Linking rattiness, geography and environmental degradation to spillover Leptospira infections in marginalised urban settings: an eco-epidemiological community-based cohort study in Brazil
Linking rattiness, geography and environmental degradation to spillover Leptospira infections in marginalised urban settings: an eco-epidemiological community-based cohort study in Brazil
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将鼠害、地理和环境退化与边缘化城市环境中钩端螺旋体感染的溢出联系起来：巴西一项基于社区的生态流行病学队列研究
DOI：
10.1101/2021.09.21.21263884
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Eyre M
中科院分区：
文献类型：
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作者：
Eyre M
背景：动物水库的人畜共患病溢出是造成重大全球公共卫生负担的原因，但在复杂的城市环境中，人们对促进溢出事件的过程知之甚少。钩端螺旋体病的病原体钩端螺旋体在边缘化城市社区的地方性传播是通过人类暴露于被老鼠水库尿液中脱落的细菌污染的环境而发生的。然而，目前还不清楚在何种程度上传输驱动的变化分布的大鼠或由雨水径流和溢出的细菌从开放式下水道system.Methods：我们进行了生态流行病学研究，在一个高风险的社区在萨尔瓦多，巴西，前瞻性地遵循一个队列的1401名居民，以确定钩端螺旋体感染的血清学证据。一个并发的大鼠生态学研究被用来收集信息的细尺度空间分布的“rattiness”，我们的代理大鼠丰度和曝光的利益。我们开发和应用了一种新的地质统计框架，联合空间建模的多个指标的疾病水库丰度和人类感染risk.Results：估计感染率为51.4（95%CI 40.4，64.2）感染每1000后续events. Results。感染风险随着年龄的增长而增加，直到30岁，并且与男性性别相关。在整个研究区域内，鼠味与居民的感染风险呈正相关，但这种影响在高海拔地区更强（OR 3.27 95% CI 1.68，19.07）（OR 1.14 95% CI 1.05，1.53）。这些发现表明，虽然频繁的洪水事件可能会将细菌分散在低海拔地区，高海拔地区的环境风险更局部化，并直接受到当地鼠群分布的影响。所开发的建模框架可能具有广泛的应用，在描绘复杂的动物-环境-人类的相互作用，在人畜共患病的溢出和确定公共卫生干预的机会。
Background:Zoonotic spillover from animal reservoirs is responsible for a significant global public health burden, but the processes that promote spillover events are poorly understood in complex urban settings. Endemic transmission of Leptospira, the agent of leptospirosis, in marginalised urban communities occurs through human exposure to an environment contaminated by bacteria shed in the urine of the rat reservoir. However, it is unclear to what extent transmission is driven by variation in the distribution of rats or by the dispersal of bacteria in rainwater runoff and overflow from open sewer systems.Methods:We conducted an eco-epidemiological study in a high-risk community in Salvador, Brazil, by prospectively following a cohort of 1401 residents to ascertain serological evidence for leptospiral infections. A concurrent rat ecology study was used to collect information on the fine-scale spatial distribution of ‘rattiness’, our proxy for rat abundance and exposure of interest. We developed and applied a novel geostatistical framework for joint spatial modelling of multiple indices of disease reservoir abundance and human infection risk.Results:The estimated infection rate was 51.4 (95% CI 40.4, 64.2) infections per 1000 follow-up events. Infection risk increased with age until 30 years of age and was associated with male gender. Rattiness was positively associated with infection risk for residents across the entire study area, but this effect was stronger in higher elevation areas (OR 3.27 95% CI 1.68, 19.07) than in lower elevation areas (OR 1.14 95% CI 1.05, 1.53).Conclusions:These findings suggest that, while frequent flooding events may disperse bacteria in regions of low elevation, environmental risk in higher elevation areas is more localised and directly driven by the distribution of local rat populations. The modelling framework developed may have broad applications in delineating complex animal-environment-human interactions during zoonotic spillover and identifying opportunities for public health intervention.