Global Morbidity and Mortality of Leptospirosis: A Systematic Review.
Global Morbidity and Mortality of Leptospirosis: A Systematic Review.
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DOI：
10.1371/journal.pntd.0003898
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发表时间：
2015
影响因子：
3.8
通讯作者：
Ko AI
中科院分区：
文献类型：
--
作者：
Costa F;Hagan JE;Calcagno J;Kane M;Torgerson P;Martinez-Silveira MS;Stein C;Abela-Ridder B;Ko AI
钩端螺旋体病是一种螺旋体人畜共患病，发生在不同的流行病学环境中，影响脆弱人群，如农村自给农民和城市贫民窟居民。虽然钩端螺旋体病是一种威胁生命的疾病，并被认为是肺出血综合征的重要原因，但缺乏对发病率和死亡率的全球估计，导致其被忽视的疾病状态。我们对已发表的发病率和死亡率研究和数据库进行了系统的审查，以提取有关发病率和病死率的信息。使用线性回归和蒙特卡罗模型获得各国、全球疾病负担(GBD)和世卫组织区域的年龄和性别调整后的疾病发病率估计数。我们使用合并了年龄和性别调整后的疾病发病率和病死率的模型来估计死亡率。审查确定了来自34个国家的80项关于疾病发病率的研究，这些研究符合质量标准。在某些区域，如非洲，几乎没有确定有质量保证的研究。回归模型结合了特定国家的人口结构、出生时预期寿命、距赤道的距离、热带岛屿和城市化等变量，在观察到的疾病发病率变化中占了很大比例(R2=0.60)。我们估计全世界每年有103万个病例(95%可信区间434,000-1,750,000)和58,900例死亡(95%可信区间23,800-95,900)。据估计，大部分病例(48%，95%可信区间40-61%)和死亡(42%，95%可信区间34-53%)发生在20-49岁的成年男性。南亚和东南亚、大洋洲、加勒比海、安第斯山脉、拉丁美洲中部和热带地区以及撒哈拉以南非洲东部的GBD地区的发病率和死亡率估计数最高。钩端螺旋体病是导致全世界发病的主要人畜共患病原因之一，造成的死亡人数接近或超过了其他原因引起的出血热。据估计，发病率和死亡率最高的是资源贫乏的国家，其中包括钩端螺旋体病负担被低估的地区。钩端螺旋体病是一种人畜共患细菌性疾病，影响农村自给农民和城市贫民窟居民等脆弱人群。虽然钩端螺旋体病会导致危及生命的临床症状，如肺出血综合征，并在全球范围内分布，但解决这一被忽视的疾病的关键障碍一直是关于其疾病负担的数据不足。我们检索已发表的有关钩端螺旋体病的文献和灰色文献研究，并利用收集的关于发病率和病死率的信息，估计国家、地区和全球水平的钩端螺旋体病发病率和死亡率。据估计，每年总的钩端螺旋体病导致103万病例和58,900人死亡。这些估计表明，钩端螺旋体病是导致发病率和死亡率的主要人畜共患病原因。此外，在世界上最贫穷的区域和不经常进行监测的区域，发病率和死亡率最高。
Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status. We conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD) and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R2 = 0.60) of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000–1,750,000) and 58,900 deaths (95% CI 23,800–95,900) due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40–61%) and deaths (42%, 95% CI 34–53%) were estimated to occur in adult males with age of 20–49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa. Leptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of haemorrhagic fever. Highest morbidity and mortality were estimated to occur in resource-poor countries, which include regions where the burden of leptospirosis has been underappreciated. Leptospirosis is a zoonotic bacterial disease that affects vulnerable populations such as rural subsistence farmers and urban slum dwellers. Although leptospirosis causes life-threatening clinical manifestations, such as pulmonary hemorrhage syndrome, and has a worldwide distribution, the key barrier to addressing this neglected disease has been insufficient data on its disease burden. We searched published literature and grey literature studies on leptospirosis and using information collected on disease incidence and case fatality, estimated leptospirosis incidence and mortality at country, regional and global level. Overall leptospirosis was estimated to cause 1.03 million cases and 58,900 deaths each year. These estimates place leptospirosis as a leading zoonotic cause of morbidity and mortality. In addition, morbidity and mortality was greatest in the poorest regions of the world and in areas where surveillance is not routinely performed.