Spatial epidemiology of Japanese encephalitis virus and other infections of the central nervous system infections in Lao PDR (2003–2011): A retrospective analysis
Spatial epidemiology of Japanese encephalitis virus and other infections of the central nervous system infections in Lao PDR (2003–2011): A retrospective analysis
复制标题
老挝人民民主共和国日本脑炎病毒和其他中枢神经系统感染的空间流行病学（2003-2011年）：回顾性分析
DOI：
10.1371/journal.pntd.0008333
复制
发表时间：
2020
影响因子：
3.8
通讯作者：
D. Parker
中科院分区：
文献类型：
--
作者：
S. Rattanavong;A. Dubot;M. Mayxay;M. Vongsouvath;Sue J Lee;J. Cappelle;P. Newton;D. Parker
背景中枢神经系统(CNS)感染是导致发病率和死亡率的重要因素，约50%的患者的病因尚未确定。某些中枢神经系统感染的病原体具有不同的时空模式。方法/主要发现在这里，我们介绍了老挝人民民主共和国2003-2011年中枢神经系统感染的空间流行病学和生态学分析的结果。这些数据来自万象Mahosot医院疑似CNS感染的住院治疗。在1065名患者中，450名被指定为确诊患者。虽然老挝人民民主共和国的许多社区都在农村和偏远地区，但这些数据中的大多数患者来自主要道路沿线的村庄。乙型脑炎病毒(JEV；n=94)和隐球菌属。70例为最常见感染。乙脑感染在雨季达到高峰，乙脑患者来自入院当月地表洪水较高的村庄。乙型脑炎病毒感染在空间上分布在农村地区，最常见的是儿童。隐球菌属感染聚集在万象(一个城市地区)附近和成年人中。结论/意义本分析中确定的空间和时间模式与复杂的环境、社会和地理因素有关。例如，感染乙脑病毒的患者来自环境条件(地表水)适合支持更大蚊媒种群的地点。这些数据中的大多数患者来自主要道路附近的村庄；很可能是地理和经济上获得医疗保健的结果，也表明该地区(特别是更偏远的地区)低估了中枢神经系统疾病。由于老挝人民民主共和国正在经历重大的发展和环境变化，中枢神经系统感染病原体的时空分布也可能发生变化。主要需要提高诊断能力；增加获得医疗保健的机会，特别是农村人口；以及在全国范围内加强监测。
Background Central nervous system (CNS) infections are important contributors to morbidity and mortality and the causative agents for ~50% patients are never identified. The causative agents of some CNS infections have distinct spatial and temporal patterns. Methodology/Principal findings Here we present the results of a spatial epidemiological and ecological analysis of CNS infections in Lao PDR (2003–2011). The data came from hospitalizations for suspected CNS infection at Mahosot Hospital in Vientiane. Out of 1,065 patients, 450 were assigned a confirmed diagnosis. While many communities in Lao PDR are in rural and remote locations, most patients in these data came from villages along major roads. Japanese encephalitis virus ((JEV); n = 94) and Cryptococcus spp. (n = 70) were the most common infections. JEV infections peaked in the rainy season and JEV patients came from villages with higher surface flooding during the same month as admission. JEV infections were spatially dispersed throughout rural areas and were most common in children. Cryptococcus spp. infections clustered near Vientiane (an urban area) and among adults. Conclusions/Significance The spatial and temporal patterns identified in this analysis are related to complex environmental, social, and geographic factors. For example, JEV infected patients came from locations with environmental conditions (surface water) that are suitable to support larger mosquito vector populations. Most patients in these data came from villages that are near major roads; likely the result of geographic and financial access to healthcare and also indicating that CNS diseases are underestimated in the region (especially from more remote areas). As Lao PDR is undergoing major developmental and environmental changes, the space-time distributions of the causative agents of CNS infection will also likely change. There is a major need for increased diagnostic abilities; increased access to healthcare, especially for rural populations; and for increased surveillance throughout the nation.