Eco-epidemiology of Schistosomiasis, Malaria and Polyparasitism in Coastal Kenya

描述（由申请人提供）：该多学科项目研究了肯尼亚沿海发展中地区多种寄生虫物种的传播动态及其对人口的相互影响。在这种生态环境中，埃及血吸虫、疟原虫、丝虫线虫和土蠕虫是常见的，导致人类泌尿血吸虫病、疟疾、淋巴丝虫病和钩虫感染的高水平。这些感染由于其综合的长期影响，似乎在造成慢性临床和亚临床人类疾病和贫穷方面发挥了重要的但尚未完全确定的协同作用。在这种情况下，这些不同寄生虫感染的传播模式和风险因素似乎往往相互关联，并广泛重叠。然而，到目前为止，大多数研究还没有接近多寄生虫生态学的复杂性，因为数据的可用性和准确性的限制，因为不同的异质性的感染风险，发现在物理和社会空间，并随着时间的推移。该项目的基本假设是，环境因素是这些寄生虫传播潜力的关键决定因素，这些因素与人口和社会经济因素相互作用，决定了观察到的寄生虫病的空间/人口模式。寄生虫生态流行病学的最新研究结果表明，这些影响都需要重新考虑在多个层面上的个人，家庭，村庄和地区范围内分别为每种寄生虫，并为合并的感染套件。传播过程和疾病模式在这多个层面上各不相同，在每个层面上也会在空间和时间上有所不同。这些地方性感染的综合影响尚未得到很好的研究，并且可能被证明具有相加或更复杂的非线性相互作用效应。因此，最佳控制策略可能需要通过共同针对这些寄生虫感染中的一种、一些或全部来局部减少传播（预防感染）和疾病表现。该项目的具体目标是通过将寄生虫学数据与景观、土地使用和社会经济风险因素相结合，查明肯尼亚沿海地区血吸虫病、疟疾、丝虫病和钩虫传播和感染的空间和人口模式;发展网络和个人的模型，以确定传输的关键特征，并预测综合控制计划对分布的潜在影响，疟疾、丝虫病、寄生虫病和钩虫病及其相关的社区疾病影响;加强传染病生态学方面的培训，以解决非洲的健康问题。

DESCRIPTION (provided by applicant): This multidisciplinary project examines the transmission dynamics of multiple parasite species and their interactive effect on human populations in developing areas of coastal Kenya. In this ecological setting, transmission of Schistosoma haematobium, Plasmodium spp., filarial nematodes, and geohelminths is common, resulting in high levels of human urinary schistosomiasis, malaria, lymphatic filariasis, and hookworm infection. These infections, because of their combined long-term effects, appear to play a significant but, as yet, incompletely defined synergistic role in the causation of chronic clinical and subclinical human disease and poverty. In this context, transmission patterns and risk factors for these diverse parasitic infections often appear to be linked and to overlap extensively. However, to date, most studies have not approached the complexity of multi-parasite ecology because of limitations on data availability and accuracy and because of variable heterogeneities of infection risk that are found across physical and social space, and over time. The project's underlying hypothesis is that environmental factors are the key determinants of transmission potential for these parasites, and that these interact with demographic and socio-economic factors in determining the observed spatial/demographic patterns of parasitic disease. Recent research findings on parasite eco-epidemiology indicate that these effects all need to be reconsidered on multiple levels-individual, household, village, and district-wide-separately for each parasite, and for the combined suite of infections. Transmission processes and disease patterns vary across these multiple levels, and will also vary spatially and temporally within each level. The combined impact of these endemic infections has not been well studied, and may prove to have additive or more complex non-linear interactive effects. Consequently, optimal control strategies may prove to require local reduction of both transmission (preventing infection) and disease manifestations through the integrated targeting of one, some, or all of these parasitic infections in concert. Specific Aims of this project are to detect spatial and demographic patterns of transmission and infection for schistosomiasis, malaria, filariasis, and hookworms in coastal Kenya through integration of parasitological data with landscape, land use, and socioeconomic risk factors; to develop network- and individual-based models to identify the critical features of transmission and predict the potential impact of integrated control programs on distribution of malaria, filaria, schistosomes, and hookworm, and their related community disease impact; and strengthen training in infectious disease ecology for health problems in Africa.