Human African trypanosomiasis in the Democratic Republic of the Congo: disease distribution and risk
Human African trypanosomiasis in the Democratic Republic of the Congo: disease distribution and risk
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DOI：
10.1186/s12942-015-0013-9
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发表时间：
2015-06-06
影响因子：
4.9
通讯作者：
Jannin, Jean G.
中科院分区：
文献类型：
--
作者：
Lumbala, Crispin;Simarro, Pere P.;Jannin, Jean G.
背景：过去三十年来，刚果民主共和国（DRC）一直是报告人类非洲锥虫病（HAT）病例数最多的国家。 2012 年，刚果民主共和国继续承受着冈比亚 HAT 的最重负担，占大陆一级报告的所有病例的 84%（即 5,968/7,106）。本文回顾了 2000 年至 2012 年刚果民主共和国昏睡病的状况，重点关注时空模式。报告显示了国家和省级的流行病学趋势。 结果：从 2000 年到 2012 年，刚果民主共和国每年报告的 HAT 病例数减少了 65%，即从 16,951 例减少到 5,968 例。在省一级，情况更为复杂。虽然赤道省的 HAT 控制对病例数量产生了巨大影响（减少了 97%），但事实证明，在其他省份，尤其是在班顿杜和开赛，该疾病更难以应对，尽管取得了重大进展，但 HAT 仍然根深蒂固。 HAT 患病率在东方省北部地区最高，该地区有许多限制因素阻碍了监测和控制。国家昏睡病控制规划和世界卫生组织在数据收集、报告、管理和绘图方面做出的重大协调努力，最终形成了 HAT 图集，使刚果民主共和国的 HAT 分布和风险比以往任何时候都更加准确。对超过 18,000 个流行病学感兴趣的地点进行了地理参考（平均精度约为 1.7 公里），相当于报告病例的 93.6%（2000 年至 2012 年期间）。对两个五年期（2003-2007 年和 2008-2012 年）有患昏睡病风险的人口进行了计算，估计人数分别为 3300 万人和 3700 万人。结论：刚果民主共和国自 2000 年以来报告的 HAT 病例逐渐减少可能反映了疾病发病率的实际下降。如果要维持这一结果，并且要在消除 HAT 的目标方面取得进一步进展，就必须密切监测和评估正在将 HAT 控制和监测纳入卫生系统的情况，并保持积极的病例发现活动，特别是在感染风险仍然很高和可能出现复发的地区。
Background: For the past three decades, the Democratic Republic of the Congo (DRC) has been the country reporting the highest number of cases of human African trypanosomiasis (HAT). In 2012, DRC continued to bear the heaviest burden of gambiense HAT, accounting for 84 % of all cases reported at the continental level (i.e., 5,968/7,106). This paper reviews the status of sleeping sickness in DRC between 2000 and 2012, with a focus on spatio-temporal patterns. Epidemiological trends at the national and provincial level are presented.Results: The number of HAT cases reported yearly from DRC decreased by 65 % from 2000 to 2012, i.e., from 16,951 to 5,968. At the provincial level a more complex picture emerges. Whilst HAT control in the Equateur province has had a spectacular impact on the number of cases (97 % reduction), the disease has proved more difficult to tackle in other provinces, most notably in Bandundu and Kasai, where, despite substantial progress, HAT remains entrenched. HAT prevalence presents its highest values in the northern part of the Province Orientale, where a number of constraints hinder surveillance and control. Significant coordinated efforts by the National Sleeping Sickness Control Programme and the World Health Organization in data collection, reporting, management and mapping, culminating in the Atlas of HAT, have enabled HAT distribution and risk in DRC to be known with more accuracy than ever before. Over 18,000 locations of epidemiological interest have been geo-referenced (average accuracy approximate to 1.7 km), corresponding to 93.6 % of reported cases (period 2000-2012). The population at risk of contracting sleeping sickness has been calculated for two five-year periods (2003-2007 and 2008-2012), resulting in estimates of 33 and 37 million people respectively.Conclusions: The progressive decrease in HAT cases reported since 2000 in DRC is likely to reflect a real decline in disease incidence. If this result is to be sustained, and if further progress is to be made towards the goal of HAT elimination, the ongoing integration of HAT control and surveillance into the health system is to be closely monitored and evaluated, and active case-finding activities are to be maintained, especially in those areas where the risk of infection remains high and where resurgence could occur.