Impact of zooprophylaxis on zoonotic cutaneous leishmaniasis transmission

动物预防对人畜共患皮肤利什曼病传播的影响

• 批准号: 9111261
• 负责人: Elyes Zhioua
• 金额: $ 13.76万
• 依托单位: INSTITUT PASTEUR DE TUNIS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-15 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9111261
• 关键词: Achievement; Adult; Affect; African; Age-Months; Animals; Antimony; Area; Biodiversity; Biological; Bite; Breeding; Calories; Canis familiaris; Central America; Chemicals; Chickens; Cholesterol; Collaborations; Communities; Country; Cutaneous Leishmaniasis; Developing Countries; Disease; Disease Reservoirs; Distress; Domestic Animals; Ecology; Economics; Ecosystem; Effectiveness; Endemic Diseases; Environment; Environmental Impact; Epidemiology; Exposure to; Family; Far East; Fatty acid glycerol esters; Female; Food; Fostering; Glucantime; Goals; Health; Health Benefit; Health Policy; Housing; Human; Human Bites; Incidence; Income; Individual; Infection; Injection of therapeutic agent; Insecticide Resistance; Insecticides; Institutes; Interruption; Intervention; Intervention Trial; Jird; Kansas; Kenya; Laboratories; Lead; Learning; Leishmania; Leishmania major; Leishmaniasis; Lesion; Livestock; Measures; Meat; Methods; Middle East; Modeling; Near East; New Zealand; Northern Africa; Nutritional; Oryctolagus cuniculus; Outcome; Parasites; Patients; Pharmaceutical Preparations; Phlebotomus; Physiology; Poisoning; Population; Poverty; Prevalence; Psammomys; Public Health; Publishing; Research; Research Personnel; Residual state; Resistance; Resources; Rodent; Role; Rural Community; Sand Flies; Sand Rats; Seasons; Secure; Site; Skin; Source; South America; Stress; Sunlight; Testing; Treatment Cost; Tunisia; United States National Institutes of Health; Universities; Urine; Vaccines; Vector-transmitted infectious disease; Vulnerable Populations; Wild Animals; Work; Zinc; authority; base; beef; chemotherapy; cost effective; disease transmission; evidence base; experience; farmer; feeding; improved; innovation; killings; low income country; low socioeconomic status; man; neglected tropical diseases; novel strategies; nutrition; programs; psychologic; rural area; scale up; social; success; transmission process; vector; vector control

 DESCRIPTION (provided by applicant): Zoonotic cutaneous leishmaniasis (ZCL) is a vector-borne disease caused by Leishmania major, transmitted by the bites of phlebotomine sand flies. The fat sand rat (Psammomys obesus) and the desert's gird (Meriones shawi ) are the main reservoir hosts of this parasite. Cutaneous leishmaniasis is considered by the WHO to be a neglected tropical disease, affecting about 1.5 million people per year worldwide. The disease is widespread in Central and South America, the Mediterranean basin, and the near and far east countries where it is strongly correlated with poverty. Although ZCL is not fatal, the lesions produced may cause substantial disfigurement and severe distress to infected individuals with lifelong psychological and social consequences. No vaccine is available and treatment of humans is largely based on chemical therapy (pentavalent antimony/glucantime). To date, resistance of L. major to glucantime, the only affordable drug in developing countries for more than 40 years, has become a major concern. New alternatives to control ZCL are urgently needed. In Tunisia, ZCL is a peridomestic disease endemic in rural areas with low socio-economic status with an annual incidence rate of 669.7/100,000 per year. Phlebotomus papatasi is the main vector of L. major in Tunisia and in North Africa. Only chemical therapy with glucantime is currently available, with neither vector nor dog control programs. Killing or diverting infected sand flies from humans can reduce the transmission of ZCL. Although indoor residual spraying (IRS) of insecticides is effective in reducing the incidence of ZCL, it requires expensive yearly applications and its applicability is thus limited by financial constraints in low income countries. Insecticide-treated curtains or bednets offer effective protection against P. papatasi; but transmission continues as before after cessation of these measures. Despite their efficacy in the interruption of ZCL transmission, programs based on the distribution of ITNs are poorly implemented in many endemic countries and are beyond the means of many families in ZCL-endemic villages. Although poisoning ZCL rodent reservoirs with zinc phosphide has reduced the incidence of ZCL, this approach is ecologically unsound. We aim to develop a sustainable method based on diverting sand fly vectors from humans to reduce the transmission of ZCL in endemic areas. Numerous studies show that host diversity could reduce the incidence of zoonotic vector- borne diseases by a dilution effect. A high species diversity in the community of vector hosts reduces the infection prevalence or abundance of the vectors by diluting the effects of the most competent disease reservoir and subsequently reducing the incidence of the disease. Zooprophylaxis is the use of wild or domestic animals, which are not reservoir hosts of a given diseases, to deflect vectors from humans creating a dilution effect. The presence of livestock around houses may diminish transmission of the disease and protect humans from the bites of infected sand flies. Our preliminary studies have shown that breeding rabbits in artificia burrows located in peri-domestic areas significantly reduces the indoor abundance of P. papatasi within houses. Rabbits strongly attract sand flies but are a dead-end host for L. major. We hypothesize that rabbits bred in man-made underground holes located in the peri-domestic areas act as a dilution hosts and exert a zooprophylactic effects on the transmission of ZCL in endemic areas. The objective of this proposal is to establish a new vector control strategy based on zooprophylaxis to reduce transmission of ZCL in endemic focus. This program will be validated in Tunisia for several reasons: (1) endemicity of disease; (2) limited current control options; (3) access to laboratory models and field sites for testing intervention strategies; and (4) ability to conduct field-based research in a representative region that is stable politically. Indeed, lessons learned from this project should impact public health policy authorities in the politically sensitive Middle East and North African (MENA) nations. This two-year project will develop a new approach to control ZCL transmission built upon the transfer of expertise from the US to Tunisia, fostering both capacity building and innovation.

 描述（由申请人提供）：人畜共患皮肤利什曼病（ZCL）是一种由大型利什曼原虫引起的媒介传播疾病，通过白蛉（Psammomys obesus）和沙漠沙蝇（Meriones shawi）的叮咬传播。皮肤利什曼病被世界卫生组织认为是一种被忽视的热带疾病，影响着该寄生虫。全世界每年约有 150 万人患有这种疾病，在中美洲和南美洲、地中海盆地以及近东和远东国家广泛传播，尽管 ZCL 并不致命，但所产生的损伤可能会导致严重毁容。对感染者造成严重困扰，造成终生的心理和社会后果，而且人类的治疗主要基于化学疗法（五价锑/葡聚糖）。迄今为止，L. Major对葡聚糖是唯一负担得起的药物。发展中国家40 多年来，ZCL 已成为人们迫切需要的新替代方案。在突尼斯，ZCL 是社会经济地位较低的农村地区的一种流行病，年发病率为 669.7/100,000。帕帕塔斯白蛉是突尼斯和北非主要白蛉的主要媒介，目前只能使用葡聚糖酶进行化学治疗，既没有媒介也没有狗控制计划。杀死或转移受感染的白蛉，使其远离人类可以减少 ZCL 的传播，尽管杀虫剂的室内滞留喷洒 (IRS) 可有效减少 ZCL 的发病率，但每年需要昂贵的施用量，因此其适用性受到低水平地区的财政限制。 经杀虫剂处理的窗帘或蚊帐可有效预防帕帕塔西疟原虫；但尽管这些措施在阻断 ZCL 传播方面有效，但许多国家实施的基于驱虫蚊帐的计划执行不力。尽管用磷化锌毒害 ZCL 啮齿动物可以降低 ZCL 的发病率，但这种方法在生态上是不健康的。开发一种基于转移白蛉媒介的可持续方法，以减少 ZCL 在流行地区的传播。 大量研究表明，宿主多样性可以通过稀释效应减少人畜共患媒介传播疾病的发病率。媒介宿主群落通过稀释最有能力的疾病储存宿主的影响来降低媒介的感染流行率或丰度，从而降低疾病的发病率。动物预防是使用不是特定储存宿主的野生或家养动物。我们的初步研究表明，在房屋周围的人工洞穴中繁殖的兔子可能会减少疾病的传播，并保护人类免受受感染白蛉的叮咬。家养区域显着减少了室内 P. papatasi 的数量。 兔子强烈吸引白蛉，但却是 L. Major 的死胡同。家庭周边地区充当稀释宿主，对 ZCL 在流行地区的传播发挥动物预防作用。本提案的目的是建立一种基于动物预防的新媒介控制策略，以减少 ZCL 在流行地区的传播。在突尼斯得到验证的原因有几个：(1) 疾病流行；(2) 目前的控制选择有限；(3) 能够利用实验室模型和现场进行干预策略的测试；事实上，从该项目中吸取的经验教训应该会影响政治敏感的中东和北非（MENA）国家的公共卫生政策当局。这个为期两年的项目将制定一种新方法。在美国向突尼斯转让专业知识的基础上控制 ZCL 输电，促进能力建设和创新。