The impact of natural environment on human alveolar echinococcosis: A township-level modeling study in Qinghai-Tibet Plateau.

Human alveolar echinococcosis (AE) is a lethal helminthic infection caused by the tapeworms Echinococcus multilocularis. The Qinghai-Tibet Plateau has the greatest endemicity of human AE globally, but the natural risk factors and its impact mechanism are still unclear. Generalized linear models and generalized additive models are used to select key linear and non-linear environmental factors associated with cases of AE. The interactive effect between different factors is identified using concurvity test. From fifty-nine variables analyzed, four key factors and one interaction term were identified associated with AE. Considering interaction terms between climatic and geographical landscape factors can significantly improve model fitting. Minimum winter precipitation, percentage of grassland cover, and minimum elevation have significant positive linear relationship with human AE incidence. The relationship between maximum summer precipitation and human AE is non-linear with high AE incidence associated with moderate precipitation. The interaction term of maximum summer precipitation and number of patches of grassland on human AE indicates that human AE incidence is highest when both factors were high. The climatic and landscape risk factors together are associated with the local transmission of human AE in Qinghai-Tibet Plateau. This study provides a scientific basis for human intervention in AE from fine-scale ecological environment.

Limitations in the implementation of control measures for bovine paratuberculosis in infected Swiss dairy and beef herds.

Various measures have been advocated for the control of Johne's disease (caused by Mycobacterium avium subsp. paratuberculosis, MAP) in different countries. Farmers' compliance has been reported to be variable depending on disease prevalence and incentives to participate in control programs. After the prevalence of MAP shedding and risk factors for within-herd spread of MAP were assessed in 17 Swiss cattle herds (10 dairy and 7 beef), general and herd-specific recommendations were given to the farmers to reduce MAP transmission within the herd. Participation in the study and implementation of control measures were voluntary, no financial incentives were provided for the realization of control measures. After a 3-year period of monitored observation including biannual farm visits and discussion of the situation, the implementation of the recommended control measures and their effect on prevalence of MAP shedding were evaluated. Implementation of recommended general and farm-specific control measures was only partially realized. Neither the number of animals tested positive (before or during the study) nor the farmers' knowledge about paratuberculosis were significantly associated with their compliance for the implementation of management changes. The apparent within-herd prevalence remained constant despite limited implementation of control measures, and no particular group of control measures was found to be associated with changes in prevalence. Farmers' compliance for the implementation of control measures to reduce the impact of Johne's disease in infected farms was very limited under Swiss farming conditions in the frame of voluntary participation in a research project. These results indicate that the losses associated with paratuberculosis in Swiss dairy and beef operations are not estimated to be high enough by the farmers to justify important efforts for control measures, and that incentives may be necessary to achieve efficient implementation of such measures.

Antibody kinetics and exposure to Toxoplasma gondii in cats: a seroepidemiological study.

Domestic cats are the most important definitive hosts for Toxoplasma gondii, the agent of an important global zoonosis. Serial sera from cats orally inoculated either withT. gondii tissue cysts (n = 3) or sporulated oocysts (n = 3) and from 65 client-owned cats, plus sera from 1,757 client-owned cats presented to veterinarians in Switzerland were analysed for an antibody response to T. gondii by ELISA. Risk factors for seropositivity and prevalence were estimated with a generalised linear and beta regression model. The first model examined the association of an OD405 value as the dependent variable, with gender, age, and outside access as possible independent variables. In the second model, we first analysed the data assuming a bimodal distribution representing two overlapping distributions of OD405 values from positive and negative cats, enabling the assignment of a probability of true infection status to each cat. Mean probabilities of true infection status across groups represent an estimate of true prevalence. These probabilities were then regressed against age, gender and outside access. Antibody kinetics in cats orally inoculated with tissue cysts, shedding oocysts, did not differ significantly from those of cats inoculated with sporulated oocysts without detectable oocyst excretion, suggesting extraintestinal parasite invasion and exposure to tachyzoites in both situations at an early stage of infection. Analysis of serial serum samples suggested a persisting long-term humoral immune response. Of the client-owned cats, 42.4% (95% confidence interval (CI): 40.1-44.6) had a positive true infection status. This was higher (56.3% (95% CI: 53.2-59.6)) in cats with outside access than in those without (22.1% (95% CI: 18.9-25.4)). In the first model, the factors age (P < 0.0001), gender (male: P = 0.046), and outside access (P < 0.0001) were independently associated with significantly higher OD405 values. In the second model, the probability of having a positive true infection status increased with age (P < 0.0001), was higher with outside access (P < 0.0001) and in outdoor male cats (P = 0.0006).

Epidemic cystic and alveolar echinococcosis in Kyrgyzstan: an analysis of national surveillance data.

BACKGROUND: Human cystic and alveolar echinococcosis are among the priority neglected zoonotic diseases for which WHO advocates control. The incidence of both cystic echinococcosis and alveolar echinococcosis has increased substantially in the past 30 years in Kyrgyzstan. Given the scarcity of adequate data on the local geographical variation of these focal diseases, we aimed to investigate within-country incidence and geographical variation of cystic echinococcosis and alveolar echinococcosis at a high spatial resolution in Kyrgyzstan. METHODS: We mapped all confirmed surgical cases of cystic echinococcosis and alveolar echinococcosis reported through the national echinococcosis surveillance system in Kyrgyzstan between Jan 1, 2014, and Dec 31, 2016, from nine regional databases. We then estimated crude surgical incidence, standardised incidence, and standardised incidence ratios (SIRs) of primary cases (ie, excluding relapses) based on age and sex at country, region, district, and local community levels. Finally, we tested the SIRs for global and local spatial autocorrelation to identify disease hotspots at the local community level. All incidence estimates were calculated per 100 000 population and averaged across the 3-year study period to obtain annual estimates. FINDINGS: The surveillance system reported 2359 primary surgical cases of cystic echinococcosis and 546 primary surgical cases of alveolar echinococcosis. Country-level crude surgical incidence was 13·1 per 100 000 population per year for cystic echinococcosis and 3·02 per 100 000 population per year for alveolar echinococcosis. At the local community level, we found annual crude surgical incidences up to 176 per 100 000 population in Sary-Kamysh (Jalal-Abad region) for cystic echinococcosis and 246 per 100 000 population in Uch-Dobo (Alay district, Osh region) for alveolar echinococcosis. Significant hotspots of cystic echinococcosis were found in four regions: Osh (five local communities in Uzgen district and four in Alay district), Naryn (three local communities in Jumgal district and one in Naryn district), Talas (three local communities in Talas district), and Chuy (one local community in Jayyl district). Significant alveolar echinococcosis hotspots were detected in the Osh region (11 communities in Alay district, including the local community of Sary Mogol, and one in Chong-Alay district) and in the Naryn region (five communities in Jumgal district and three in At-Bashy district), in the southwest and centre of the country. INTERPRETATION: Our analyses reveal remarkable within-country variation in the surgical incidence of cystic echinococcosis and alveolar echinococcosis in Kyrgyzstan. These high-resolution maps identify precise locations where interventions and epidemiological research should be targeted to reduce the burden of human cystic echinococcosis and alveolar echinococcosis. FUNDING: Swiss National Science Foundation.