Review: analysis of parasite and other skewed counts

To bin or not to bin: why parasite abundance data should not be lumped into categories for statistical analysis

The impact of macroparasites on their hosts is proportional to the number of parasites per host, or parasite abundance. Abundance values are count data, i.e. integers ranging from 0 to some maximum number, depending on the host-parasite system. When using parasite abundance as a predictor in statistical analysis, a common approach is to bin values, i.e. group hosts into infection categories based on abundance, and test for differences in some response variable (e.g. a host trait) among these categories. There are well-documented pitfalls associated with this approach. Here, I use a literature review to show that binning abundance values for analysis has been used in one-third of studies published in parasitological journals over the past 15 years, and half of the studies in ecological and behavioural journals, often without any justification. Binning abundance data into arbitrary categories has been much more common among studies using experimental infections than among those using naturally infected hosts. I then use simulated data to demonstrate that true and significant relationships between parasite abundance and host traits can be missed when abundance values are binned for analysis, and vice versa that when there is no underlying relationship between abundance and host traits, analysis of binned data can create a spurious one. This holds regardless of the prevalence of infection or the level of parasite aggregation in a host sample. These findings argue strongly for the practice of binning abundance data as a predictor variable to be abandoned in favour of more appropriate analytical approaches.

Egg reappearance periods associated with anthelmintic treatments given to horses in winter and summer over two years

Shortened egg reappearance periods (ERP) have been seen as an early warning of anthelmintic resistance development in cyathostomins in horses. The hypothesis has been that in these instances, efficacy against egg laying adult cyathostomins remains high, but a decline in activity against later larval stages leads to the earlier resumption of egg shedding after treatment. In this study using a single herd of horses we investigated the ERP of a number of commonly used equine anthelmintics and examined whether ERP might show seasonal variation between winter and summer. Four main Faecal egg count reduction tests (FECRT1-4) were conducted respectively in Winter (Jun/Jul) 2019, Summer (Jan/Feb) 2020, Winter 2020 and Summer 2021. The tests examined the efficacy and ERP of ivermectin, moxidectin, abamectin and fenbendazole. Egg counts of two groups of horses were monitored before and for 6-7 weeks after treatment - however long it took for counts to return to at least 10 % of what they had been before treatment. One additional FECRT was also conducted, using a second abamectin-containing product (FECRT5 - Spring 2020). Treatment with ivermectin (FECRT1-4), moxidectin (FECRT 1-2) and the first abamectin product tested (FECRT3) all reduced egg counts by >99 % for 4 weeks after treatment, with ERP of 5-7 weeks and with minimal differences between the 3 treatments. There was a tendency for counts to rise more rapidly in summer, and in the second year of testing as opposed to the first. Both the second abamectin product (FECRT5) and the fenbendazole (FECRT4) were found to be ineffective, reducing egg counts immediately after treatment by 68 and 52 % respectively.

POPULATION STRUCTURE AND BARTONELLA QUINTANA IN HEAD AND BODY LICE IN POKHARA, NEPAL (ANOPLURA: PEDICULIDAE)

This study examined the population structure of head and body lice infesting a random sample of people in Pokhara, Nepal during 2003, 2004, and 2005. A total of 106 participants (6 to 72 yr old, median = 12) volunteered to have lice collected from their heads and clothing. Most participants (70%) harbored only head lice, some (15%) had only body lice, and some (15%) had concurrent infestations of head and body lice (dual infestations). A total of 1,472 lice was collected. Significantly more nymphs were collected than adult lice. Louse populations were generally small (geometric mean = 8.8 lice per person) but a few participants harbored larger louse populations (maximum = 65 lice). People with dual infestations harbored significantly more lice than people with single infestations; however, there was no difference in the infestation intensities between people infested with head lice only vs. those infested with body lice only. Male participants harbored significantly more lice than did females. There were no significant differences in infestation intensity due to participant age or their socioeconomic level. The sex ratio of adult lice was increasingly female biased with increasing adult louse density. Infection of lice with Bartonella quintana was low (ca. 1.5%). Pediculosis is a common problem in urban Nepal.

Cluster randomized controlled trial analysis at the cluster level: The clan command

In this article, we introduce a new command, clan, that conducts a cluster-level analysis of cluster randomized trials. The command simplifies adjusting for individual- and cluster-level covariates and can also account for a stratified design. It can be used to analyze a continuous, binary, or rate outcome.

Efficacy of the spatial repellent product Mosquito Shield™ against wild pyrethroid-resistant Anopheles arabiensis in south-eastern Tanzania

BACKGROUND

Spatial repellents that create airborne concentrations of an active ingredient (AI) within a space offer a scalable solution to further reduce transmission of malaria, by disrupting mosquito behaviours in ways that ultimately lead to reduced human-vector contact. Passive emanator spatial repellents can protect multiple people within the treated space and can last for multiple weeks without the need for daily user touchpoints, making them less intrusive interventions. They may be particularly advantageous in certain use cases where implementation of core tools may be constrained, such as in humanitarian emergencies and among mobile at-risk populations. The purpose of this study was to assess the efficacy of Mosquito Shield™ deployed in experimental huts against wild, free-flying, pyrethroid-resistant Anopheles arabiensis mosquitoes in Tanzania over 1 month.

METHODS

The efficacy of Mosquito Shield™ transfluthrin spatial repellent in reducing mosquito lands and blood-feeding was evaluated using 24 huts: sixteen huts were allocated to Human Landing Catch (HLC) collections and eight huts to estimating blood-feeding. In both experiments, half of the huts received no intervention (control) while the remaining received the intervention randomly allocated to huts and remained fixed for the study duration. Outcomes measured were mosquito landings, blood-fed, resting and dead mosquitoes. Data were analysed by multilevel mixed effects regression with appropriate dispersion and link function accounting for volunteer, hut and day.

RESULTS

Landing inhibition was estimated to be 70% (57-78%) [IRR 0.30 (95% CI 0.22-0.43); p < 0.0001] and blood-feeding inhibition was estimated to be 69% (56-79%) [IRR 0.31 (95% CI 0.21-0.44; p < 0.0001] There was no difference in the protective efficacy estimates of landing and blood-feeding inhibition [IRR 0.98 (95% CI 0.53-1.82; p = 0.958].

CONCLUSIONS

This study demonstrated that Mosquito Shield™ was efficacious against a wild pyrethroid-resistant strain of An. arabiensis mosquitoes in Tanzania for up to 1 month and could be used as a complementary or stand-alone tool where gaps in protection offered by core malaria vector control tools exist. HLC is a suitable technique for estimating bite reductions conferred by spatial repellents especially where direct blood-feeding measurements are not practical or are ethically limited.

CDC light traps underestimate the protective efficacy of an indoor spatial repellent against bites from wild Anopheles arabiensis mosquitoes in Tanzania

BACKGROUND

Methods for evaluating efficacy of core malaria interventions in experimental and operational settings are well established but gaps exist for spatial repellents (SR). The objective of this study was to compare three different techniques: (1) collection of blood-fed mosquitoes (feeding), (2) human landing catch (HLC), and (3) CDC light trap (CDC-LT) collections for measuring the indoor protective efficacy (PE) of the volatile pyrethroid SR product Mosquito Shield^™ METHODS: The PE of Mosquito Shield^™ against a wild population of pyrethroid-resistant Anopheles arabiensis mosquitoes was determined via feeding, HLC, or CDC-LT using four simultaneous 3 by 3 Latin squares (LS) run using 12 experimental huts in Tanzania. On any given night each technique was assigned to two huts with control and two huts with treatment. The LS were run twice over 18 nights to give a sample size of 72 replicates for each technique. Data were analysed by negative binomial regression.

RESULTS

The PE of Mosquito Shield^™ measured as feeding inhibition was 84% (95% confidence interval (CI) 58-94% [Incidence Rate Ratio (IRR) 0.16 (0.06-0.42), p < 0.001]; landing inhibition 77% [64-86%, (IRR 0.23 (0.14-0.36) p < 0.001]; and reduction in numbers collected by CDC-LT 30% (0-56%) [IRR 0.70 (0.44-1.0) p = 0.160]. Analysis of the agreement of the PE measured by each technique relative to HLC indicated no statistical difference in PE measured by feeding inhibition and landing inhibition [IRR 0.73 (0.25-2.12) p = 0.568], but a significant difference in PE measured by CDC-LT and landing inhibition [IRR 3.13 (1.57-6.26) p = 0.001].

CONCLUSION

HLC gave a similar estimate of PE of Mosquito Shield^™ against An. arabiensis mosquitoes when compared to measuring blood-feeding directly, while CDC-LT underestimated PE relative to the other techniques. The results of this study indicate that CDC-LT could not effectively estimate PE of the indoor spatial repellent in this setting. It is critical to first evaluate the use of CDC-LT (and other tools) in local settings prior to their use in entomological studies when evaluating the impact of indoor SR to ensure that they reflect the true PE of the intervention.

Host genetic identity determines parasite community structure across time and space in oyster restoration

Intraspecific variation in host susceptibility to individual parasite species is common, yet how these effects scale to mediate the structure of diverse parasite communities in nature is less well understood. To address this knowledge gap, we tested how host genetic identity affects parasite communities on restored reefs seeded with juvenile oysters from different sources-a regional commercial hatchery or one of two wild progenitor lines. We assessed prevalence and intensity of three micro- and two macroparasite species for 4 years following restoration. Despite the spatial proximity of restored reefs, oyster source identity strongly predicted parasite community prevalence across all years, with sources varying in their relative susceptibility to different parasites. Oyster seed source also predicted reef-level parasite intensities across space and through time. Our results highlight that host intraspecific variation can shape parasite community structure in natural systems, and reinforce the importance of considering source identity and diversity in restoration design.

Experimental removal of nematode parasites increases growth, sprint speed, and mating success in brown anole lizards

Parasites interact with nearly all free-living organisms and can impose substantial fitness costs by reducing host survival, mating success, and fecundity. Parasites may also indirectly affect host fitness by reducing growth and performance. However, experimentally characterizing these costs of parasitism is challenging in the wild because common antiparasite drug formulations require repeated dosing that is difficult to implement in free-living populations, and because the extended-release formulations that are commercially available for livestock and pets are not suitable for smaller animals. To address these challenges, we developed a method for the long-term removal of nematode parasites from brown anole lizards (Anolis sagrei) using an extended-release formulation of the antiparasite drug ivermectin. This treatment eliminated two common nematode parasites in captive adult males and dramatically reduced the prevalence and intensity of infection by these parasites in wild adult males and females. Experimental parasite removal significantly increased the sprint speed of captive adult males, the mating success of wild adult males, and the growth of wild juveniles of both sexes. Although parasite removal did not have any effect on survival in wild anoles, parasites may influence fitness directly through reduced mating success and indirectly through reduced growth and performance. Our method of long-term parasite manipulation via an extended-release formulation of ivermectin should be readily adaptable to many other small vertebrates, facilitating experimental tests of the extent to which parasites affect host phenotypes, fitness, and eco-evolutionary dynamics in the wild.

Reflections and future directions for continued development and refinement of guidelines for anthelmintic efficacy studies

This reflection paper complements the WAAVP (World Association for the Advancement of Veterinary Parasitology) general anthelmintic efficacy guideline, which outlines the general principles of anthelmintic efficacy evaluation across all animal host species. It provides background to the recommendations made in the WAAVP general anthelmintic efficacy guideline, with insights into the discussions leading to specific recommendations in the general guideline or the absence thereof. Furthermore, this paper discusses recent technological advancements with potential value to the evaluation of anthelmintic efficacy that may be considered for future versions of the general or species-specific guidelines if supported by sufficient levels of evidence. Finally, it also identifies potential research questions, such as the statistical approach for comparing worm counts between groups of animals.

Equine strongylids: Ivermectin efficacy and fecal egg shedding patterns

Equine cyathostomins are ubiquitous in grazing horses around the world and a main target in parasite control programs. Anthelmintic resistance has been reported with increasing frequency in these parasites over the past decades, and recent findings of fulminant resistance to the macrocyclic lactone class have raised severe concerns. This study aimed to evaluate ivermectin efficacy in cohorts of yearlings and mares present on four different farms in Central Kentucky. Strongylid egg counts were determined with an automated egg counting system, and the percent fecal egg count reduction (FECR) was calculated using a hierarchical Bayesian analysis. Novel principles were used for classification of groups to either no signs of anthelmintic resistance, evidence of resistance, or inconclusive. Furthermore, an epidemiological analysis was conducted evaluating the possible influence of pregnancy status, time of foaling, and year of arrival on mare strongylid egg shedding levels. A total of 102 yearlings and 247 mares were enrolled in the study. Evidence of ivermectin resistance was documented in one group of yearlings with a mean FECR of 91.2% and a 95% credible interval of 84.0-95.8. The results from one mare group and one additional yearling group were deemed inconclusive, whereas the remaining five groups displayed no evidence of ivermectin resistance. Strongylid shedding in the mares was not positively associated with any of the evaluated factors. This study is the first to demonstrate ivermectin resistance in US bred horses, and the findings emphasize the need for routine monitoring of anthelmintic efficacy on horse farms.

Eco-epidemiological screening of multi-host wild rodent communities in the UK reveals pathogen strains of zoonotic interest

Wild rodent communities represent ideal systems to study pathogens and parasites shared among sympatric species. Such studies are useful in the investigation of eco-epidemiological dynamics, improving disease management strategies and reducing zoonotic risk. The aim of this study was to investigate pathogen and parasites shared among rodent species (multi-host community) in West Wales in an area where human/wildlife disease risk was not previously assessed. West Wales is predominantly rural, with human settlements located alongside to grazing areas and semi-natural landscapes, creating a critical human-livestock-wildlife interface. Ground-dwelling wild rodent communities in Wales were live-trapped and biological samples - faeces and ectoparasites - collected and screened for a suite of pathogens and parasites that differ in types of transmission and ecology. Faecal samples were examined to detect Herpesvirus, Escherichia coli, and Mycobacterium microti. Ticks and fleas were collected, identified to species based on morphology and genetic barcodes, and then screened for Anaplasma phagocytophilum, Babesia microti, Borrelia burgdorferi sensu lato, and Bartonella sp. All the pathogens and parasites screened pose a characteristic epidemiological challenge, such as variable level of generalism, unknown zoonotic potential, and lack of data. The results showed that the bank vole Myodes glareolus had the highest prevalence of all pathogens and parasites. Higher flea species diversity was detected than in previous studies, and at least two Bartonella species were found circulating, one of which has not previously been detected in the UK. These key findings offer new insights into the distribution of selected pathogen and parasites and subsequent zoonotic risk, and provide new baselines and perspectives for further eco-epidemiological research.

Distribution of different species of metacercariae in two freshwater fishes: Haludaria fasciata (Teleostei: Cyprinidae) and Pseudosphromenus cupanus (Teleostei: Osphromenidae)

Information on the distribution and abundance patterns of trematodes are essential to reveal the ecology of host-parasite interactions. The Western Ghats of India, a biodiversity hotspot, is rich in freshwater fish diversity and endemism. Though there are several studies on various other aspects of fish ecology, studies on their parasitic fauna is meager. The objective of the present study is to explore the distribution and infection patterns of metacercariae of five species of trematodes in the freshwater fishes, Haludaria fasciata and Pseudosphromenus cupanus. The infection parameters were analyzed for each host and CART model was applied to analyze the environmental factors affecting parasite distribution patterns. All species of metacercariae showed an over-dispersed aggregate distributions. The classification tree models indicated that among the environmental factors considered, differences in host locality was the most influential factor in both fishes, followed at a greater distance by the factor seasonality. The parasite communities exhibited temporal and spatial differences in the infection pattern in response to seasonal and locational variations.

Schistosome infection in Senegal is associated with different spatial extents of risk and ecological drivers for Schistosoma haematobium and S. mansoni

Schistosome parasites infect more than 200 million people annually, mostly in sub-Saharan Africa, where people may be co-infected with more than one species of the parasite. Infection risk for any single species is determined, in part, by the distribution of its obligate intermediate host snail. As the World Health Organization reprioritizes snail control to reduce the global burden of schistosomiasis, there is renewed importance in knowing when and where to target those efforts, which could vary by schistosome species. This study estimates factors associated with schistosomiasis risk in 16 villages located in the Senegal River Basin, a region hyperendemic for Schistosoma haematobium and S. mansoni. We first analyzed the spatial distributions of the two schistosomes’ intermediate host snails (Bulinus spp. and Biomphalaria pfeifferi, respectively) at village water access sites. Then, we separately evaluated the relationships between human S. haematobium and S. mansoni infections and (i) the area of remotely-sensed snail habitat across spatial extents ranging from 1 to 120 m from shorelines, and (ii) water access site size and shape characteristics. We compared the influence of snail habitat across spatial extents because, while snail sampling is traditionally done near shorelines, we hypothesized that snails further from shore also contribute to infection risk. We found that, controlling for demographic variables, human risk for S. haematobium infection was positively correlated with snail habitat when snail habitat was measured over a much greater radius from shore (45 m to 120 m) than usual. S. haematobium risk was also associated with large, open water access sites. However, S. mansoni infection risk was associated with small, sheltered water access sites, and was not positively correlated with snail habitat at any spatial sampling radius. Our findings highlight the need to consider different ecological and environmental factors driving the transmission of each schistosome species in co-endemic landscapes.

Schistosome parasites infect more than 200 million people worldwide, mainly in sub-Saharan Africa, where many people are at-risk for infection by multiple schistosome species simultaneously. To reduce the global burden of schistosomiasis, control of the parasites’ intermediate host–specific species of freshwater snails–has been elevated in priority to complement mass drug administration campaigns in endemic areas. To maximize the efficacy and efficiency of snail control efforts, a better understanding of where to target intermediate host snails is badly needed. This includes a better understanding of the spatial scale at which snails in the environment contribute to human infection risk, and, in co-endemic settings, how ecological determinants of infection risk vary by schistosome species. We used quantitative snail sampling and remotely-sensed data at 16 villages in the Senegal River Basin to compare and contrast ecological correlates and spatial scales of infection risk from freshwater snails that transmit Schistosoma haematobium versus S. mansoni. We found that infection risk for S. haematobium was associated with snail habitat at a larger spatial radius than is typically considered for schistosomiasis monitoring and control, whereas infection risk for S. mansoni was not positively correlated with snail habitat at any spatial sampling radius, but was associated with small water access sites enclosed by emergent vegetation. Our findings highlight the need to consider the different ecological and environmental factors driving the transmission of each schistosome species in co-endemic landscapes.

The Role of Nile Tilapia (Oreochromis niloticus) in the Life Cycle of Toxocara spp

The present study aimed to experimentally assess Nile tilapia as potential paratenic host of Toxocara spp. A total of 15 Nile tilapia (Oreochromis niloticus) were fed with 300 embryonated Toxocara canis eggs by oral gavage, while five others of the control group received distilled water. The fish were individually analyzed at 16, 24, 48, 72, and 240 h after inoculation. Water contamination was assessed, and tissue migration by liver, gastrointestinal tract (GIT), eyes, and central nervous system. A murine model was used as the paratenic host for egg infectivity assessment. Eggs and larvae were found in plastic tank water and fish GIT, ranging from 23 to 86% per fish. Eggs and larvae were recovered from the tank water (76.3%) and fish GIT (23.7%). The counting of eggs and larvae observed was negatively correlated with number of eggs and larvae in the water tank (rho = -0.698, p = 0.003). Shedding of embryonated eggs was first detected at 16 and up to 240 h, with significant egg and larvae yield decrease on water-shedding (p = 0.001) and in the GIT (p = 0.007). Although no T. canis larva was recovered in fish tissues, egg infectivity after fish GIT transit was experimentally confirmed by mice assessment. In conclusion, despite shedding viable embryonated eggs through the gastrointestinal tract, tilapias may not play a role as a suitable paratenic hosts for Toxocara spp., posing low risk of zoonotic transmission by fish meat consumption.

Locomotor activity in Aedes aegypti with different insecticide resistance profiles

OBJECTIVE:

To evaluate locomotor activity in four field populations of Ae. aegypti with different insecticide resistance profiles from the state of São Paulo for two years.

METHODS:

This study comprised the susceptible Rockefeller strain and four populations from São Paulo, Brazil: two considered populations with “reduced susceptibility” to pyrethroids (Campinas and Marília), and two “resistant populations” (Santos and Ribeirão Preto). First, 2016 and 2017 eggs from these five populations were hatched in laboratory. Virgin females underwent experiments under laboratory conditions at 25°C, with 12:12h light/dark (LD) photoperiod; 24-hour individual activity was recorded using a locomotor activity monitor (LAM).

RESULTS:

In females from 2016 field populations, both resistant populations showed significant more locomotor activity than the two reduced susceptibility populations and the Rockefeller strain (p < 0.05). As for females from 2017 field populations, reduced susceptibility populations showed a significant increased locomotor activity than the Rockefeller strain, but no significant difference when compared to Santos resistant population (p > 0.05).

CONCLUSIONS:

Our results indicate that insecticide-resistant Ae. aegypti populations show increased locomotor activity, which may affect the transmission dynamics of their arboviruses.

Fecal Indicator Bacteria Data to Characterize Drinking Water Quality in Low-Resource Settings: Summary of Current Practices and Recommendations for Improving Validity

Fecal indicator bacteria (FIB) values are widely used to assess microbial contamination in drinking water and to advance the modeling of infectious disease risks. The membrane filtration (MF) testing technique for FIB is widely adapted for use in low- and middle-income countries (LMICs). We conducted a systematic literature review on the use of MF-based FIB data in LMICs and summarized statistical methods from 172 articles. We then applied the commonly used statistical methods from the review on publicly available datasets to illustrate how data analysis methods affect FIB results and interpretation. Our findings indicate that standard methods for processing samples are not widely reported, the selection of statistical tests is rarely justified, and, depending on the application, statistical methods can change risk perception and present misleading results. These results raise concerns about the validity of FIB data collection, analysis, and presentation in LMICs. To improve evidence quality, we propose a FIB data reporting checklist to use as a reminder for researchers and practitioners.

Geographic distribution of boophilid ticks in communal grazing cattle in the north-eastern region of the Eastern Cape Province, South Africa

The boophilid ticks are regarded as highly adaptive tick species in tropical and subtropical regions and considered to be the most economically important ectoparasites to cattle worldwide. To that, a geographical survey to investigate the distribution of boophilid ticks on grazing cattle was conducted seasonally between October 2018 and September 2019 at Elundini, Senqu and Walter Sisulu Local Municipalities in the north-eastern region of the Eastern Cape Province (ECP). Ten cattle were selected randomly during the tick sampling at each locality. Ticks were carefully removed from cattle and placed into sampling tubes containing 70% ethanol. During tick sampling, special attention was paid to the tick predilection sites such as lower perineum, neck, dewlap and ventral body parts which are the preferred sites for blue ticks. Based on the morphological traits, a total of 6176 ticks belonging to two boophilid tick species of Rhipicephalus were identified: Rhipicephalus decoloratus (98.30%) and Rhipicephalus microplus (1.70%). Locality and season significantly influenced boophilid tick distribution (P < 0.05). Rhipicephalus decoloratus had a significantly higher prevalence (P < 0.05) in Elundini during the hot-dry (3.37 ± 0.121) and hot-wet (3.35 ± 0.121) seasons compared to other localities. In Senqu, R. microplus had high counts (P < 0.05) during the post-rainy season (1.06 ± 0027) compared to other localities. Interestingly, the current study recorded Asiatic invasive pantropical blue tick (R. microplus) for the first time in the north-eastern region of the ECP. This tick is of great veterinary economic importance locally and globally, and thus necessitates continuous monitoring and control.

Helminth infections among rural schoolchildren in Southern Ethiopia: A cross-sectional multilevel and zero-inflated regression model

Although the prevalence of helminths infection among schoolchildren is known, there has been little progress in the application of count model for modelling the risk factors of helminths egg. Only a few studies applied multilevel analysis to explore the variation in helminths prevalence across schools and classes. This study aimed to assess the prevalence, intensity of helminths infection, and identify risk factors at the individual-, household-, and school-level among schoolchildren in Southern Ethiopia. Using multistage random sampling, we recruited 864 students in the Wonago District. We applied multilevel-logistic and zero-inflated negative binomial regression models (ZINB). Risk factors were concentrated at the individual level; school-level and class-level variables explained less than 5% of the variance. The overall helminths prevalence was 56% (479/850); Trichuris trichiura prevalence was 42.4% (360/850); and Ascaris lumbricoides prevalence was 18.7% (159/850). The rate of any helminths increased among thin children (AOR: 1.73 [95% CI: (1.04, 2.90]), anemic (AOR: 1.45 [95% CI: 1.04, 2.03]), mothers who had no formal education (AOR: 2.08 [95% CI: 1.25, 3.47]), and those in households using open containers for water storage (AOR: 2.06 [95% CI: 1.07, 3.99]). In the ZINB model, A. lumbricoides infection intensity increased with increasing age (AOR: 1.08 [95% CI: 1.01, 1.16]) and unclean fingernails (AOR: 1.47 [95% CI: 1.07, 2.03]). Handwashing with soap (AOR: 0.68 [95% CI: 0.48, 0.95]), de-worming treatment [AOR: 0.57 (95% CI: 0.33, 0.98)], and using water from protected sources [AOR: 0.46 (95% CI: 0.28, 0.77)] were found to be protective against helminths infection. After controlling for clustering effects at the school and class levels and accounting for excess zeros in fecal egg counts, we found an association between helminths infection and the following variables: age, thinness, anemia, unclean fingernails, handwashing, de-worming treatment, mother's education, household water source, and water storage protection. Improving hygiene behavior, providing safe water at school and home, and strengthening de-worming programs is required to improve the health of schoolchildren in rural Gedeo.

Revisiting the adequacy of infection criteria recommended in VICH GL 7 for anthelmintic effectiveness studies: Retrospective simulations

Studies conducted to support registration or approval of veterinary anthelmintics generally follow study design recommendations provided by the VICH (International Cooperation on Harmonisation of Technical Requirements for Registration of Veterinary Medicinal Products), "Efficacy of Anthelmintics: General Requirements" (VICH GL7). For dose confirmation studies, VICH GL7 provides recommendations for determining that the control animals had an adequate infection "to permit the appropriate standards of efficacy to be met with acceptable statistical and biological certitude/confidence." In the simulation studies described in this report, we investigated the performance of one method, the statistical criterion given in Section 4.5 of VICH GL7, for evaluating the adequacy of infection in anthelmintic studies, in combination with the conventional criterion of a minimum of six adequately infected animals. We conducted numerical simulations, based on parasite data from previously conducted dose confirmation studies in dogs and cattle, to investigate how the statistical criterion impacts adequacy of infection determinations when used with the conventional criterion at various sample sizes. Simulation studies in common nematode species in both dogs and cattle indicated that under certain circumstances the statistical criterion can guard against overinterpreting the evaluation of adequacy of infection as sample size is increased. However, the statistical criterion may be overly restrictive for samples with adequate infection but containing multiple zero parasite counts and adding it to the conventional criterion does not provide any additional benefit when the sample contains no zero counts. It is important for investigators designing efficacy studies to understand the potential impact this criterion may have when establishing adequacy of infection criteria in study protocols.

Prevalence and seasonal variation of gastrointestinal nematodes and coccidia infecting ovine grazing on communal rangelands in the Eastern Cape, South Africa

Nematodes and coccidia are major pathogens causing parasitic infections in livestock production. This study aimed to determine the prevalence and seasonality of gastrointestinal helminths and coccidia in communal sheep grazing in humid, semi-humid and arid zones of the Eastern Cape Province. A total of 3299 faecal samples were collected from sheep between January 2012 and December 2015. Of the collected roundworm species (faecal eggs and faecal cultures), Haemonchus contortus was the only species found. The prevalence of gastrointestinal parasites was significantly higher in the humid zone (H. contortus 81% and coccidia 37%), followed by a semi-humid zone (H. contortus 75% and coccidia 22%) and the arid zone was the lowest (H. contortus 71% and coccidia 14%). Haemonchus contortus had significantly higher faecal egg counts (FEC) during spring (1465.73 ± 143.56) and summer (1418.73 ± 160.73) and the lowest during autumn (496.67 ± 219.13) and winter (352.05 ± 164.44) in all agro-ecological zone. The humid zone had significantly higher FEC in seasonal occurrence of H. contortus and coccidia compared with other agro-ecological zones (P < 0.05). There was no significant difference (P > 0.05) observed in the seasonal occurrence of H. contortus species in arid zone. Surprisingly, higher coccidia counts (352.17 ± 43.58) during 2012 winter season in humid zone and in summer season (0.00 ± 559.72) of 2013 in the semi-humid zone than other agro-ecological zones. However, agro-ecological zone differences and seasonal variations had an influence on H. contortus and coccidia distribution and abundance. This study confirms that helminths and coccidia are major causative agents causing parasitic infections in livestock production, and therefore, good animal health management practices including proper hygiene should be followed to prevent parasitic infection in small ruminants.

A first nation-wide assessment of soil-transmitted helminthiasis in Fijian primary schools, and factors associated with the infection, using a lymphatic filariasis transmission assessment survey as surveillance platform

BACKGROUND

Soil-transmitted helminthiasis (STH) is endemic in Fiji but its prevalence is not known and likely to have changed after a decade of mass drug administration (MDA) for lymphatic filariasis (LF). By linking with LF transmission assessment surveys (LF-TAS), we undertook the first nation-wide assessment of STH in Fijian primary schools, as well as an analysis of factors associated with STH infections.

METHODOLOGY/PRINCIPAL FINDINGS

A cross-sectional assessment for STH was conducted in all four Divisions of Fiji from 2014 to 2015. In the Western, Central, and Northern Divisions, schools were sub-sampled after LF-TAS, while, in the Eastern Division, schools were selected via simple random sampling. For the diagnosis of STH, stool samples were examined by coproscopy with a single Kato-Katz thick smear (KK) and the formol-ether-acetate concentration technique, except for the samples from the Eastern Division where only KK was used. Mean prevalence of any STH among class 1-2 students at the national level was 10.5% (95% CI: 6.9-15.5). Across the three Divisions via LF-TAS, the prevalence levels for ascariasis were 8.7% (95% CI: 4.3-16.6), hookworm 3.9% (95% CI: 2.3-6.6) and trichuriasis 0%. In the Eastern Division, ascariasis prevalence was 13.3% (95% CI: 6.4-25.6), and hookworm 0.7% (95% CI: 0.2-2.5), with one case of trichuriasis. Among class 3-8 students, ascariasis prevalence was lower. Lower risk of any STH was associated with wearing shoes (adjusted OR 0.54, 95% CI: 0.32-0.90) and having piped water from the Fiji Water Authority at home (adjusted OR 0.48, 95% CI: 0.25-0.92).

CONCLUSIONS

After a decade of community-based LF-MDA, STH in school-age children in Fiji is now close to 10%, but localities of endemicity remain. Preventive chemotherapy should be maintained in areas with elevated STH prevalence alongside targeted delivery of integrated WASH interventions. LF-TAS has provided an opportunity to develop future public health surveillance platforms.

Market integration and soil-transmitted helminth infection among the Shuar of Amazonian Ecuador

BACKGROUND

Soil-transmitted helminth (STH) infections have many negative health outcomes (e.g., diarrhea, nutritional deficiencies) that can also exacerbate poverty. These infections are generally highest among low-income populations, many of which are also undergoing market integration (MI; increased participation in a market-based economy). Yet the direct impact of MI-related social and environmental changes on STH infection patterns is poorly understood, making it unclear which lifestyle factors should be targeted to better control disease spread. This cross-sectional study examines if household infrastructure associated with greater MI is associated with lower STH burdens among Indigenous Ecuadorian Shuar.

METHODS

Kato-Katz fecal smears were used to determine STH infection status and intensity (n = 620 participants; 308 females, 312 males, aged 6 months-86 years); Ascaris lumbricoides (ascarid) and Trichuris trichiura (whipworm) were the primary infection types detected. Structured interviews assessing lifestyle patterns (e.g., measures of household infrastructure) measured participant MI. Multilevel regression analyses and zero-inflated negative binomial regression models tested associations between MI measures and STH infection status or intensity, controlling for individual and community characteristics.

RESULTS

Participants residing in more market-integrated households exhibited lower infection rates and intensities than those in less market integrated households. Parasite infection status and T. trichiura infection intensity were lower among participants living in houses with wood floors than those with dirt floors, while individuals using well or piped water from a spring exhibited lower A. lumbricoides infection intensities compared to those using river or stream water. Unexpectedly, latrine type was not significantly related to STH infection status or intensity. These results suggest that sources of exposure differ between the two helminth species.

CONCLUSIONS

This study documents associations between household measures and STH infection among an Indigenous population undergoing rapid MI. These findings can help healthcare programs better target interventions and reduce STH exposure among at-risk populations.

Filarial infections in California sea lions vary spatially within the Gulf of California, Mexico

At least two species of filarial worms, Dirofilaria immitis and Acanthocheilonema (Dipetalonema) odendhali, infect otariid pinnipeds, including the California sea lion (Zalophus californianus). To date, evidence of infection in sea lions has come from dead or captive animals, and little is known about filariasis in free-living populations. We sampled 45 California sea lion adults and 197 pups captured at 12 rookeries from different ecological regions within the Gulf of California and detected and quantified D. immitis and A. odendhali microfilariae in blood smears. We investigated differences in prevalence and parasite load (intensity of infection) among ecological regions. Microfilariae were detected in the blood of 35 of the 45 (77.78%) adult females and in 1 of the 197 (0.51%) pups examined. The average burden of A. odendhali per microlitre of blood was nearly twice that of D. immitis. Prevalence and intensity of infection differed significantly among regions, being highest for colonies within the northern and northcentral regions and lowest in the southern region. Dirofilaria immitis and A. odendhali infections displayed a similar spatial pattern of prevalence. Colony density inversely predicted the prevalence of microfilariae. Based on the clinical parameters typically associated with filarial infections in carnivores and physical examinations, none of the sea lions appeared to have evidence of disease. This is a first approximation to investigate the prevalence of microfilaria infections in free-ranging California sea lions and to explore their relevance to population health.

Shedding and characterization of gastrointestinal nematodes of growing beef heifers in Central Texas

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Bos indicus crossbred females had higher fecal eggs as calves than as yearlings.

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More Bos indicus background had higher eggs per gram of feces through 1 year of age.

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Cooperia and Haemonchus species predominated through 1 year of heifer age.

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Ostertagia and Trichostrongylus species were detected mostly after 1 year of age.

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Eggs per gram of feces correlated with few production traits of heifers.

Gastrointestinal nematodes (GIN) do not detrimentally affect cattle to the extent of small ruminants. However, they are developing resistance to drugs used to treat them. Genetic strategies to control the nematodes and/or their detrimental effects could be a sustainable alternative to treatment with drugs. An essential first step in development of such a strategy is characterization of nematode populations in commonly used breed types of cattle in local conditions. Fecal egg counts (FEC) were obtained every two months on a cohort of 53 crossbred Nellore-Angus heifers grazing Central Texas pastures from an average heifer age of 3 months to approximately 2 years of age. For 10 of those 12 sets of samples, coprocultures were set up to characterize gastrointestinal nematode species present. Heifers were ½ Nellore ½ Angus (n = 18) or ¾ Angus ¼ Nellore (n = 35). They were born in the spring of 2014 to cows that were from 3–5 years old. They were maintained as a group throughout weaning, postweaning, exposure to bulls as yearlings, and as pregnant cows through the birth of their first calves. An interaction of breed group with sampling time (P < 0.0001) highlighted favorable FEC of ¼ Nellore heifers as compared to ½ Nellore in all but two sampling times. Fecal egg count means were, in general, higher for heifers of both groups in sampling times up to one year of age. Season effects on FEC may be important, but the effect of age may have obscured their detection. There were few significant correlation coefficients for FEC traits with a variety of production traits of these females. Average FEC residuals were positively correlated (r = 0.28 and 0.41; P < 0.05) with winter coat shedding score evaluated at approximately 17 and 24 months of age. Residual correlations of average FEC with calf weaning weight and incidence of shedding with calf age at weaning (r> 0.3) may be indicative of the increased susceptibility of females that lactate heavily or longer to internal parasite infection. Proportions of GIN genera by sampling day differed from χ2 expectation (P < 0.0001). Cooperia and Haemonchus species were detected in large proportions in sampling dates that corresponded to heifers less than one year of age. Ostertagia and Trichostrongylus species predominated in sampling dates after heifers reached one year of age.

How we are misinterpreting physical activity intention - behavior relations and what to do about it

Background

Studies of the physical activity intention-behavior gap, and factors that may moderate the gap (e.g., habit, perceived behavioral control), can inform physical activity promotion efforts. Yet, these studies typically apply linear modeling procedures, and so conclusions rely on linearity and homoscedasticity assumptions, which may not hold.

Methods

We modelled and plotted physical activity intention-behavior associations and the moderation effects of habit using simulated data based on (a) normal distributions with no shared variance, (b) correlated parameters with normal distribution, and (c) realistically correlated and non-normally distributed parameters.

Results

In the uncorrelated and correlated normal distribution datasets, no violations were unmet, and the moderation effects applied across the entire data range. However, because in the realistic dataset, few people who engaged in physical activity behavior had low intention scores, the intention-behavior association was non-linear, resulting in inflated linear moderation estimations of habit. This finding was replicated when tested with intention-behavior moderation of perceived behavioral control.

Conclusions

Comparisons of the three scenarios illustrated how an identical correlation coefficient may mask different types of intention-behavior association and moderation effects. These findings highlight the risk of misinterpreting tests of the intention-behavior gap and its moderators for physical activity due to unfounded statistical assumptions. The previously well-documented moderating effects of habit, whereby the impact of intention on behavior weakens as habit strength increases, may be based on statistical byproducts of unmet model assumptions.

Roofing material and irrigation frequency influence microbial risk from consuming homegrown lettuce irrigated with harvested rainwater

Rooftop harvested rainwater has become an alternative, potable, and non-potable water source used around the world. In the United States, rooftop harvested rainwater is most commonly used for irrigation. Rooftop harvested rainwater may contain contaminants from bird or animal feces that may present a risk to water users. Different roofing materials may influence the survival of fecal bacteria on the rooftop prior to runoff during rainfall. In this study, three pathogen groups (E. coli, enterococci and Salmonella enterica) in rooftop runoff from three, replicated roof types (asphalt shingle, synthetic slate, and wood shake) were quantified in multiple rain events. Matched roofs were selected from locations with differing amounts of tree cover. Enterococci were the most frequently detected bacteria from all roof types. Wood shake and asphalt shingle roofing materials had the poorest microbial water quality. Rainwater runoff from two of the six buildings failed to meet United States Food and Drug Administration microbial standards for irrigation water. A quantitative microbial risk assessment indicated that the annual probability of illness from consuming lettuce irrigated with rooftop harvested rainwater varied by roofing material, irrigation water withholding period, and exposure frequency. Consuming lettuce immediately after irrigation with rooftop rainwater presented the highest human health risk based on the probability of illness from E. coli and enterococci exposure. Withholding irrigation by 1 day prior to harvest decreased the annual probability of illness from E. coli by 2 log, but had a minimal effect on the risk from enterococci.

A randomized, blinded, controlled trial to assess sand fly mortality of fluralaner administered orally in dogs

Background

Leishmania infantum is the parasite responsible for the disease in humans known as zoonotic visceral leishmaniasis (ZVL). Dogs are considered the main domestic reservoir of ZVL and sand flies are the proven vectors. The use of systemic insecticides in dogs has been studied as an alternative strategy to control ZVL in endemic areas. One systemic insecticide in dogs, fluralaner, has a proven anti-sand fly effect in membrane-fed studies. However, the efficacy and duration on sand flies directly feeding from dogs treated with fluralaner remains unknown.

Methods

Direct feeding bioassays were performed on 10 beagle dogs that had been randomly assigned to two groups: one with five dogs orally treated with Bravecto® (fluralaner) and other five as a control. About 30 females of Phlebotomus papatasi were allowed to directly feed from dogs at seven days before the administration of the treatment and Days 3, 17, 31, 45 and 73 post-treatment. Sand fly mortality after feeding was observed every 24 h for 5 days. The Kaplan-Meyer method, Henderson-Tilton formula and a negative binomial mixed model were used to respectively calculate: (i) mortality and its 95% confidence interval (CI); (ii) efficacy of the insecticide at killing sand flies in 24 h; and (iii) differences in the risk of sand fly death at 24 h after feeding.

Results

Control sand fly mortality 24 h after feeding was always ≤ 20% and mortality in the fluralaner group ranged from 2% (95% CI: 0–4%) 7 days before treatment to 100% at 3 days post-treatment. Fluralaner efficacy was 100, 93, 94 and 75% at Days 3, 17, 31 and 45, respectively (P < 0.0001). The increase in the risk of sand fly death was 32.9 (95% CI: 4–263), 76 (95% CI: 8–705), 95.8 (95% CI: 9–1029) and 10.6 times (95% CI: 1.43–79) on Days 3, 17, 31 and 45, respectively

Conclusions

The efficacy of fluralaner, orally administered to dogs, against sand-flies was above 90% for 31 days. Fluralaner administered to dogs should be further evaluated as a control strategy in ZVL endemic areas.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-3231-8) contains supplementary material, which is available to authorized users.

Factors associated with the utilization of antenatal care and prevention of mother-to-child HIV transmission services in Ethiopia: applying a count regression model

BACKGROUND

Prevention of Mother-to-Child HIV Transmission (PMTCT) coverage has been low in Ethiopia and the service has been implemented in a fragmented manner. Solutions to this problem have mainly been sought on the supply-side in the form of improved management and allocation of limited resources. However, this approach largely ignores the demand-side factors associated with low PMTCT coverage in the country. The study assesses the factors associated with the utilization of PMTCT services taking into consideration counts of visits to antenatal care (ANC) services in urban high-HIV prevalence and rural low-HIV prevalence settings in Ethiopia.

METHODS

A multivariate regression model was employed to identify significant factors associated with PMTCT service utilization. Poisson and negative binomial regression models were applied, considering the number of ANC visits as a dependent variable. The explanatory variables were age; educational status; type of occupation; decision-making power in the household; living in proximity to educated people; a neighborhood with good welfare services; location (urban high-HIV prevalence and rural low-HIV prevalence); transportation accessibility; walking distance (in minutes); and household income status. The alpha dispersion test (a) was performed to measure the goodness-of-fit of the model. Significant results were reported at p-values of < 0.05 and < 0.001.

RESULTS

Household income, socio-economic setting (urban high-HIV prevalence and rural low-HIV prevalence) and walking distance (in minutes) had a statistically significant relationship with the number of ANC visits by pregnant women (p < 0.05). A pregnant woman from an urban high-HIV prevalence setting would be expected to make 34% more ANC visits (counts) than her rural low-HIV prevalence counterparts (p < 0.05). Holding other variables constant, a unit increase in household income would increase the expected ANC visits by 0.004%. An increase in walking distance by a unit (a minute) would decrease the number of ANC visits by 0.001(p < 0.001).

CONCLUSION

Long walking distance, low household income and living in a rural setting are the significant factors associated with low PMTCT service utilization. The primary strategies for a holistic policy to improve ANC/PMTCT utilization should thus include improving the geographical accessibility of ANC/PMTCT services, expanding household welfare and paying more attention to remote rural areas.

Seasonality of helminth infection in wild red deer varies between individuals and between parasite taxa

Parasitism in wild mammals can vary according to myriad intrinsic and extrinsic factors, many of which vary seasonally. However, seasonal variation in parasitism is rarely studied using repeated samples from known individuals. Here we used a wild population of individually recognized red deer (Cervus elaphus) on the Isle of Rum to quantify seasonality and intrinsic factors affecting gastrointestinal helminth parasitism over the course of a year. We collected 1020 non-invasive faecal samples from 328 known individuals which we then analysed for propagules of three helminth taxa: strongyle nematodes, the common liver fluke Fasciola hepatica and the tissue nematode Elaphostrongylus cervi. Zero-inflated Poisson models were used to investigate how season, age and sex were associated with parasite prevalence and count intensity, while Poisson models were used to quantify individual repeatability within and between sampling seasons. Parasite intensity and prevalence varied according to all investigated factors, with opposing seasonality, age profiles and sex biases between parasite taxa. Repeatability was moderate, decreased between seasons and varied between parasites; both F. hepatica and E. cervi showed significant between-season repeatability, while strongyle nematode counts were only repeatable within-season and showed no repeatability within individuals across the year.

Phlebotomine mortality effect of systemic insecticides administered to dogs

BACKGROUND

Zoonotic visceral leishmaniasis (ZVL) caused by Leishmania (Leishmania) infantum is an important disease in humans and dogs. Different mammal species are reservoirs but dogs are considered to be the main one. Phlebotomine sand flies are the proven vector. Four systemic insecticides approved for their use in dogs were previously selected based on their potential to be used in endemic countries as part of the control programs of ZVL. These insecticides are proved to be safe and effective against the on-label insects and parasites, but there is no information about their activity against phlebotomine sand flies.

METHODS

The phlebotomine mortality of four systemic insecticides in dogs was evaluated using two randomized clinical trials. For the first trial, thirty dogs were randomly allocated into five groups: four treatments and one control, of equal size. The treatments evaluated were: Guardian®SR, Elanco (moxidectin); Comfortis®, Elanco (spinosad); Bravecto®, Merck Animal Health (fluralaner); and NexGard®, Merial (afoxolaner). Blood from dogs was taken at days 2, 4, 21 and 31 post-treatment (trial 1). The compound that showed the highest efficacy was selected for a second trial (trial 2) with 20 dogs sampled at days 0, 2, 4, 7, 14, 18, 32, 39, 51 and 84 post-treatment. Membrane feeding bioassays with Phlebotomus papatasi were used to evaluate the phlebotomine mortality efficacy of the different treatments. Phlebotomine mortality was observed every 24 h following the membrane feeding during 5 days. A mixed model for a negative binomial logistic regression, and a Cox proportional hazard mixed model were used to estimate phlebotomine mortality due to different treatments.

RESULTS

Fluralaner was the only compound that showed significant phlebotomine mortality. Fluralaner maintained the phlebotomine mortality between 60-80% for 30 days after treatment. In trial 1 we found that fluralaner increased the risk of death by 1.9 times (95% CI: 1.02-3.6) and 1.7 times (95% CI: 1.09-2.6) at days 2 and 4 after treatment. The Cox model resulted in an increase of 1.47 (95% CI: 1.1-1.96) times in hazard risk at day 2 and 1.89 (95% CI: 1.35-2.45) at day 4 after treatment. In trial 2 we found that fluralaner increased the risk of death by 1.64 times (95% CI: 1.16-2.54) and 1.97 times (95% CI: 1.23-3.17) at days 14 and 32. The hazard risk was also increased by 1.92 (95% CI: 1.4-2.64) times at day 14 after treatment. Phlebotomine survival including all experimental days was significantly lower in the fluralaner group in both trials.

CONCLUSIONS

A single oral treatment of fluralaner in dogs induces phlebotomine mortality. Systemic insecticides in dogs should be considered as a potential preventive measure of ZVL.

Assessing dengue transmission risk and a vector control intervention using entomological and immunological indices in Thailand: study protocol for a cluster-randomized controlled trial

Background

Dengue fever is the most common and widespread mosquito-borne arboviral disease in the world. There is a compelling need for cost-effective approaches and practical tools that can reliably measure real-time dengue transmission dynamics that enable more accurate and useful predictions of incidence and outbreaks. Sensitive surveillance tools do not exist today, and only a small handful of new control strategies are available. Vector control remains at the forefront for combating dengue transmission. However, the effectiveness of many current vector control interventions is fraught with inherent weaknesses. No single vector control method is effective enough to control both vector populations and disease transmission. Evaluations of novel larval and adult control interventions are needed.

Methods/design

A cluster-randomized controlled trial will be carried out between 2017 and 2019 in urban community clusters in Khon Kaen and Roi Et cities, northeastern Thailand. The effectiveness of a pyriproxyfen/spinosad combination treatment of permanent water storage containers will be evaluated on epidemiological and entomological outcomes, including dengue incidence, number of female adult dengue vectors infected or not infected with dengue virus (DENV), human exposure to Aedes mosquito bites, and several other indices. These indices will also be used to develop predictive models for dengue transmission and impending outbreaks. Epidemiological and entomological data will be collected continuously for 2 years, with the intervention implemented after 1 year.

Discussion

The aims of the trial are to simultaneously evaluate the efficacy of an innovative dengue vector control intervention and developing predictive dengue models. Assessment of human exposure to mosquito bites by detecting antibodies generated against Aedes saliva proteins in human blood samples has, so far, not been applied in dengue epidemiological risk assessment and disease surveillance methodologies. Likewise, DENV detection in mosquitoes (adult and immature stages) has not been used in any practical way for routine disease surveillance strategies. The integration of multiple outcome measures will assist health authorities to better predict outbreaks for planning and applying focal and timely interventions. The trial outcomes will not only be important for Thailand, but also for the entire Southeast Asian region and further afield.

Trial registration

ISRCTN, ISRCTN73606171. Registered on 23 June 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2490-1) contains supplementary material, which is available to authorized users.

Bionomics of Phlebotomus argentipes in villages in Bihar, India with insights into efficacy of IRS-based control measures

Background

Visceral leishmaniasis (VL) is a deadly vector-borne disease. Approximately 90% of Indian VL cases occur in Bihar, where the sand fly, Phlebotomus argentipes, is the principal vector. Sand fly control in Bihar consists of indoor residual spraying (IRS), the practice of spraying the inner walls of village dwellings with insecticides. Prior researchers have evaluated success of IRS-control by estimating vector abundance in village houses, but the number of sampling periods (n = 2–3) were minimal, and outdoor-resting P. argentipes were neglected. We describe a large-scale field study, performed in 24 villages within two Bihari districts, during which P. argentipes were collected biweekly over 47-weeks, in cattle enclosures, houses, and outdoors in peri-domestic vegetation. The objectives of this study were to provide updated P. argentipes ecological field data, and determine if program-initiated IRS-treatment had led to noticeable differences in vector abundance.

Principal findings

P. argentipes (n = 126,901) relative abundance was greatest during the summer months (June-August) when minimum temperatures were highest. P. argentipes were most frequently collected from cattle enclosures (~46% total; ~56% blood fed). Many sand flies were found to have taken blood from multiple sources, with ~81% having blood fed on humans and ~60% blood feeding on bovines. Nonparametric statistical tests were determined most appropriate for evaluating IRS-treatment. Differences in P. argentipes abundance in houses, cattle enclosures and vegetation were detected between IRS-treated and untreated villages in only ~9% of evaluation periods occurring during the peak period of human-vector exposure (June-August) and in ~8% of the total observations. No significant differences were detected between the numbers of P. argentipes collected in vegetation close to the experimental villages.

Conclusion

The results of this study provide updated data regarding P. argentipes seasonal abundance, spatial distribution, and host preferances, and suggest vector abundance has not significantly declined in IRS-treated villages. We suggest that IRS be supplemented with vector control strategies targeting exophagic, exophilic P. argentipes, and that disease surveillance be accompanied by rigorous vector population monitoring.

Visceral leishmaniasis is a disease caused by a deadly vector-borne parasite (Leishmania donovani) transmitted to man by phlebotomine sand flies. Indoor residual spraying (IRS), performed within village dwellings, is the primary means of sand fly control performed in Bihar, India and more explicit methods of evaluating the success of control are warranted. A field-based study was conducted to collect ecological sand fly data for use in evaluating the effectiveness of IRS in reducing relative sand fly abundance. Results indicate that sand flies blood feed primarily on humans and cattle and are most frequently found within cattle enclosures. Results further suggest IRS-treatment has a limited impact on vector density. Our approach incorporates detailed evaluation of sand fly spatial distribution (cattle enclosures, houses, vegetation), seasonal fluctuations in abundance, host blood meal preferences within Bihari villages, and dates of IRS performed within treated villages. Hence, this study provides an explicit means of monitoring vector populations and evaluating control measures in Bihar.

Responses of Sri Lankan indigenous goats and their Jamnapari crosses to artificial challenge with Haemonchus contortus

Goat farming plays an important role in the Sri Lankan rural economy. Sri Lankan indigenous (SLI) goats and their crossbreds are reared mainly under extensive management and indiscriminately exposed to pathogens and parasites. This study was designed to evaluate resistance to haemonchosis in SLI goats and their Jamnapari crossbreds (JCB) in the dry zone of Sri Lanka. Twenty SLI and 20 JCB 4-month-old male goats were artificially challenged with 5000 H. contortus L₃ larvae_. Faecal egg counts (FEC), body weights, FAffa MAlan CHArt (FAMACHA®) scores, packed cell volumes (PCV), red blood cell counts, total and differential white blood cell counts, blood haemoglobin contents, serum total protein and albumin contents, and serum pepsinogen and antibody levels were determined at 0, 21, 28, 35 and 42days after challenge. Effects of measurement time were significant for all variables (P<0.05). Breed effects approached significance (P=0.06) and measurement time×breed interaction was significant (P<0.05) for FEC. Peak FEC occurred at day 35 in both goat types, and JCB goats had higher FEC than SLI goats at days 28 (P<0.001), 35 (P<0.10), and 42 (P<0.10). Means for FEC at day 35 were 1783±446 eggs per gram of feces (epg) for SLI kids and 3329±850 epg for JCB kids. Haematological parameters, serum chemistry, and FAMACHA scores suggested that SLI goats were recovering from parasitic infection by day 42, whereas JCB goats had increasing severity of anaemia. Means for PCV in SLI goats decreased from 26.8±0.7% at day 0 to 19.7±0.9% at day 35 and thereafter increased to 20.2±0.9% at day 42. Means for PCV in JCB goats declined from 25.9±0.6% at day 0 to 17.2±0.9% at day 42. Eosinophilia was observed in both genotypes. The JCB goats were heavier than SLI goats and had higher antibody titres, reflecting higher levels of parasitism. Both goat types significantly increased in body weight during the experiment and therefore tolerated parasite infection without severe production losses. We concluded that SLI goats were more resistant to haemonchosis than JCB goats, but that JCB goats were somewhat resilient to parasitic infection. Substantial variability in measurements associated with parasite infection in both breeds indicated potential to improve parasite resistance. Phenotypic information should be coupled with genomic information to identify appropriate breeding goals for future selection programs.

High prevalence of very-low Plasmodium falciparum and Plasmodium vivax parasitaemia carriers in the Peruvian Amazon: insights into local and occupational mobility-related transmission

BACKGROUND

The incidence of malaria due both to Plasmodium falciparum and Plasmodium vivax in the Peruvian Amazon has risen in the past 5 years. This study tested the hypothesis that the maintenance and emergence of malaria in hypoendemic regions such as Amazonia is determined by submicroscopic and asymptomatic Plasmodium parasitaemia carriers. The present study aimed to precisely quantify the rate of very-low parasitaemia carriers in two sites of the Peruvian Amazon in relation to transmission patterns of P. vivax and P. falciparum in this area.

METHODS

This study was carried out within the Amazonian-ICEMR longitudinal cohort. Blood samples were collected for light microscopy diagnosis and packed red blood cell (PRBC) samples were analysed by qPCR. Plasma samples were tested for total IgG reactivity against recombinant PvMSP-10 and PfMSP-10 antigens by ELISA. Occupation and age 10 years and greater were considered surrogates of occupation-related mobility. Risk factors for P. falciparum and P. vivax infections detected by PRBC-qPCR were assessed by multilevel logistic regression models.

RESULTS

Among 450 subjects, the prevalence of P. vivax by PRBC-PCR (25.1%) was sixfold higher than that determined by microscopy (3.6%). The prevalence of P. falciparum infection was 4.9% by PRBC-PCR and 0.2% by microscopy. More than 40% of infections had parasitaemia under 5 parasites/μL. Multivariate analysis for infections detected by PRBC-PCR showed that participants with recent settlement in the study area (AOR 2.1; 95% CI 1.03:4.2), age ≥ 30 years (AOR 3.3; 95% CI 1.6:6.9) and seropositivity to P. vivax (AOR 1.8; 95% CI 1.0:3.2) had significantly higher likelihood of P. vivax infection, while the odds of P. falciparum infection was higher for participants between 10 and 29 years (AOR 10.7; 95% CI 1.3:91.1) and with a previous P. falciparum infection (AOR 10.4; 95% CI 1.5:71.1).

CONCLUSIONS

This study confirms the contrasting transmission patterns of P. vivax and P. falciparum in the Peruvian Amazon, with stable local transmission for P. vivax and the source of P. falciparum to the study villages dominated by very low parasitaemia carriers, age 10 years and older, who had travelled away from home for work and brought P. falciparum infection with them.

Loop-mediated isothermal DNA amplification for asymptomatic malaria detection in challenging field settings: Technical performance and pilot implementation in the Peruvian Amazon

BACKGROUND

Loop-mediated isothermal DNA amplification (LAMP) methodology offers an opportunity for point-of-care (POC) molecular detection of asymptomatic malaria infections. However, there is still little evidence on the feasibility of implementing this technique for population screenings in isolated field settings.

METHODS

Overall, we recruited 1167 individuals from terrestrial ('road') and hydric ('riverine') communities of the Peruvian Amazon for a cross-sectional survey to detect asymptomatic malaria infections. The technical performance of LAMP was evaluated in a subgroup of 503 samples, using real-time Polymerase Chain Reaction (qPCR) as reference standard. The operational feasibility of introducing LAMP testing in the mobile screening campaigns was assessed based on field-suitability parameters, along with a pilot POC-LAMP assay in a riverine community without laboratory infrastructure.

RESULTS

LAMP had a sensitivity of 91.8% (87.7-94.9) and specificity of 91.9% (87.8-95.0), and the overall accuracy was significantly better among samples collected during road screenings than riverine communities (p≤0.004). LAMP-based diagnostic strategy was successfully implemented within the field-team logistics and the POC-LAMP pilot in the riverine community allowed for a reduction in the turnaround time for case management, from 12-24 hours to less than 5 hours. Specimens with haemolytic appearance were regularly observed in riverine screenings and could help explaining the hindered performance/interpretation of the LAMP reaction in these communities.

CONCLUSIONS

LAMP-based molecular malaria diagnosis can be deployed outside of reference laboratories, providing similar performance as qPCR. However, scale-up in remote field settings such as riverine communities needs to consider a number of logistical challenges (e.g. environmental conditions, labour-intensiveness in large population screenings) that can influence its optimal implementation.

Epidemiology of gastrointestinal nematode infections in grazing yearling beef cattle in Saskatchewan

The objective of this study was to provide contemporary data on the epidemiology of gastrointestinal nematode parasite infections of grazing yearling beef cattle in the province of Saskatchewan. Fecal samples (n = 1290) were collected over 4 time periods during the summer grazing season from 21 separately managed groups of cattle. Fecal egg counts (FEC) were estimated using generalized estimating equations with a negative binomial distribution with log link function, adjusting for clustering of samples within each herd for each time period. Nematodirus spp. and Trichuris spp. eggs were enumerated separately and were detected in 5.7% (73/1290) and 1.7% (22/1290) of samples, respectively. One or more strongyle-type eggs were detected in 79.5% (1025/1290) of the samples and FEC increased by 2.8 times over the summer grazing season. Interestingly, FEC were ~3.4 times higher on pastures located in dark brown versus brown soil zones, a finding that warrants further investigation.

Freshwater mussels (Anodonta anatina) reduce transmission of a common fish trematode (eye fluke, Diplostomum pseudospathaceum)

Recent results suggest that bivalves can play an important role in restraining the spread of various aquatic infections. However, the ability of mussels to remove free-living stages of macroparasites and reduce their transmission is still understudied, especially for freshwater ecosystems. We investigated the influence of the common freshwater mussel (Anodonta anatina) on the transmission of a trematode (eye fluke, Diplostomum pseudospathaceum), which frequently infects fish in farms and natural habitats. In our experiments, mussels caused a significant decrease (P < 0·001) in the abundance of trematode free-living stages, from 6520 to 1770 cercariae L-1 on average (about 4-fold in 2 h). Individual clearance rates of mussels were 0·6‒3·7 L per hour (mean 1·9). These tests were followed by experimental infections of rainbow trout (Oncorhynchus mykiss) with different doses of D. pseudospathaceum cercariae in the presence or absence of mussels. Exposure of fish to cercariae in the presence of mussels significantly (P < 0·05) reduced the infection intensities in fish (by 30-40%) at all exposure doses. Our results indicate that freshwater bivalves can markedly reduce local cercariae densities and could be useful in mitigation of trematodoses harmful to fish farming.

Consistency of Use and Effectiveness of Household Water Treatment among Indian Households Claiming to Treat Their Water

Household water treatment (HWT) can improve drinking water quality and prevent disease if used correctly and consistently by populations at risk. Current international monitoring estimates by the Joint Monitoring Programme for water and sanitation suggest that at least 1.1 billion people practice HWT. These estimates, however, are based on surveys that may overstate the level of consistent use and do not address microbial effectiveness. We sought to assess how HWT is practiced among households identified as HWT users according to these monitoring standards. After a baseline survey (urban: 189 households, rural: 210 households) to identify HWT users, 83 urban and 90 rural households were followed up for 6 weeks. Consistency of reported HWT practices was high in both urban (100%) and rural (93.3%) settings, as was availability of treated water (based on self-report) in all three sampling points (urban: 98.8%, rural: 76.0%). Nevertheless, only 13.7% of urban and 25.8% of rural households identified at baseline as users of adequate HWT had water free of thermotolerant coliforms at all three water sampling points. Our findings raise questions about the value of the data gathered through the international monitoring of HWT as predictors of water quality in the home, as well as questioning the ability of HWT, as actually practiced by vulnerable populations, to reduce exposure to waterborne diseases.

Faecal contamination of household drinking water in Rwanda: A national cross-sectional study

Unsafe drinking water is a leading cause of morbidity and mortality, especially among young children in low-income settings. We conducted a national survey in Rwanda to determine the level of faecal contamination of household drinking water and risk factors associated therewith. Drinking water samples were collected from a nationally representative sample of 870 households and assessed for thermotolerant coliforms (TTC), a World Health Organization (WHO)-approved indicator of faecal contamination. Potential household and community-level determinants of household drinking water quality derived from household surveys, the 2012 Rwanda Population and Housing Census, and a precipitation dataset were assessed using multivariate logistic regression. Widespread faecal contamination was present, and only 24.9% (95% CI 20.9-29.4%, n=217) of household samples met WHO Guidelines of having no detectable TTC contamination, while 42.5% (95% CI 38.0-47.1%, n=361) of samples had >100TTC/100mL and considered high risk. Sub-national differences were observed, with poorer water quality in rural areas and Eastern province. In multivariate analyses, there was evidence for an association between detectable contamination and increased open waste disposal in a sector, lower elevation, and water sources other than piped to household or rainwater/bottled. Risk factors for intermediate/high risk contamination (>10TTC/100mL) included low population density, increased open waste disposal, lower elevation, water sources other than piped to household or rainwater/bottled, and occurrence of an extreme rain event the previous day. Modelling suggests non-household-based risk factors are determinants of water quality in this setting, and these results suggest a substantial proportion of Rwanda's population are exposed to faecal contamination through drinking water.

Analysing risk factors of co-occurrence of schistosomiasis haematobium and hookworm using bivariate regression models: Case study of Chikwawa, Malawi

Schistosomiasis and soil-transmitted helminth (STH) infections constitute a major public health problem in many parts of sub-Saharan Africa. In areas where prevalence of geo-helminths and schistosomes is high, co-infection with multiple parasite species is common, resulting in disproportionately elevated burden compared with single infections. Determining risk factors of co-infection intensity is important for better design of targeted interventions. In this paper, we examined risk factors of hookworm and S. haematobium co-infection intensity, in Chikwawa district, southern Malawi in 2005, using bivariate count models. Results show that hookworm and S. haematobium infections were much localised with small proportion of individuals harbouring more parasites especially among school-aged children. The risk of co-intensity with both hookworm and S. haematobium was high for all ages, although this diminished with increasing age, increased with fishing (hookworm: coefficient. = 12.29; 95% CI = 11.50-13.09; S. haematobium: 0.040; 95% CI = 0.0037, 3.832). Both infections were abundant in those with primary education (hookworm: coef. = 0.072; 95% CI = 0.056, 0.401 and S. haematobium: coef. = 0.286; 95% CI = 0.034, 0.538). However, much lower risk was observed for those who were farmers (hookworm: coef. = - 0.349, 95% CI = - 0.547,-0.150; S. haematobium: coef. - 0.239, 95% CI = - 0.406, - 0.072). In conclusion, our findings suggest that efforts to control helminths infection should be co-integrated and health promotion campaigns should be aimed at school-going children and adults who are in constant contact with water.

Consistency of Use and Effectiveness of Household Water Treatment Practices Among Urban and Rural Populations Claiming to Treat Their Drinking Water at Home: A Case Study in Zambia

Household water treatment (HWT) can improve drinking water quality and prevent disease, if used correctly and consistently. While international monitoring suggests that 1.8 billion people practice HWT, these estimates are based on household surveys that may overstate the level of consistent use and do not address microbiological effectiveness. We sought to examine how HWT is practiced among households identified as HWT users according to international monitoring standards. Case studies were conducted in urban and rural Zambia. After a baseline survey (urban: 203 households, rural: 276 households) to identify HWT users, 95 urban and 82 rural households were followed up for 6 weeks. Consistency of HWT reporting was low; only 72.6% of urban and 50.0% of rural households reported to be HWT users in the subsequent visit. Similarly, availability of treated water was low, only 23.3% and 4.2% of urban and rural households, respectively, had treated water on all visits. Drinking water was significantly worse than source water in both settings. Only 19.6% of urban and 2.4% of rural households had drinking water free of thermotolerant coliforms on all visits. Our findings raise questions about the value of the data gathered through the international monitoring of HWT practices as predictors of water quality in the home.

Tolerance and efficacy of emamectin benzoate and ivermectin for the treatment of Pseudocapillaria tomentosa in laboratory zebrafish (Danio rerio)

Tolerance of adult zebrafish and efficacy of emamectin benzoate and ivermectin in eliminating Pseudocapillaria tomentosa infection were evaluated. In the tolerance study, behavioral changes, fecundity, histopathology, and mortality were evaluated for in-feed administration of emamectin (0.05, 0.10, and 0.25 mg/kg) and ivermectin (0.05 and 0.10 mg/kg). All doses of emamectin were well tolerated. Ivermectin 0.05 mg/kg administration resulted in mild behavioral changes and a transient decrease in fecundity. Ivermectin 0.10 mg/kg administration resulted in severe behavioral changes and some mortality. In the efficacy study, emamectin (0.05 and 0.25 mg/kg) and ivermectin (0.05 mg/kg) were evaluated for their efficacy in eliminating P. tomentosa infection. Emamectin reduced parasite burden in infected zebrafish, and ivermectin eliminated intestinal nematode infections. Despite a small margin of safety, ivermectin 0.05 mg/kg was effective at eliminating P. tomentosa infection in adult zebrafish. Higher doses or a longer course of treatment may be needed for complete elimination of P. tomentosa infection using emamectin. In this study, we propose two possible treatments for intestinal nematode infections in zebrafish.

Evaluating the sterilizing effect of pyriproxyfen treated mosquito nets against Anopheles gambiae at different blood-feeding intervals

Pyrethroid resistant malaria vectors are widespread throughout sub-Saharan Africa and new insecticides with different modes of action are urgently needed. Pyriproxyfen is a juvenile hormone mimic that reduces fecundity and fertility of adult Anopheles mosquitoes when used as a contact insecticide. A long-lasting insecticidal net incorporating pyriproxyfen is under development. As wild, host-seeking females may succeed in blood-feeding at different intervals after initial contact with mosquito nets the aim of this study was to determine the effect that age and gonotrophic status (nulliparous or parous) and the interval between initial pyriproxyfen exposure and blood-feeding has in terms of subsequent reduced fecundity and fertility. Anopheles gambiae s.s. were exposed to pyriproxyfen LLIN for three minutes in WHO cone bioassays. Four regimens were tested with different blood-feeding intervals A-1 hour (nulliparous), B-1 hour (parous), C-24h (nulliparous), or D-120h (nulliparous) after pyriproxyfen exposure. Mosquito oviposition rate, fecundity and fertility of eggs were recorded for several days. All four treatment regimens produced levels of mortality similar to unexposed females. The overall reduction in reproductive rate of 99.9% for regimen A relative to the untreated net was primarily due to oviposition inhibition in exposed females (97%). Pyriproxyfen was equally effective against older parous mosquitoes and when blood-feeding was 24h after exposure. Regimen D produced a reduction in reproductive rate of 60.1% but this was of lesser magnitude than other regimens and was the only regimen that failed to reduce fertility of laid eggs, indicating the effects of pyriproxyfen exposure on reproduction are to some extent reversible as mosquitoes age. In an area of moderate to high mosquito net coverage a host-seeking mosquito is likely to contact a treated mosquito net before: (a) penetrating a holed net and blood-feeding shortly after exposure or, (b) be frustrated by intact nets before succeeding in blood-feeding on an unprotected individual the following night. Mosquito nets are an appropriate delivery system for pyriproxyfen, based on the large reductions in reproductive rate when blood-feeding between 1h and 24h after exposure. Combining with a pyrethroid should be an effective approach if susceptible mosquitoes are killed and resistant mosquitoes sterilized.