States
| | - Giulio A. De Leo
- Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, United States
| | - Renato Casagrandi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy
| | - Marino Gatto
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy
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Mari L, Ciddio M, Casagrandi R, Perez-Saez J, Bertuzzo E, Rinaldo A, Sokolow SH, De Leo GA, Gatto M. Heterogeneity in schistosomiasis transmission dynamics. J Theor Biol 2017; 432:87-99. [PMID: 28823529 PMCID: PMC5595357 DOI: 10.1016/j.jtbi.2017.08.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/30/2017] [Accepted: 08/15/2017] [Indexed: 01/30/2023]
Abstract
Transmission dynamics of schistosomiasis presents multiple heterogeneity sources. A comprehensive framework for heterogeneous disease transmission is proposed. Heterogeneous multigroup communities can be more prone to parasite transmission. Presence of multiple water sources can hinder parasite transmission. Spatial and temporal heterogeneities can have nontrivial implications for endemicity.
Simple models of disease propagation often disregard the effects of transmission heterogeneity on the ecological and epidemiological dynamics associated with host-parasite interactions. However, for some diseases like schistosomiasis, a widespread parasitic infection caused by Schistosoma worms, accounting for heterogeneity is crucial to both characterize long-term dynamics and evaluate opportunities for disease control. Elaborating on the classic Macdonald model for macroparasite transmission, we analyze families of models including explicit descriptions of heterogeneity related to differential transmission risk within a community, water contact patterns, the distribution of the snail host population, human mobility, and the seasonal fluctuations of the environment. Through simple numerical examples, we show that heterogeneous multigroup communities may be more prone to schistosomiasis than homogeneous ones, that the availability of multiple water sources can hinder parasite transmission, and that both spatial and temporal heterogeneities may have nontrivial implications for disease endemicity. Finally, we discuss the implications of heterogeneity for disease control. Although focused on schistosomiasis, results from this study may apply as well to other parasitic infections with complex transmission cycles, such as cysticercosis, dracunculiasis and fasciolosis.
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Affiliation(s)
- Lorenzo Mari
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy.
| | - Manuela Ciddio
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy
| | - Renato Casagrandi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy
| | - Javier Perez-Saez
- Laboratory of Ecohydrology, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
| | - Enrico Bertuzzo
- Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari Venezia, 30170 Venezia Mestre, Italy
| | - Andrea Rinaldo
- Laboratory of Ecohydrology, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland; Dipartimento ICEA, Università di Padova, 35131 Padova, Italy
| | - Susanne H Sokolow
- Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, USA; Marine Science Institute, University of California, Santa Barbara, CA 93106, USA
| | - Giulio A De Leo
- Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, USA
| | - Marino Gatto
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy
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Abstract
Schistosomiasis is a chronic disease that affects ∼200 million people. The extended health impact of the disease has been estimated to exceed that of malaria or tuberculosis and to be nearer to that of HIV/AIDS. Within endemic areas, children carry the heaviest burden of infection. Infection/disease is controlled by the treatment of infected subjects with the anthelminthic drug praziquantel. Global initiatives from Partners of Parasite Control, including the World Health Organization (WHO), advocate regular school-based deworming strategies to reduce the development of severe morbidity, promote school-child health and development, and improve the cognitive potential of children. Until recently, preschool-aged children were excluded from schistosome treatment, creating a health inequity in affected populations. In 2010, the WHO updated their recommendations for the treatment of schistosomiasis in preschool-aged children (ie, children aged ≤5 years). This change was the culmination of several decades of research on schistosome epidemiology, immunology, and pathology in this age group. The recent development of a pediatric formulation of praziquantel (soon to enter clinical trials) should advance control efforts in preschool-aged children, with the goal of including these children in preventative chemotherapy (as currently occurs for soil-transmitted helminths). This review discusses the research work supporting the WHO revision of recommendations for treating preschool-aged children, as well as current barriers and knowledge gaps in pediatric schistosomiasis control.
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Affiliation(s)
- Francisca Mutapi
- Institute of Immunology and Infection Research, Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
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7
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Bisanzio D, Mutuku F, Bustinduy AL, Mungai PL, Muchiri EM, King CH, Kitron U. Cross-sectional study of the burden of vector-borne and soil-transmitted polyparasitism in rural communities of Coast Province, Kenya. PLoS Negl Trop Dis 2014; 8:e2992. [PMID: 25057825 PMCID: PMC4109907 DOI: 10.1371/journal.pntd.0002992] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Abstract
Background In coastal Kenya, infection of human populations by a variety of parasites often results in co-infection or poly-parasitism. These parasitic infections, separately and in conjunction, are a major cause of chronic clinical and sub-clinical human disease and exert a long-term toll on economic welfare of affected populations. Risk factors for these infections are often shared and overlap in space, resulting in interrelated patterns of transmission that need to be considered at different spatial scales. Integration of novel quantitative tools and qualitative approaches is needed to analyze transmission dynamics and design effective interventions. Methodology Our study was focused on detecting spatial and demographic patterns of single- and co-infection in six villages in coastal Kenya. Individual and household level data were acquired using cross-sectional, socio-economic, and entomological surveys. Generalized additive models (GAMs and GAMMs) were applied to determine risk factors for infection and co-infections. Spatial analysis techniques were used to detect local clusters of single and multiple infections. Principal findings Of the 5,713 tested individuals, more than 50% were infected with at least one parasite and nearly 20% showed co-infections. Infections with Schistosoma haematobium (26.0%) and hookworm (21.4%) were most common, as was co-infection by both (6.3%). Single and co-infections shared similar environmental and socio-demographic risk factors. The prevalence of single and multiple infections was heterogeneous among and within communities. Clusters of single and co-infections were detected in each village, often spatially overlapped, and were associated with lower SES and household crowding. Conclusion Parasitic infections and co-infections are widespread in coastal Kenya, and their distributions are heterogeneous across landscapes, but inter-related. We highlighted how shared risk factors are associated with high prevalence of single infections and can result in spatial clustering of co-infections. Spatial heterogeneity and synergistic risk factors for polyparasitism need to be considered when designing surveillance and intervention strategies. In Coast Province, Kenya, infections with Schistosoma haematobium, Plasmodium spp., filarial nematodes, and geohelminths are common, resulting in high levels of both single infections and polyparasitism. The long-term effect of these infections, separately or in combination, has a major impact on human health and on the economic welfare of affected populations. The transmission dynamics of these parasitic infections can be linked to shared risk factors that often overlap in space. We studied human and environmental factors driving transmission and the resulting spatial pattern of infections in six communities, using cross-sectional, socio-economic and entomological surveys. Single and co-infections were widespread in the communities, and were associated with environmental, demographic and socio-economic risk factors, including distance of community from the coast, sanitation and human age and crowding. The spatial patterns of single and co-infections were heterogeneous among and within communities, with overlapping clusters of single and multiple infections in areas where houses with lower socio-economic status and more crowding were located. The heterogeneities among and within communities can provide important insights when designing surveillance and intervention strategies when planning appropriate surveillance and control strategies targeting polyparasitism.
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Affiliation(s)
- Donal Bisanzio
- Department of Environmental Sciences, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Francis Mutuku
- Department of Environmental Sciences, Emory University, Atlanta, Georgia, United States of America
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Amaya L. Bustinduy
- Parasitology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter L. Mungai
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Eric M. Muchiri
- Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Uriel Kitron
- Department of Environmental Sciences, Emory University, Atlanta, Georgia, United States of America
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Luong LT, Chapman EG, Harwood JD, Hudson PJ. Linking predator-prey interactions with exposure to a trophically transmitted parasite using PCR-based analyses. Mol Ecol 2012; 22:239-48. [PMID: 23110593 DOI: 10.1111/mec.12095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/18/2012] [Accepted: 09/20/2012] [Indexed: 11/29/2022]
Abstract
Parasite transmission is determined by the rate of contact between a susceptible host and an infective stage and susceptibility to infection given an exposure event. Attempts to measure levels of variation in exposure in natural populations can be especially challenging. The level of exposure to a major class of parasites, trophically transmitted parasites, can be estimated by investigating the host's feeding behaviour. Since the parasites rely on the ingestion of infective intermediate hosts for transmission, the potential for exposure to infection is inherently linked to the definitive host's feeding ecology. Here, we combined epidemiological data and molecular analyses (polymerase chain reaction) of the diet of the definitive host, the white-footed mouse (Peromyscus leucopus), to investigate temporal and individual heterogeneities in exposure to infection. Our results show that the consumption of cricket intermediate hosts accounted for much of the variation in infection; mice that had consumed crickets were four times more likely to become infected than animals that tested negative for cricket DNA. In particular, pregnant female hosts were three times more likely to consume crickets, which corresponded to a threefold increase in infection compared with nonpregnant females. Interestingly, males in breeding condition had a higher rate of infection even though breeding males were just as likely to test positive for cricket consumption as nonbreeding males. These results suggest that while heterogeneity in host diet served as a strong predictor of exposure risk, differential susceptibility to infection may also play a key role, particularly among male hosts. By combining PCR analyses with epidemiological data, we revealed temporal variation in exposure through prey consumption and identified potentially important individual heterogeneities in parasite transmission.
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Affiliation(s)
- Lien T Luong
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA.
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Gurarie D, Wang X, Bustinduy AL, King CH. Modeling the effect of chronic schistosomiasis on childhood development and the potential for catch-up growth with different drug treatment strategies promoted for control of endemic schistosomiasis. Am J Trop Med Hyg 2011; 84:773-81. [PMID: 21540388 DOI: 10.4269/ajtmh.2011.10-0642] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In areas endemic for schistosomiasis having limited healthcare, targeted drug treatment of school-age children is recommended for control of Schistosoma-associated morbidity. However, optimal timing, number, and frequency of treatments are not established. Because longitudinal studies of long-term impact of treatment are few, for current policy considerations we performed quantitative simulation (based on calibrated modeling of Schistosoma-associated disease formation) to project the impact of different school-age treatment regimens. Using published efficacy data from targeted programs, combined with age-specific risk for growth retardation and reinfection, we examined the likely impact of different strategies for morbidity prevention. Results suggest the need for early, repeated treatment through primary school years to optimally prevent the disabling sequelae of stunting and undernutrition. Dynamics of infection/reinfection during childhood and adolescence, combined with early treatment effects against reversible infection-associated morbidities, create a need for aggressive retreatment of preadolescents to achieve optimal suppression of morbidity where drug-based control is used.
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Affiliation(s)
- David Gurarie
- Department of Mathematics, Department of Pediatrics, and Center for Global Health and Diseases, Case Western Reserve University, 2103 Cornell Road, Cleveland, OH 44106, USA.
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Midzi N, Mtapuri-Zinyowera S, Sangweme D, Paul NH, Makware G, Mapingure MP, Brouwer KC, Mudzori J, Hlerema G, Chadukura V, Mutapi F, Kumar N, Mduluza T. Efficacy of integrated school based de-worming and prompt malaria treatment on helminths -Plasmodium falciparum co-infections: A 33 months follow up study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2011; 11:9. [PMID: 21696629 PMCID: PMC3141662 DOI: 10.1186/1472-698x-11-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/22/2011] [Indexed: 11/10/2022]
Abstract
Background The geographical congruency in distribution of helminths and Plasmodium falciparum makes polyparasitism a common phenomenon in Sub Saharan Africa. The devastating effects of helminths-Plasmodium co-infections on primary school health have raised global interest for integrated control. However little is known on the feasibility, timing and efficacy of integrated helminths-Plasmodium control strategies. A study was conducted in Zimbabwe to evaluate the efficacy of repeated combined school based antihelminthic and prompt malaria treatment. Methods A cohort of primary schoolchildren (5-17 years) received combined Praziquantel, albendazole treatment at baseline, and again during 6, 12 and 33 months follow up surveys and sustained prompt malaria treatment. Sustained prompt malaria treatment was carried out throughout the study period. Children's infection status with helminths, Plasmodium and helminths-Plasmodium co-infections was determined by parasitological examinations at baseline and at each treatment point. The prevalence of S. haematobium, S. mansoni, STH, malaria, helminths-Plasmodium co-infections and helminths infection intensities before and after treatment were analysed. Results Longitudinal data showed that two rounds of combined Praziquantel and albendazole treatment for schistosomiasis and STHs at 6 monthly intervals and sustained prompt malaria treatment significantly reduced the overall prevalence of S. haematobium, S. mansoni, hookworms and P. falciparum infection in primary schoolchildren by 73.5%, 70.8%, 67.3% and 58.8% respectively (p < 0.001, p < 0.001, p < 0.001, p < 0.001 respectively). More importantly, the prevalence of STH + schistosomes, P. f + schistosomes, and P. f + STHs + schistosomes co-infections were reduced by 68.0%, 84.2%, and 90.7%, respectively. The absence of anti-helminthic treatment between the 12 mth and 33 mth follow-up surveys resulted in the sharp increase in STHs + schistosomes co-infection from 3.3% at 12 months follow up survey to 10.7%, slightly more than the baseline level (10.3%) while other co-infection combinations remained significantly low. The overall prevalence of heavy S. haematobium, S. mansoni and hookworms infection intensities were significantly reduced from: 17.9-22.4% to 2.6-5.1%, 1.6-3.3% to 0.0% and 0.0-0.7% to 0.0% respectively. Conclusion Biannual Integrated school based antihelminthic and sustained prompt malaria treatment has a potential to reduce the burden of helminths-plasmodium co-infections in primary school children. In areas of stable malaria transmission, active case finding is recommended to track and treat asymptomatic malaria cases as these may sustain transmission in the community.
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Affiliation(s)
- Nicholas Midzi
- University of Zimbabwe, Department of Biochemistry, P,O Box MP167, Mount Pleasant, Harare, Zimbabwe.
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Mushayabasa S, Bhunu CP. Modeling schistosomiasis and HIV/AIDS codynamics. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2011; 2011:846174. [PMID: 21350680 PMCID: PMC3042740 DOI: 10.1155/2011/846174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 09/11/2010] [Indexed: 12/26/2022]
Abstract
We formulate a mathematical model for the cointeraction of schistosomiasis and HIV/AIDS in order to assess their synergistic relationship in the presence of therapeutic measures. Comprehensive mathematical techniques are used to analyze the model steady states. The disease-free equilibrium is shown to be locally asymptotically stable when the associated disease threshold parameter known as the basic reproduction number for the model is less than unity. Centre manifold theory is used to show that the schistosomiasis-only and HIV/AIDS-only endemic equilibria are locally asymptotically stable when the associated reproduction numbers are greater than unity. The impact of schistosomiasis and its treatment on the dynamics of HIV/AIDS is also investigated. To illustrate the analytical results, numerical simulations using a set of reasonable parameter values are provided, and the results suggest that schistosomiasis treatment will always have a positive impact on the control of HIV/AIDS.
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Affiliation(s)
- S Mushayabasa
- Modelling Biomedical Systems Research Group, Department of Applied Mathematics, National University of Science and Technology, P.O. Box 939 Ascot, Bulawayo, Zimbabwe.
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12
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Clerinx J, Van Gompel A. Schistosomiasis in travellers and migrants. Travel Med Infect Dis 2011; 9:6-24. [DOI: 10.1016/j.tmaid.2010.11.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 11/09/2010] [Accepted: 11/18/2010] [Indexed: 02/07/2023]
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13
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Volkova V, Howey R, Savill N, Woolhouse M. Potential for transmission of infections in networks of cattle farms. Epidemics 2010; 2:116-122. [DOI: 10.1016/j.epidem.2010.05.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/14/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022] Open
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14
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A new approach to modelling schistosomiasis transmission based on stratified worm burden. Parasitology 2010; 137:1951-65. [PMID: 20624336 DOI: 10.1017/s0031182010000867] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND/OBJECTIVE Multiple factors affect schistosomiasis transmission in distributed meta-population systems including age, behaviour, and environment. The traditional approach to modelling macroparasite transmission often exploits the 'mean worm burden' (MWB) formulation for human hosts. However, typical worm distribution in humans is overdispersed, and classic models either ignore this characteristic or make ad hoc assumptions about its pattern (e.g., by assuming a negative binomial distribution). Such oversimplifications can give wrong predictions for the impact of control interventions. METHODS We propose a new modelling approach to macro-parasite transmission by stratifying human populations according to worm burden, and replacing MWB dynamics with that of 'population strata'. We developed proper calibration procedures for such multi-component systems, based on typical epidemiological and demographic field data, and implemented them using Wolfram Mathematica. RESULTS Model programming and calibration proved to be straightforward. Our calibrated system provided good agreement with the individual level field data from the Msambweni region of eastern Kenya. CONCLUSION The Stratified Worm Burden (SWB) approach offers many advantages, in that it accounts naturally for overdispersion and accommodates other important factors and measures of human infection and demographics. Future work will apply this model and methodology to evaluate innovative control intervention strategies, including expanded drug treatment programmes proposed by the World Health Organization and its partners.
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Sheep movement networks and the transmission of infectious diseases. PLoS One 2010; 5:e11185. [PMID: 20567504 PMCID: PMC2887355 DOI: 10.1371/journal.pone.0011185] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 05/24/2010] [Indexed: 11/19/2022] Open
Abstract
Background and Methodology Various approaches have been used to investigate how properties of farm contact networks impact on the transmission of infectious diseases. The potential for transmission of an infection through a contact network can be evaluated in terms of the basic reproduction number, R0. The magnitude of R0 is related to the mean contact rate of a host, in this case a farm, and is further influenced by heterogeneities in contact rates of individual hosts. The latter can be evaluated as the second order moments of the contact matrix (variances in contact rates, and co-variance between contacts to and from individual hosts). Here we calculate these quantities for the farms in a country-wide livestock network: >15,000 Scottish sheep farms in each of 4 years from July 2003 to June 2007. The analysis is relevant to endemic and chronic infections with prolonged periods of infectivity of affected animals, and uses different weightings of contacts to address disease scenarios of low, intermediate and high animal-level prevalence. Principal Findings and Conclusions Analysis of networks of Scottish farms via sheep movements from July 2003 to June 2007 suggests that heterogeneities in movement patterns (variances and covariances of rates of movement on and off the farms) make a substantial contribution to the potential for the transmission of infectious diseases, quantified as R0, within the farm population. A small percentage of farms (<20%) contribute the bulk of the transmission potential (>80%) and these farms could be efficiently targeted by interventions aimed at reducing spread of diseases via animal movement.
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16
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The relative importance of host characteristics and co-infection in generating variation in Heligmosomoides polygyrus fecundity. Parasitology 2010; 137:1003-12. [PMID: 20109249 DOI: 10.1017/s0031182009991892] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We examined the relative importance of intrinsic host factors and microparasite co-infection in generating variation in Heligmosomoides polygyrus fecundity, a parameter that serves as a proxy for infectiousness. We undertook extensive trapping of Apodemus flavicollis, the yellow-necked mouse in the woodlands of the Italian Alps and recorded eggs in utero from the dominant nematode species H. polygyrus, and tested for the presence of five microparasite infections. The results showed that sex and breeding status interact, such that males in breeding condition harboured more fecund nematodes than other hosts; in particular, worms from breeding males had, on average, 52% more eggs in utero than worms from non-breeding males. In contrast, we found a weak relationship between intensity and body mass, and no relationship between intensity and sex or intensity and breeding condition. We did not find any evidence to support the hypothesis that co-infection with microparasites contributed to variation in worm fecundity in this system. The age-intensity profiles for mice singly-infected with H. polygyrus and those co-infected with the nematode and at least one microparasite were both convex and not statistically different from each other. We concluded that intrinsic differences between hosts, specifically with regard to sex and breeding condition, contribute relatively more to the variation in worm fecundity than parasite co-infection status.
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17
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Stothard JR, French MD, Khamis IS, Basáñez MG, Rollinson D. The epidemiology and control of urinary schistosomiasis and soil-transmitted helminthiasis in schoolchildren on Unguja Island, Zanzibar. Trans R Soc Trop Med Hyg 2009; 103:1031-44. [DOI: 10.1016/j.trstmh.2009.03.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 03/11/2009] [Accepted: 03/11/2009] [Indexed: 11/26/2022] Open
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18
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Filipiak L, Mathieu F, Moreau J. Caution on the assessment of intestinal parasitic load in studying parasite-mediated sexual selection: The case of Blackbirds coccidiosis. Int J Parasitol 2009; 39:741-6. [DOI: 10.1016/j.ijpara.2008.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 11/06/2008] [Accepted: 11/11/2008] [Indexed: 10/21/2022]
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19
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King CH. Long-term outcomes of school-based treatment for control of urinary schistosomiasis: a review of experience in Coast Province, Kenya. Mem Inst Oswaldo Cruz 2008; 101 Suppl 1:299-306. [PMID: 17308786 DOI: 10.1590/s0074-02762006000900047] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 06/26/2006] [Indexed: 11/22/2022] Open
Abstract
Urinary schistosomiasis remains a significant burden for Africa and the Middle East. The success of population-based control programs will depend on their impact, over many years, on Schistosoma haematobium reinfection and associated disease. In a multi-year (1984-1992) control program in Kenya, we examined risk for S. haematobium reinfection and late disease during and after annual school-based treatment. In this setting, long-term risk of new infection was independently associated with location, age, hematuria, and incomplete treatment, but not with sex or frequency of water contact. Thus, very local environmental features and age-related factors played an important role in S. haematobium transmission, such that population-based control programs should optimally tailor their efforts to local conditions on a village-by-village basis. In 2001-2002, the late benefits of earlier participation in school-based antischistosomal therapy were estimated in a cohort of formerly-treated adult residents compared to never-treated adults from the same villages. Among age-matched subjects, current infection prevalence was lower among those who had received remote therapy. In addition, prevalence of bladder abnormality was lower in the treated group, who were free of severe bladder disease. Treatment of affected adults resulted in rapid resolution of infection and any detectable bladder abnormalities. We conclude that continued treatment into adulthood, as well as efforts at long-term prevention of infection (transmission control) are necessary to achieve optimal morbidity control in affected communities.
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Affiliation(s)
- Charles H King
- Center for Global Health and Diseases, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
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20
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Shaman J. Amplification due to spatial clustering in an individual-based model of mosquito-avian arbovirus transmission. Trans R Soc Trop Med Hyg 2007; 101:469-83. [PMID: 17270228 DOI: 10.1016/j.trstmh.2006.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 11/13/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022] Open
Abstract
Theory and observations indicate that spatial clustering of birds and mosquitoes may be necessary for epizootic amplification of arboviruses with avian zoonoses. In this paper, I present an individual-based model of zoonotic arbovirus transmission among birds and mosquitoes. The results of initial ensemble model simulations indicate that the co-location of a vector mosquito oviposition site with an infected bird roost increases the local vector-to-host density and increases the likelihood of arbovirus amplification within the infected roost. Such amplification also increases the likelihood of secondary amplification at other roost sites, produces higher vector and host infection rates, increases the time to virus extinction within the model population, and increases the total number of birds infected. Additional oviposition locations within the model domain also increase the likelihood of secondary amplification. These findings support the idea that spatial clustering of mosquitoes and birds may facilitate arbovirus amplification. This model provides a basis for future exploration of specific zoonotic transmission cycles, including West Nile virus, and could be used to test the efficacy of various control strategies.
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Affiliation(s)
- Jeffrey Shaman
- College of Oceanic and Atmospheric Sciences, Oregon State University, 104 COAS Admin Building, Corvallis, OR 97331, USA.
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21
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Woolhouse MEJ, Shaw DJ, Matthews L, Liu WC, Mellor DJ, Thomas MR. Epidemiological implications of the contact network structure for cattle farms and the 20-80 rule. Biol Lett 2007; 1:350-2. [PMID: 17148204 PMCID: PMC1617140 DOI: 10.1098/rsbl.2005.0331] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The network of movements of cattle between farm holdings is an important determinant of the potential rates and patterns of spread of infectious diseases. Because cattle movements are uni-directional, the network is unusual in that the risks of acquiring infection (by importing cattle) and of passing infection on (by exporting cattle) can be clearly distinguished, and there turns out to be no statistically significant correlation between the two. This means that the high observed degree of heterogeneity in numbers of contacts does not result in an increase in the basic reproduction number, R0, in contrast to findings from studies of other contact networks. Despite this, it is still the case that just 20% of holdings contribute at least 80% of the value of R0.
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Affiliation(s)
- M E J Woolhouse
- Centre for Infectious Diseases, College of Medicine and Veterinary Medicine, University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, UK.
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22
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Brooker S. Spatial epidemiology of human schistosomiasis in Africa: risk models, transmission dynamics and control. Trans R Soc Trop Med Hyg 2007; 101:1-8. [PMID: 17055547 PMCID: PMC1975763 DOI: 10.1016/j.trstmh.2006.08.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 08/18/2006] [Accepted: 08/21/2006] [Indexed: 11/25/2022] Open
Abstract
This paper reviews recent studies on the spatial epidemiology of human schistosomiasis in Africa. The integrated use of geographical information systems, remote sensing and geostatistics has provided new insights into the ecology and epidemiology of schistosomiasis at a variety of spatial scales. Because large-scale patterns of transmission are influenced by climatic conditions, an increasing number of studies have used remotely sensed environmental data to predict spatial distributions, most recently using Bayesian methods of inference. Such data-driven approaches allow for a more rational implementation of intervention strategies across the continent. It is suggested that improved incorporation of transmission dynamics into spatial models and assessment of uncertainties inherent in data and modelling approaches represent important future research directions.
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Affiliation(s)
- Simon Brooker
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
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23
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Otterstatter MC, Thomson JD. Within-host dynamics of an intestinal pathogen of bumble bees. Parasitology 2006; 133:749-61. [PMID: 16948877 DOI: 10.1017/s003118200600120x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2006] [Revised: 05/30/2006] [Accepted: 06/20/2006] [Indexed: 11/06/2022]
Abstract
The success of a pathogen depends not only on its transmission to new hosts, but also on its ability to colonize and persist within its current host. Studies of within-host dynamics have focused on only a few diseases of humans, whereas little is known about the factors that influence pathogen populations as they develop inside non-human hosts. Here, we investigate pathogen dynamics occurring within bumble bees (Bombus impatiens) infected by the gut trypanosome Crithidia bombi. Infection by C. bombi showed several features characteristic of vertebrate diseases, including a rapid initial increase in infection intensity, marked oscillations in parasitaemia, and the stimulation of a systemic immune response in infected bees. Within-host dynamics generated substantial variation in the infectiousness and flower-visiting behaviour of bumble bees. Changes in bee foraging that arise from infection may influence the probability of C. bombi transmission between bees at flowers.
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Affiliation(s)
- M C Otterstatter
- Department of Zoology, University of Toronto, 25 Harbord Street, Toronto, Ontario, Canada, M5S 3G5.
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24
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Bethony J, Williams JT, Brooker S, Gazzinelli A, Gazzinelli MF, LoVerde PT, Corrêa-Oliveira R, Kloos H. Exposure to Schistosoma mansoni infection in a rural area in Brazil. Part III: household aggregation of water-contact behaviour. Trop Med Int Health 2004; 9:381-9. [PMID: 14996368 DOI: 10.1111/j.1365-3156.2004.01203.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Much research points to the importance of the household in the study of water-borne diseases such as schistosomiasis. An important aspect of the household is the clustering of domestic activities associated with water collection, storage and usage. Such activities can result in the sharing of water-contact sites and water-contact behaviour, which expose household members to similar risks of infection. In previous studies, we determined that shared residence accounted for 28% of the variance in Schistosoma faecal egg excretion rates. We now quantify the effect of shared residence on the variation in water-related health behaviours. We found that shared residence accounted for 30% of the variation in total water contacts per week. It also accounted for a large proportion of the variation in individual water-contact behaviour: e.g. agricultural contacts (63%), washing limbs (56%) or bathing (41%). These results implicate the household as an important composite measure of the complex relationships between socioeconomic, environmental and behavioural factors that influence water-contact behaviour and, therefore, the transmission of schistosomiasis. Our results also support a focus on the household in the implementation of schistosomiasis prevention and control efforts.
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Affiliation(s)
- Jeffrey Bethony
- Department of Microbiology & Tropical Medicine, The George Washington University Medical Center, Washington, DC 20037, USA.
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25
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Abstract
Cholera dynamics in endemic regions display regular seasonal cycles and pronounced interannual variability. We review here the current quantitative evidence for the influence of climate on cholera dynamics with reference to the early literature on the subject. We also briefly review the incipient status of mathematical models for cholera and argue that these models are important for understanding climatic influences in the context of the population dynamics of the disease. A better understanding of disease risk related to the environment should further underscore the need for changing the socioeconomic conditions conducive to cholera.
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Affiliation(s)
- Mercedes Pascual
- Department of Ecology and Evolutionary Biology, University of Michigan, 830 N. University Avenue, Ann Arbor, MI 48109-1048, USA.
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26
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Woolhouse ME, Dye C, Etard JF, Smith T, Charlwood JD, Garnett GP, Hagan P, Hii JL, Ndhlovu PD, Quinnell RJ, Watts CH, Chandiwana SK, Anderson RM. Heterogeneities in the transmission of infectious agents: implications for the design of control programs. Proc Natl Acad Sci U S A 1997; 94:338-42. [PMID: 8990210 PMCID: PMC19338 DOI: 10.1073/pnas.94.1.338] [Citation(s) in RCA: 775] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/1996] [Accepted: 10/07/1996] [Indexed: 02/03/2023] Open
Abstract
From an analysis of the distributions of measures of transmission rates among hosts, we identify an empirical relationship suggesting that, typically, 20% of the host population contributes at least 80% of the net transmission potential, as measured by the basic reproduction number, R0. This is an example of a statistical pattern known as the 20/80 rule. The rule applies to a variety of disease systems, including vector-borne parasites and sexually transmitted pathogens. The rule implies that control programs targeted at the "core" 20% group are potentially highly effective and, conversely, that programs that fail to reach all of this group will be much less effective than expected in reducing levels of infection in the population as a whole.
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Affiliation(s)
- M E Woolhouse
- Wellcome Trust Centre for the Epidemiology of Infectious Disease, Department of Zoology, University of Oxford, United Kingdom.
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Woolhouse ME, Hasibeder G, Chandiwana SK. On estimating the basic reproduction number for Schistosoma haematobium. Trop Med Int Health 1996; 1:456-63. [PMID: 8765453 DOI: 10.1046/j.1365-3156.1996.d01-88.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Existing estimates of the basic reproduction number, Ro, for human schistosomes are mostly in the range 1-4, implying that schistosomes should be relatively easy to eliminate from endemic areas, which is contrary to practical experience. An estimate of Ro for a site in Zimbabwe is obtained here using a mathematical model explicitly incorporating two features believed to be epidemiologically significant; age-dependent exposure and acquired immunity. Parameter estimates are, as far as possible, obtained independently, but the coefficients representing man-snail and snail-man transmission, as well as parameters representing effects of acquired immunity, must be estimated indirectly by fitting the model to field data. Heterogeneity in human exposure and contamination is crudely incorporated by considering "wormy' and non-wormy' fractions of the population. The results suggest Ro to be in the range 4-5 or more, higher than previous estimates and despite only moderate levels of infection at this site. It is shown that this estimate is sensitive to the form of the underlying model. The application of less realistic models may lead to less reliable estimates of Ro.
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28
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Wacher TJ, Milligan PJ, Rawlings P, Snow WF. Tsetse-trypanosomiasis challenge to village N'Dama cattle in The Gambia: field assessments of spatial and temporal patterns of tsetse-cattle contact and the risk of trypanosomiasis infection. Parasitology 1994; 109 ( Pt 2):149-62. [PMID: 8084661 DOI: 10.1017/s0031182000076265] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The severity of the trypanosomiasis problem in a particular location is traditionally assessed in terms of a challenge index-the product of some measure of tsetse abundance and infection-rate-which is assumed to be proportional to the force of infection. However, this index masks variation in the force of infection between herds and among individuals within herds. It is also not comparable between sites since the relative abundance of tsetse to hosts may vary. We have studied spatial distribution of herds of cattle in relation to tsetse in The Gambia and calculated an index of challenge based on the ratio of vectors to hosts over the livestock ranging area. This index is strongly correlated with estimates of the force of infection calculated from the incidence of infection in susceptible zebu; and it provides information on heterogeneity in exposure of different herds to tsetse.
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Affiliation(s)
- T J Wacher
- International Trypanotolerance Centre, Banjul, The Gambia
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29
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Woolhouse ME. A theoretical framework for immune responses and predisposition to helminth infection. Parasite Immunol 1993; 15:583-94. [PMID: 7877835 DOI: 10.1111/pim.1993.15.10.583] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Many field studies of human helminth infections have reported a positive correlation between parasite burdens and the rate of re-establishment of infection following chemotherapy, i.e., predisposition. Some studies have also reported the relationships between re-establishment and exposure and immune responses. The interpretation of these data is made difficult by the complexity of the underlying immunoepidemiological processes. In this paper, simple mathematical models are used to explore expected patterns, especially in relation to host age. These patterns are determined by rates of infection, parasite life expectancy, the level of immunological responsiveness, the duration of immunological memory, and may be greatly affected by the immunogenic roles of different parasite stages. In general, acquired immunity is predicted to reduce the degree of predisposition. This reduction is age-dependent and may generate 'negative predisposition' in some age classes. Age-dependent reductions in the correlation between re-establishment and exposure are also predicted. The correlation between re-establishment and protective immune responses is also predicted to be age-dependent, but may remain positive for all ages despite significant acquired immunity. The results suggest that great care is needed in the interpretation of immunoepidemiological data from treatment-reinfection studies.
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Chandiwana SK, Woolhouse ME. Heterogeneities in water contact patterns and the epidemiology of Schistosoma haematobium. Parasitology 1991; 103 Pt 3:363-70. [PMID: 1780173 DOI: 10.1017/s0031182000059874] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Variations in the amount of water contact made by individuals and in the amount of water contact made at different sites may have significant impacts on patterns of human schistosome infection. Previous studies have reported variations in the rate of water contact and differences in the sites used between age/sex classes, but there is limited information on variations in individual water contact behaviour. In this paper we report and analyse observations of essentially all water contacts made over a two week period by all individuals in a rural community in eastern Zimbabwe. The mean rate of water contact was 0.43 contacts/person/day. These data were over-dispersed, ranging from zero to 3.3 contacts/person/day; 90% of contacts were made by only 37% of the population. Contact rates were related to age (highest in 8 to 10-year-olds) but not sex, with substantial variation unaccounted for by these variables. Age and sex classes differed in types of water-related activities and the time of day of contact. A greater diversity of sites was used by children than by adults and by males than by females. Individual contact rates were correlated with intensities of infection, although the risk of infection per contact was estimated to be highest in 2 to 4-year-old children and higher for males than females. Five contact sites were used during the study period, with more than 50% of contacts occurring at just 2 sites. Different age and sex classes used different sites and there were additional site-related differences in types of activity and the time of day of use. The implications of these water contact patterns for schistosome epidemiology are discussed. In particular the results provide strong quantitative support for control programmes aimed at heavily used sites (e.g. focal mollusciciding) or at the minority of individuals making most water contacts (e.g. targeted chemotherapy).
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