Plasmodium-Helminth Coinfection and Its Sources of Heterogeneity Across East Africa
Plasmodium-Helminth Coinfection and Its Sources of Heterogeneity Across East Africa
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DOI：
10.1093/infdis/jir844
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发表时间：
2012-03-01
影响因子：
6.4
通讯作者：
Snow, Robert W.
中科院分区：
文献类型：
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作者：
Brooker, Simon J.;Pullan, Rachel L.;Snow, Robert W.
背景疟原虫-蠕虫合并感染可能对受感染的宿主产生许多后果，但我们对多种环境下合并感染的流行病学知识有限。本研究调查了东非恶性疟原虫和3种主要蠕虫共感染的分布和异质性。在肯尼亚、乌干达和埃塞俄比亚的299所学校的28050名儿童中进行了横断面寄生虫调查。收集了关于个人、家庭和环境风险因素的数据，并使用空间显式贝叶斯模型框架来调查物种感染和合并感染及其风险因素的异质性，以及物种之间的学校和个人水平的关联。疟原虫-蠕虫合并感染的大范围地理模式受到最不常见感染和物种特异性环境因素的强烈影响。在个体水平上，恶性疟原虫和钩虫之间存在持久的正相关，但恶性疟原虫和血吸虫之间没有相关性。然而，这种个体内关联的相对重要性低于空间因素在影响合并感染风险方面的作用。共同感染的模式似乎更多地受到最不常见物种的分布及其环境风险因素的影响，而不是任何持久的个体内关联。
Background. Plasmodium-helminth coinfection can have a number of consequences for infected hosts, yet our knowledge of the epidemiology of coinfection across multiple settings is limited. This study investigates the distribution and heterogeneity of coinfection with Plasmodium falciparum and 3 major helminth species across East Africa.Methods. Cross-sectional parasite surveys were conducted among 28 050 children in 299 schools across a range of environmental settings in Kenya, Uganda, and Ethiopia. Data on individual, household, and environmental risk factors were collected and a spatially explicit Bayesian modeling framework was used to investigate heterogeneities of species infection and coinfection and their risk factors as well as school- and individual-level associations between species.Results. Broad-scale geographical patterns of Plasmodium-helminth coinfection are strongly influenced by the least common infection and by species-specific environmental factors. At the individual level, there is an enduring positive association between P. falciparum and hookworm but no association between P. falciparum and Schistosoma species. However, the relative importance of such within-individual associations is less than the role of spatial factors in influencing coinfection risks.Conclusions. Patterns of coinfection seem to be influenced more by the distribution of the least common species and its environmental risk factors, rather than any enduring within-individual associations.