Spatial distribution of, and risk factors for, Opisthorchis viverrini infection in southern Lao PDR.
Spatial distribution of, and risk factors for, Opisthorchis viverrini infection in southern Lao PDR.
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DOI：
10.1371/journal.pntd.0001481
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发表时间：
2012
影响因子：
3.8
通讯作者：
Odermatt P
中科院分区：
文献类型：
--
作者：
Forrer A;Sayasone S;Vounatsou P;Vonghachack Y;Bouakhasith D;Vogt S;Glaser R;Utzinger J;Akkhavong K;Odermatt P
Opisthorchis viverrini 是一种食源性吸虫，可能引起胆道疾病和致命的胆管癌。在老挝人民民主共和国，估计有 250 万人感染 O. viverrini，但流行病学研究很少，感染的空间分布仍有待确定。我们的目的是绘制 O. viverrini 在老挝人民民主共和国南部的分布图，确定潜在的风险因素，并预测 O. viverrini 在非调查地点的流行情况。 2007年上半年，对占巴塞省的51个村庄进行了横断面寄生虫学和问卷调查。人口、社会经济状况、供水、卫生和行为数据与遥感环境数据相结合，并输入地理信息系统。采用贝叶斯地统计模型来识别风险因素并研究 O. viverrini 感染的空间模式。利用贝叶斯克里金法来预测非调查地点的感染风险。在 3,371 名有完整数据记录的研究参与者中，O. viverrini 的患病率为 61.1%。地统计模型将年龄、老鲁姆族群、教育程度、职业（即稻农、渔民和动物饲养员）和不安全的饮用水源确定为感染的危险因素。吡喹酮治疗史、卫生设施的使用情况以及距淡水水体的距离被发现是保护因素。 O. viverrini 的空间模式主要受环境因素控制，预测模型确定了两种不同的风险状况：山区 O. viverrini 的低风险和湄公河走廊的高风险。我们展示了占巴塞省第一个 O. viverrini 感染风险图，这对于控制工作的空间定位非常重要。 O. viverrini 感染似乎与第二中间宿主鱼的接触、人类行为和文化密切相关，而高传播率则因缺乏卫生设施而持续。肝吸虫 Opisthorchis viverrini 主要发生在老挝人民民主共和国和泰国。人类通过食用生的或未煮熟的淡水鱼而受到感染。慢性感染可能导致严重的肝脏（胆管）疾病，最终发展为预后极差的胆管癌。目前的控制工作旨在防止严重的发病率和死亡率。近年来，利用精心设计的调查数据进行空间建模，已被用来更好地了解寄生虫病的分布和决定因素，以指导后续控制。然而，空间建模方法之前尚未用于 O. viverrini。本研究的目的是绘制老挝人民民主共和国南部占巴塞省 O. viverrini 感染的分布图，以确定感染的危险因素，并预测非调查地点的分布情况。我们发现，生活在靠近淡水水体的人们感染 O. viverrini 的风险较高，而卫生设施的缺乏导致了环境污染和传播。占巴塞省高风险区集中在湄公河走廊，防控重点应集中在湄公河沿岸。
Opisthorchis viverrini is a food-borne trematode species that might give rise to biliary diseases and the fatal cholangiocarcinoma. In Lao PDR, an estimated 2.5 million individuals are infected with O. viverrini, but epidemiological studies are scarce and the spatial distribution of infection remains to be determined. Our aim was to map the distribution of O. viverrini in southern Lao PDR, identify underlying risk factors, and predict the prevalence of O. viverrini at non-surveyed locations. A cross-sectional parasitological and questionnaire survey was carried out in 51 villages in Champasack province in the first half of 2007. Data on demography, socioeconomic status, water supply, sanitation, and behavior were combined with remotely sensed environmental data and fed into a geographical information system. Bayesian geostatistical models were employed to identify risk factors and to investigate the spatial pattern of O. viverrini infection. Bayesian kriging was utilized to predict infection risk at non-surveyed locations. The prevalence of O. viverrini among 3,371 study participants with complete data records was 61.1%. Geostatistical models identified age, Lao Loum ethnic group, educational attainment, occupation (i.e., rice farmer, fisherman, and animal breeder), and unsafe drinking water source as risk factors for infection. History of praziquantel treatment, access to sanitation, and distance to freshwater bodies were found to be protective factors. Spatial patterns of O. viverrini were mainly governed by environmental factors with predictive modeling identifying two different risk profiles: low risk of O. viverrini in the mountains and high risk in the Mekong corridor. We present the first risk map of O. viverrini infection in Champasack province, which is important for spatial targeting of control efforts. Infection with O. viverrini appears to be strongly associated with exposure to the second intermediate host fish, human behavior and culture, whereas high transmission is sustained by the lack of sanitation. The liver fluke Opisthorchis viverrini mainly occurs in Lao PDR and Thailand. Humans become infected through the consumption of raw or insufficiently cooked freshwater fish. Chronic infections may lead to severe liver (bile duct) diseases that eventually develop into a bile duct cancer with extremely poor prognosis. Current control efforts aim at preventing heavy morbidity and mortality. In recent years, spatial modeling, using data from well designed surveys, has been employed to better understand the distribution and determinants of parasitic diseases for guiding subsequent control. However, a spatial modeling approach has not been used for O. viverrini before. The purpose of the current study was to map the distribution of O. viverrini infection in Champasack province in southern Lao PDR, to identify risk factors of infection, and to predict the distribution at non-surveyed locations. We found that the risk of O. viverrini infection is higher for people living in close proximity to freshwater bodies, whereas the lack of sanitation sustained environmental contamination and transmission. High risk zones in Champasack province are concentrated in the Mekong River corridor, and hence control efforts should be targeted along the Mekong River.
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