Associations of water contact frequency, duration, and activities with schistosome infection risk: A systematic review and meta-analysis.
Associations of water contact frequency, duration, and activities with schistosome infection risk: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pntd.0011377
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发表时间：
2023-06
影响因子：
3.8
通讯作者：
Chami, Goylette F.
中科院分区：
文献类型：
--
作者：
Reitzug, Fabian;Ledien, Julia;Chami, Goylette F.
血吸虫病是一种水传播的寄生虫病，影响全球2.3亿多人。与开放的淡水水体接触和嗜水气单胞菌感染的可能性之间的关系仍然很难量化，尽管它对于理解传播和参数化传播模型很重要。我们进行了一项系统评价，以估计水接触时间、频率和活动对细菌感染可能性的平均影响。我们检索了Embase、MEDLINE（包括PubMed）、Global Health、Global Index Medicus、Web of Science和科克伦对照试验中央登记中心，从开始到2022年5月13日。观察性和干预性研究报告的比值比（OR），风险比（HR），或足够的信息，以重建个人水平的影响大小之间的关联水接触和感染任何血吸虫属的资格纳入。使用具有逆方差加权的随机效应荟萃分析来计算合并OR和95%置信区间（CI）。我们筛选了1，411项研究，其中101项研究代表了非洲，亚洲和南美洲的192，691名参与者。纳入的研究主要报告了与水接触的活动（69%; 70/101）和与水接触的活动（33%; 33/101）。96%的研究（97/101）使用调查来测量暴露。对33项研究的荟萃分析显示，与没有接触水的人相比，接触水的人感染的可能性高3.14倍（OR 3.14; 95% CI：2.08-4.75）。亚组分析显示，与包括成人和儿童的研究相比，儿童中水接触与感染的正相关性显著较弱（OR 1.67; 95% CI：1.04-2.69 vs. OR 4.24; 95% CI：2.59-6.97）。只有在≥10%的人群中才发现水接触与感染相关。除直接观察研究（I2范围= 44%-98%）外，所有亚组的总体异质性均显著（I2 = 93%），且仍较高。我们没有发现职业性水接触，如渔业和农业（OR 2.57; 95% CI：1.89-3.51）与娱乐用水接触（OR 2.13; 95% CI：1.75-2.60）或生活用水接触（OR 1.91; 95% CI：1.47-2.48）相比，会显著增加寄生虫感染的风险。较高的持续时间或频率的水接触并没有显着改变感染的可能性。各分析的研究质量大多为中等或较差。任何当前的水接触都与疟原虫感染状态密切相关，这种关系在成人和儿童以及流行率大于10%的疟原虫流行区都存在。在了解水接触与年龄和性别的相互作用以及这些相互作用对感染可能性的影响方面，已发表的研究仍存在很大差距。因此，需要进行更多的实证研究，以准确地确定传播模型中的暴露参数。我们的研究结果意味着需要在地方性环境中进行全人群的治疗和预防策略，因为这些社区内的暴露并不局限于目前优先考虑的高风险群体，如渔民。血吸虫病是一种被忽视的热带疾病，在78个国家流行，影响全球2.3亿多人，主要是在撒哈拉以南非洲。与湖泊、河流和水坝等开放的淡水源接触会使人们面临感染的风险。现有的系统性审查将艾滋病毒感染与性别和缺乏清洁饮用水和卫生基础设施等风险因素联系起来。然而，虽然这些风险因素可能是由水接触行为介导的，但水接触与严重感染可能性的直接关联仍然很难量化。我们对接触水的频率、持续时间和活动与细菌感染可能性之间的关系进行了系统评价。我们发现，与没有水接触相比，有任何水接触的感染可能性高出3.14倍。这种关系在成人和儿童之间以及在中度和高度流行的环境中都存在。在11种水接触活动中，10种活性物质与感染风险增加有关。职业、家庭和娱乐暴露与类似的感染可能性相关。本荟萃分析中包含的关于感染相关性的证据主要来自通过横断面调查得出的自我报告措施。超过90%的纳入研究没有提到测量水接触作为他们的目标之一，这意味着暴露测量不是他们的主要重点。研究质量大多是中等或低，研究中采用的回忆期从一天到一年不等。需要专家达成一致意见，以一致地衡量暴露程度。研究应报告所用的测量周期和水接触类别的定义。很少有研究报告了水接触与感染强度的相关性;未来的研究需要这些信息，以更好地了解传播。
Schistosomiasis is a water-borne parasitic disease which affects over 230 million people globally. The relationship between contact with open freshwater bodies and the likelihood of schistosome infection remains poorly quantified despite its importance for understanding transmission and parametrising transmission models. We conducted a systematic review to estimate the average effect of water contact duration, frequency, and activities on schistosome infection likelihood. We searched Embase, MEDLINE (including PubMed), Global Health, Global Index Medicus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception until May 13, 2022. Observational and interventional studies reporting odds ratios (OR), hazard ratios (HR), or sufficient information to reconstruct effect sizes on individual-level associations between water contact and infection with any Schistosoma species were eligible for inclusion. Random-effects meta-analysis with inverse variance weighting was used to calculate pooled ORs and 95% confidence intervals (CIs). We screened 1,411 studies and included 101 studies which represented 192,691 participants across Africa, Asia, and South America. Included studies mostly reported on water contact activities (69%; 70/101) and having any water contact (33%; 33/101). Ninety-six percent of studies (97/101) used surveys to measure exposure. A meta-analysis of 33 studies showed that individuals with water contact were 3.14 times more likely to be infected (OR 3.14; 95% CI: 2.08–4.75) when compared to individuals with no water contact. Subgroup analyses showed that the positive association of water contact with infection was significantly weaker in children compared to studies which included adults and children (OR 1.67; 95% CI: 1.04–2.69 vs. OR 4.24; 95% CI: 2.59–6.97). An association of water contact with infection was only found in communities with ≥10% schistosome prevalence. Overall heterogeneity was substantial (I2 = 93%) and remained high across all subgroups, except in direct observation studies (I2 range = 44%–98%). We did not find that occupational water contact such as fishing and agriculture (OR 2.57; 95% CI: 1.89–3.51) conferred a significantly higher risk of schistosome infection compared to recreational water contact (OR 2.13; 95% CI: 1.75–2.60) or domestic water contact (OR 1.91; 95% CI: 1.47–2.48). Higher duration or frequency of water contact did not significantly modify infection likelihood. Study quality across analyses was largely moderate or poor. Any current water contact was robustly associated with schistosome infection status, and this relationship held across adults and children, and schistosomiasis-endemic areas with prevalence greater than 10%. Substantial gaps remain in published studies for understanding interactions of water contact with age and gender, and the influence of these interactions for infection likelihood. As such, more empirical studies are needed to accurately parametrise exposure in transmission models. Our results imply the need for population-wide treatment and prevention strategies in endemic settings as exposure within these communities was not confined to currently prioritised high-risk groups such as fishing populations. Schistosomiasis is a neglected tropical disease endemic to 78 countries and affects over 230 million people globally, mostly in sub-Saharan Africa. Contact with open freshwater sources such as lakes, rivers, and dams puts people at risk of infection. Existing systematic reviews have linked schistosome infection to risk factors such as gender and a lack of access to clean drinking water and hygiene infrastructure. Yet, while these risk factors may be mediated by water contact behaviours, the direct association of water contact with schistosome infection likelihood remains poorly quantified. We conducted a systematic review of associations between water contact frequency, duration, and activities on schistosome infection likelihood. We found that having any water contact was associated with 3.14 times higher likelihood of infection compared to having no water contact. This relationship held across adults and children and across medium and high-prevalence settings. Out of 11 water contact activities, 10 actives were associated with increased infection risk. Occupational, domestic, and recreational exposure was associated with similar infection likelihood. The evidence on exposure-schistosome infection associations included in this meta-analysis comes largely from self-reported measures elicited through cross-sectional surveys. Over 90% of included studies did not mention measurement of water contact as one of their aims, meaning exposure measurement was not their primary focus. Study quality was mostly moderate or low and recall periods employed in studies varied between one day and one year. There is a need for an expert consensus to consistently measure exposure. Studies should report on the measurement periods and definitions of water contact categories that were used. Few studies reported on correlations of water contact with infection intensity; this information is needed from future studies to better understand transmission.
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