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Developing a strategy for cysticercosis control in Rwanda, to reduce the burden of epilepsy

制定卢旺达囊尾蚴病控制战略，以减轻癫痫负担

基本信息

批准号：
MR/P025471/1
负责人：
Rupert Quinnell
金额：
$ 64.23万
依托单位：
University of Leeds
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2017
资助国家：
英国
起止时间：
2017 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FP025471%2F1
关键词：
Developing strategy cysticercosis control Rwanda

项目摘要

The pig tapeworm is the leading cause of preventable epilepsy worldwide. Adult tapeworms live in the human small intestine, eggs are passed in faeces and if eaten by pigs will develop into larval cysts in muscles. Eating cysts in under-cooked pork completes the life-cycle in humans. However, ingested eggs can also develop into cysts in humans, and if cysts develop in the brain, they can cause neurocysticercosis, with epilepsy the most important symptom. The prevalence of epilepsy is high in low and middle income countries, and around a third of epilepsy cases in endemic areas are thought to be due to tapeworm infection, where poor sanitation enables exposure of pigs and people to infective eggs in human faeces. The burden of disease is particularly high in sub-Saharan Africa, and is likely to increase as pig production and pork consumption is increasing rapidly.A number of methods are have recently become available to control of pig tapeworm infection. This includes effective drugs to treat pigs and people, and a newly developed vaccine that protects pigs from infection. Using these methods it has been shown to be possible to control the disease in Peru in an intensive control programme. There is now a need to study how best to use these methods to sustainably control infection in African countries such as Rwanda. Rwanda is a small but densely populated country, mostly engaged in subsistence agriculture, with a very low per capita GDP. There has been significant investment in agriculture, including pig introduction, and the pig population has increased dramatically to more than 1 million in the last decade as demand for pork increases. Most pig production is small scale, and is an important source of income for smallholders, but these production methods are associated with a high risk of cysticercosis in neighbouring countries. Cysticercosis is also a large economic cost for pig production, as infection reduces the value of the meat by up to 50%. There is a clear need for new control initiatives, and Rwanda provides an excellent opportunity, with small size and relatively strong institutions and infrastructure. The prevalence of epilepsy in Rwanda is high, with a severe social stigma attached to the disease. However, there is almost no detailed information available on the prevalence of infection in pigs and humans in Rwanda, nor on the economics of pig production in the country. Our objectives are to collect these essential data on pig production methods and economics, the prevalence of infection in pork entering the food chain and in pigs and humans across the country, and determine the risk factors for infection in humans and pigs. We will then use these results, and inputs from important stakeholders, to develop a national country strategy. This will include developing economic models for investment in disease control in pigs, such as new markets for disease-free pork, and exploring how private sector business and public sector disease control efforts can be effectively combined. Finally, we will establish a partnership between national government, scientists and disease control experts, to plan the implementation of disease control. The outcomes of the project will be the first assessment of the importance of cysticercosis in Rwanda for human health and agricultural production, and the development of a national plan for disease control. To achieve these outcomes, we will establish a new collaboration between UK and Rwandan investigators to build local capacity in parasitological research.

猪绦虫是全球可预防癫痫的主要原因。绦虫成虫生活在人类小肠中，虫卵通过粪便传播，如果被猪吃掉，会在肌肉中发育成幼虫包囊。食用未煮熟的猪肉中的包囊完成人类的生命周期。然而，摄入的卵也可以在人体内发展成囊肿，如果囊肿在大脑中发展，它们可以引起神经囊虫病，癫痫是最重要的症状。癫痫在低收入和中等收入国家的发病率很高，流行地区约三分之一的癫痫病例被认为是由于绦虫感染，卫生条件差使猪和人暴露于人类粪便中的感染性虫卵。疾病负担在撒哈拉以南非洲特别高，并且随着猪生产和猪肉消费的迅速增加，可能会增加。这包括治疗猪和人的有效药物，以及保护猪免受感染的新开发疫苗。使用这些方法，在秘鲁的强化控制方案中，已证明有可能控制该病。现在需要研究如何最好地利用这些方法来可持续地控制卢旺达等非洲国家的感染。卢旺达是一个人口密集的小国，主要从事自给农业，人均国内生产总值很低。对农业进行了大量投资，包括引进生猪，随着猪肉需求的增加，过去十年生猪数量急剧增加至100多万头。大多数生猪生产规模较小，是小农的重要收入来源，但这些生产方法与邻国囊虫病的高风险有关。囊虫病也是养猪生产的一个巨大经济成本，因为感染会使肉的价值降低高达50%。显然需要采取新的控制举措，而卢旺达提供了一个极好的机会，因为卢旺达面积小，机构和基础设施相对较强。癫痫在卢旺达的发病率很高，社会上对这种疾病有严重的偏见。然而，几乎没有关于卢旺达猪和人感染流行情况的详细资料，也没有关于该国养猪经济情况的详细资料。我们的目标是收集这些关于猪的生产方法和经济学的基本数据，进入食物链的猪肉以及全国猪和人的感染率，并确定人和猪感染的风险因素。然后，我们将利用这些结果和重要利益攸关方的投入，制定一项国家战略。这将包括开发投资于猪疾病控制的经济模式，例如无病猪肉的新市场，并探索如何有效地将私营部门的业务和公共部门的疾病控制工作结合起来。最后，我们将在国家政府、科学家和疾病控制专家之间建立伙伴关系，以规划疾病控制的实施。该项目的成果将是首次评估卢旺达囊虫病对人类健康和农业生产的重要性，并制定一项国家疾病控制计划。为了实现这些成果，我们将在英国和卢旺达调查人员之间建立新的合作，以建立当地的寄生虫学研究能力。