Household transmission of leptospira infection in urban slum communities.
Household transmission of leptospira infection in urban slum communities.
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DOI：
10.1371/journal.pntd.0000154
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发表时间：
2008-01-30
影响因子：
3.8
通讯作者：
Ko AI
中科院分区：
文献类型：
--
作者：
Maciel EA;de Carvalho AL;Nascimento SF;de Matos RB;Gouveia EL;Reis MG;Ko AI
钩端螺旋体病是一种螺旋体人畜共患疾病，是导致城市贫民窟社区高死亡率的流行病的原因。致病性钩端螺旋体感染发生在环境暴露过程中，传统上与职业风险活动有关。然而，贫民窟居民居住的地方距离环境污染源很近，这表明城市流行病期间的传播发生在家庭环境中。进行了一项调查，以确定钩端螺旋体感染是否聚集在巴西萨尔瓦多市贫民窟社区的家庭中。在一次爆发期间，医院监测发现了 89 例钩端螺旋体病确诊病例。血清样本是从位于同一贫民窟社区的 22 个钩端螺旋体病指示病例家庭和 52 个对照家庭的成员中获取的。抗钩端螺旋体凝集抗体的存在被用作先前感染的标志。在有指示病例的家庭中，74 名成员中有 22 名（30%）有抗钩端螺旋体抗体，而对照家庭的 195 名成员中有 16 名（8%）有抗钩端螺旋体抗体。在来自病例家庭和对照家庭的具有凝集抗体的受试者中，分别有 95% 和 100% 的受试者针对黄疸出血血清群的问号钩虫血清型达到最高滴度。居住在有钩端螺旋体病指示病例的家庭中与感染钩端螺旋体的风险增加相关（OR 5.29，95% CI 2.13-13.12）。居住在有指示病例的家庭中的所有年龄组均发现感染风险增加，包括 <15 岁的儿童 (P = 0.008)。这项研究发现，在钩端螺旋体病反复流行的贫民窟社区中，钩端螺旋体感染存在显着的家庭聚集性。研究结果支持这样的假设：家庭环境是城市贫民窟环境中重要的传播决定因素。因此，预防需要针对贫民窟居民居住地发生的污染源和风险活动。钩端螺旋体病已成为城市贫民窟的健康问题。由于贫民窟定居点的迅速扩张，导致以黄疸、急性肾功能衰竭和出血为特征的严重钩端螺旋体病的流行，现在在发展中国家的城市中都有报道，这反过来又为啮齿动物传播螺旋体病原体创造了生态条件。在巴西萨尔瓦多市进行了一项调查，以确定钩端螺旋体感染的风险是否集中在贫民窟社区内的家庭中，其中一名成员患有严重的钩端螺旋体病。我们发现，患有钩端螺旋体病指示病例的家庭成员获得既往感染血清学证据的风险是同一社区的邻里家庭成员的五倍以上。居住在这些家庭的所有年龄段的人都发现感染风险增加。钩端螺旋体感染在特定贫民窟家庭中聚集的发现表明，与这种环境相关的因素是传播的重要决定因素。需要进一步研究以确定贫民窟居民居住地的污染源和风险暴露，以便能够有效地以社区为基础预防城市钩端螺旋体病。
Leptospirosis, a spirochaetal zoonotic disease, is the cause of epidemics associated with high mortality in urban slum communities. Infection with pathogenic Leptospira occurs during environmental exposures and is traditionally associated with occupational risk activities. However, slum inhabitants reside in close proximity to environmental sources of contamination, suggesting that transmission during urban epidemics occurs in the household environment. A survey was performed to determine whether Leptospira infection clustered within households located in slum communities in the city of Salvador, Brazil. Hospital-based surveillance identified 89 confirmed cases of leptospirosis during an outbreak. Serum samples were obtained from members of 22 households with index cases of leptospirosis and 52 control households located in the same slum communities. The presence of anti-Leptospira agglutinating antibodies was used as a marker for previous infection. In households with index cases, 22 (30%) of 74 members had anti-Leptospira antibodies, whereas 16 (8%) of 195 members from control households had anti-Leptospira antibodies. Highest titres were directed against L. interrogans serovars of the Icterohaemorrhagiae serogroup in 95% and 100% of the subjects with agglutinating antibodies from case and control households, respectively. Residence in a household with an index case of leptospirosis was associated with increased risk (OR 5.29, 95% CI 2.13–13.12) of having had a Leptospira infection. Increased infection risk was found for all age groups who resided in a household with an index case, including children <15 years of age (P = 0.008). This study identified significant household clustering of Leptospira infection in slum communities where recurrent epidemics of leptospirosis occur. The findings support the hypothesis that the household environment is an important transmission determinant in the urban slum setting. Prevention therefore needs to target sources of contamination and risk activities which occur in the places where slum inhabitants reside. Leptospirosis has emerged to become an urban slum health problem. Epidemics of severe leptospirosis, characterized by jaundice, acute renal failure and haemorrhage, are now reported in cities throughout the developing world due to rapid expansion of slum settlements, which in turn has produced the ecological conditions for rodent-borne transmission of the spirochete pathogen. A survey was performed in the city of Salvador, Brazil, to determine whether the risk of Leptospira infection clustered in households within slum communities in which a member had developed severe leptospirosis. We found that members of households with an index case of leptospirosis had more than five times the risk of having serologic evidence for a prior infection than members of neighbourhood households in the same communities. Increased risk of infection was found among all age groups who resided in these households. The finding that Leptospira infection clusters in specific slum households indicates that the factors associated with this environment are important determinants for transmission. Further research is needed to identify the sources of contamination and risk exposures which occur in the places where slum inhabitants reside such that effective community-based prevention of urban leptospirosis can be implemented.
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DOI：
10.1080/0960312002001500
发表时间：
2000-12-01
影响因子：
3.2
作者：
Barcellos, C;Sabroza, PC
通讯作者：
Sabroza, PC
影响因子：
13.6
作者：
Cumberland, P;Everard, COR;Levett, PN
通讯作者：
Levett, PN
影响因子：
11.8
作者：
Phraisuwan P;Whitney EA;Tharmaphornpilas P;Guharat S;Thongkamsamut S;Aresagig S;Liangphongphanthu J;Junthima K;Sokampang A;Ashford DA
通讯作者：
Ashford DA
影响因子：
7.8
作者：
KUPERSTEIN, M
通讯作者：
KUPERSTEIN, M
影响因子：
5
作者：
Lingappa, J;Kuffner, T;McNicholl, J
通讯作者：
McNicholl, J