Estimating the burden of scrub typhus: A systematic review.
Estimating the burden of scrub typhus: A systematic review.
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DOI：
10.1371/journal.pntd.0005838
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发表时间：
2017-09
影响因子：
3.8
通讯作者：
Paris DH
中科院分区：
文献类型：
--
作者：
Bonell A;Lubell Y;Newton PN;Crump JA;Paris DH
丛林斑疹伤寒是一种病媒传播的人畜共患疾病，可危及生命。没有获得许可的疫苗，也没有采取适当的媒介控制措施。尽管流行地区的认识不断提高，但对恙虫病的公共卫生负担和全球分布仍然知之甚少。我们系统地回顾了来自公共卫生记录、发热研究和奥维德MEDLINE、Embase Classic + Embase和EconLit数据库中可用报告的所有文献，以估计自2000年以来恙虫病的负担。在亚洲的前瞻性发热研究中，恙虫病是可治疗的非疟疾性发热性疾病的主要原因。血清流行病学数据还表明，恙虫病东方体感染在亚洲很常见，血清阳性率范围为9.3%-27.9%（中位数22.2%，IQR 18.6-25.7）。韩国、日本、中国和泰国的被动国家监测系统报告了最低疾病发病率的显著上升（中位数为4.6/10万/10年，中国最高，为11.2/10万/10年）。据报告，在印度南部和泰国北方，药物敏感性降低地区的病死率风险分别为12.2%和13.6%。死亡率报告差异很大，未经治疗的恙虫病的中位死亡率为6.0%，经治疗的为1.4%。有限的证据表明并发中枢神经系统受累的恙虫病死亡率高（死亡率13.6%），多器官功能障碍（24.1%），妊娠流产率高，新生儿结局差。恙虫病似乎是一种真正被忽视的热带疾病，主要影响农村人口，但也越来越多地影响大都市地区。在过去8-10年中，已建立监测系统的国家报告了最低发病率的上升。根据南美洲和非洲的报告，丛林斑疹伤寒的分布可能会更广泛，而不仅仅是亚洲。不幸的是，目前关于恙虫病流行病学的可用数据的质量和数量对于任何经济的数学建模或绘图方法来说都太有限了。恙虫病是一种可危及生命的螨传播的传染病。诊断这种疾病是困难的，需要特殊的技术，往往不容易获得。由于恙虫病对人群的实际影响及其地理分布仍然未知，我们系统地检索了医学数据库中的可用信息。恙虫病很常见：在恙虫病发生的地区，超过五分之一的人携带抗体，作为以前接触的标志。在过去的8-10年里，所有建立了监测系统的国家都记录了恙虫病病例的增加，而来自南美洲和非洲的报告表明，亚洲以外的地区分布更广。恙虫病是一种严重的疾病：如果不治疗，大约6%的病例死亡，如果治疗，死亡率为1.5%，但在通常治疗并不总是有效的地区，死亡率可达13%。并发症的死亡率更高，在脑感染中达到14%，多器官衰竭达到24%，而患有恙虫病的妊娠结局很差，流产率很高。尽管现有报告的数量和质量有许多限制，但我们发现，恙虫病是一种严重被低估的热带疾病，主要影响农村人口，但也越来越多地影响城市地区。
Scrub typhus is a vector-borne zoonotic disease that can be life-threatening. There are no licensed vaccines, or vector control efforts in place. Despite increasing awareness in endemic regions, the public health burden and global distribution of scrub typhus remains poorly known. We systematically reviewed all literature from public health records, fever studies and reports available on the Ovid MEDLINE, Embase Classic + Embase and EconLit databases, to estimate the burden of scrub typhus since the year 2000. In prospective fever studies from Asia, scrub typhus is a leading cause of treatable non-malarial febrile illness. Sero-epidemiological data also suggest that Orientia tsutsugamushi infection is common across Asia, with seroprevalence ranging from 9.3%–27.9% (median 22.2% IQR 18.6–25.7). A substantial apparent rise in minimum disease incidence (median 4.6/100,000/10 years, highest in China with 11.2/100,000/10 years) was reported through passive national surveillance systems in South Korea, Japan, China, and Thailand. Case fatality risks from areas of reduced drug-susceptibility are reported at 12.2% and 13.6% for South India and northern Thailand, respectively. Mortality reports vary widely around a median mortality of 6.0% for untreated and 1.4% for treated scrub typhus. Limited evidence suggests high mortality in complicated scrub typhus with CNS involvement (13.6% mortality), multi-organ dysfunction (24.1%) and high pregnancy miscarriage rates with poor neonatal outcomes. Scrub typhus appears to be a truly neglected tropical disease mainly affecting rural populations, but increasingly also metropolitan areas. Rising minimum incidence rates have been reported over the past 8–10 years from countries with an established surveillance system. A wider distribution of scrub typhus beyond Asia is likely, based on reports from South America and Africa. Unfortunately, the quality and quantity of the available data on scrub typhus epidemiology is currently too limited for any economical, mathematical modeling or mapping approaches. Scrub typhus is a mite-transmitted infectious disease that can be life-threatening. Diagnosing this disease is difficult, requiring special techniques that are often not readily available. As the actual impact of scrub typhus on the population and its geographical distribution remains unknown, we searched systematically for available information in medical databases. Scrub typhus is common: more than every fifth person in areas where scrub typhus occurs carry antibodies as a sign of previous contact. All countries with an established surveillance system have recorded an increase in scrub typhus cases over the past 8–10 years, while reports from South America and Africa suggest a wider distribution beyond Asia. Scrub typhus is a serious disease: approximately 6% of cases die if untreated, and 1.5% if treated, but mortality can reach 13% in areas where the usual treatment does not always work well. Death rates of complications are higher, reaching 14% in brain infections, 24% with multiple organ failure, and pregnancies with scrub typhus can have poor outcomes, with high miscarriage rates. Despite many limitations on the amount and quality of available reports, we found that scrub typhus is a severely underappreciated tropical disease, affecting mainly rural populations, but increasingly urban areas as well.
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DOI：
10.4269/ajtmh.2012.11-0409
发表时间：
2012-02-01
影响因子：
3.3
作者：
Kasper, Matthew R.;Blair, Patrick J.;Putnam, Shannon D.
通讯作者：
Putnam, Shannon D.
影响因子：
9.4
作者：
Izzard, Leonard;Fuller, Andrew;Stenos, John
通讯作者：
Stenos, John
影响因子：
3.7
作者：
Acestor N;Cooksey R;Newton PN;Ménard D;Guerin PJ;Nakagawa J;Christophel E;González IJ;Bell D
通讯作者：
Bell D
影响因子：
3.8
作者：
Chansamouth, Vilada;Thammasack, Syvilay;Newton, Paul N.
通讯作者：
Newton, Paul N.
影响因子：
3.7
作者：
De W;Jing K;Huan Z;Qiong ZH;Monagin C;Min ZJ;Ping H;Wen KC;Yan LJ
通讯作者：
Yan LJ