Devleesschauwer, Brecht

Dorny, Pierre

Duchateau, Luc

Speybroeck, Niko

English

Ghent University Academic Bibliography

Unravelling the burden of parasitic zoonoses in Nepal 1 Institut de Recherche Santé et Société, Université catholique de Louvain, Brussels, Belgium 2 Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium 3 Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium 4 Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium Brecht Devleesschauwer1,2 Pierre Dorny2,3  ●  Luc Duchateau4  ●  Niko Speybroeck1  In settings with limited surveillance capacity, it is possible to quantify the health impact of parasitic zoonoses (PZ) and other neglected diseases by applying various statistical methods, thereby unraveling the burden of these diseases and interrupting the vicious circle of neglect.  Conclusions  Parasitic zoonoses (PZ) pose a significant but often neglected threat to public health, especially in developing countries.[1] In order to get a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year or DALY-metric.[2] However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of underrecognition and underfunding.   Background  Based on the first qualitative assessment, a classification of PZ could be made:      Based on published DALYs per case and preliminary incidence estimates, the endemic PZ for which sufficient quantitative data were available could be ranked according to their importance:                    Preliminary results Endemic (quantitative data) Probably endemic (no quantitative data) Probably not endemic (no data) Echinococcus granulosus Echinococcus multilocularis Angiostrongylus spp. Intestinal protozoa Foodborne trematodes Anisakis spp. Intestinal helminths Leishmania major Capillaria philippinensis Taenia solium - NCC Toxocara spp. Diphyllobothrium spp. Taenia spp. – taeniosis Trichinella spp. Trypanosoma cruzi Toxoplasma gondii Rank Endemic PZ 1 Toxoplasma gondii 2 Taenia solium neurocysticercosis 3 Intestinal protozoa 4 Echinococcus granulosus 5 Intestinal helminths 6 Taenia spp. taeniosis Brecht.Devleesschauwer@UGent.be http://studwww.ugent.be/~bdvleess/  We reviewed the burden of parasitic zoonoses in Nepal, one of the poorest countries in the world.         The review process took place in two phases: 1. A qualitative assessment to identify the endemic PZ and available data, and; 2. A quantitative health impact assessment expressed in terms of DALYs. Since no PZ are included in the current lab-based surveillance systems, a comprehensive collection of online and offline data sources was conducted, and various statistical methods were applied to these data sources, including meta-regression, predictive modeling, stochastic simulation, and data extrapolation.  Methodology India China Nepal Figure 2. Nepal, a South Asian country bordered by India and China Figure 3. Free-ranging pigs in southeastern Nepal. This practice promotes the occurrence of the pork tapeworm, Taenia solium, one of the most important zoonotic parasites in Nepal.  In Nepal, we found that several PZ are endemic and are imposing a not insignificant burden to public health; however, still several critical data gaps could be identified. As effective surveillance systems are key to any public health intervention, these systems should be promoted in developing countries such as Nepal, as these countries are affected the most by PZ and other neglected diseases.  The quantitative assessments will be worked out in the near future, and should lead to health impact quantifications in terms of DALYs, with corresponding uncertainty intervals.    Discussion  [1] Torgerson PR, Macpherson CN (2011). The socioeconomic burden of parasitic zoonoses: global trends. Veterinary Parasitology 182(1), 79-95. [2] Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (2006). Global Burden of Disease and Risk Factors. World Bank and Oxford University press, Washington DC, pp 475.  References  This study has been made possible through the financial support of the Special Research Fund (BOF) of Ghent University. Several people have, to a greater or lesser extent, contributed to the success of this study. We specially would like to thank Ms Anita Ale, Mr Arjun Aryal, Ms Meena Dahal, Ms Bimala Poudel and Prof Jeevan Sherchand for their valuable support throughout the study.  Acknowledgments  Disease burden; Nepal; Parasitic zoonoses.  Keywords Figure 1. Data mining in Nepal. Given the limited availability of electronic databases, data had to be collected manually. 

Unravelling the burden of parasitic zoonoses in Nepal

UNRAVELLING THE BURDEN OF PARASITIC ZOONOSES IN NEPAL  Brecht Devleesschauwer1,2, Pierre Dorny1,3, Luc Duchateau4, Niko Speybroeck2  1Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium 2Institute of Health and Society, Faculty of Public Health, Université catholique de Louvain, Brussels, Belgium 3Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium 4Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium  Background Parasitic zoonoses (PZ) pose a significant but often neglected threat to public health, especially in developing countries. In order to get a better understanding of their health impact, summary measures of population health may be calculated, such as the disability-adjusted life year or DALY-metric. However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of underrecognition and underfunding.  Methods We reviewed the burden of PZ in Nepal, one of the poorest and least develop countries in the world. This review process took place in two phases: (1) a qualitative assessment to identify the endemic PZ and available data, and (2) a quantitative health impact assessment expressed in terms of DALYs. Since no PZ are included in the current lab-based surveillance systems, a comprehensive collection of online and offline data sources was conducted, and various statistical methods were applied to these data sources, including meta-regression, predictive modelling, stochastic simulation, and data extrapolation.  Principal findings It was found that the highest public health impact was imposed by toxoplasmosis, followed by neurocysticercosis, zoonotic intestinal protozoal and helminths infections, and cystic echinococcosis. Nepal is likely to be endemic for larva migrans, trichinellosis, foodborne trematodiasis and alveolar echinococcosis, but insufficient data were available to quantify their health impact, due to their low or focalized incidence. No evidence was found for the occurrence of anisakiasis, zoonotic schistosomiasis, or zoonotic trypanosomiasis.  Conclusions In settings with limited surveillance capacity, it is possible to quantify the health impact of PZ and other neglected diseases by applying various statistical methods, thereby unravelling the burden of these diseases and interrupting the vicious circle of neglect. In Nepal, we found that several PZ are endemic and are imposing a not insignificant burden to public health. However, still several critical data gaps could be identified. As effective surveillance systems are key to any public health intervention, these systems should be further promoted in developing countries such as Nepal, as these countries are affected the most by PZ and other neglected diseases. 

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Unravelling the burden of parasitic zoonoses in Nepal

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Ghent University Academic Bibliography

Ghent University Academic Bibliography