Targeted screening for Taenia solium tapeworms

猪带绦虫的靶向筛查

基本信息

批准号：
8129451
负责人：
Seth E O'Neal
金额：
$ 12.41万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-15 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8129451
关键词：
Adult Advisory Committees Africa South of the Sahara Age Algorithms Animal Husbandry Annelida Area Asia Brain Central Nervous System Parasitic Infections Cestoda Cestode Infections China Clinical Communities Consumption Control Groups Cyst Cysticercosis Data Decision Making Detection Development Disadvantaged Disease Economics Education Effectiveness Enzyme-Linked Immunosorbent Assay Epilepsy Family suidae Feasibility Studies Feces Food Safety Goals Grant Household Human Human Identifications Infection Infection prevention International Intervention Investigation Larva Latin America Lesion Longevity Low Prevalence Marketing Measures Meat Mentorship Methods Neurocysticercosis Peru Physicians Prevalence Public Health Recording of previous events Relative (related person)Research Research Infrastructure Research Training Resources Rural Screening Result Screening procedure Seizures Seroprevalences Sewage Source Taenia solium Technology Tongue Training Vaccines base cohort cost design effective therapy egg experience group intervention health economics human migration nervous system disorder oxfendazole performance tests population based programs public health relevance reproductive socioeconomics tool transmission process two-arm study

项目摘要

DESCRIPTION (provided by applicant): Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system, and the leading cause of acquired epilepsy in the developing world. It occurs when someone ingests Taenia solium eggs passed in the feces of a pork tapeworm carrier. The eggs grow into larvae which then form cysts throughout the body; cysts in the brain are responsible for 30% of seizures in the developing world. In Latin America, over 400,000 people of all ages and socioeconomic classes have symptomatic NCC. Sustainability of control efforts is limited by migration of human tapeworm carriers, persistent conditions for transmission and the enormous reproductive capacity of tapeworms. Our long-term goals are two-fold; 1) to develop an effective, affordable and sustainable strategy for T. solium control in endemic areas, and 2) to increase population-based research capacity around neurologic disorders in rural regions of Peru. In this R21 grant, we begin with a feasibility study of targeted screening as a control strategy, and by leveraging the resources of an existing consortium to extend research and MPH training, field experience, and mentorship to two physicians in Puno, Peru. Field data show spatial clustering of infected pigs around tapeworm carriers. With the short lifespan of pigs raised for consumption, this suggests that infected pigs may mark the presence of a nearby tapeworm carrier. Our specific aims include: 1) To implement and assess targeted screening for human T. solium tapeworm carriers in household clusters surrounding infected pigs, and 2) To identify the most effective screening tools for tapeworm carriers in the context of targeted screening. We propose an intervention cohort with two study arms. Communities in the intervention group receive ongoing targeted screening for tapeworm carriers in household clusters around infected pigs, using all available screening tools (history of passing worm segments, O&P, coproantigen ELISA, EITB, and PCR). Communities in the control group receive education about the T. solium lifecycle and how to prevent infection. We conduct pig serosurveys in both groups every 5 months, using pig seroprevalence to measure overall transmission, and provide mass tapeworm screening and treatment at study end. Our primary hypothesis is that ongoing targeted screening and treatment of tapeworm carriers will decrease transmission of T. solium infection in an endemic area, measured by serial pig seroprevalence. Our secondary hypothesis is that targeted screening around pigs with cysticercosis will increase detection of T. solium tapeworms compared to generalized screening in endemic areas. We estimate prevalence of infection among household clusters using latent-class analysis of all screening results. Finally, we use decision-making analysis to determine the most effective screening tool for targeted screening, taking into consideration test performance, cost, and relative accessibility. Our results will guide design of a subsequent large-scale T. solium control intervention using the most promising methods identified in this study. PUBLIC HEALTH RELEVANCE: Cysticercosis is an emerging public health problem in much of the developing world, where it is the leading cause of preventable epilepsy. This proposal examines targeted screening for pork tapeworm carriers as a potentially effective, affordable and sustainable control strategy.

描述（由申请人提供）：神经囊虫病（NCC）是中枢神经系统中最常见的寄生虫感染，也是发展中国家获得癫痫的主要原因。当有人在猪肉tape子携带者的粪便中摄取taenia solium卵时，就会发生这种情况。卵生长成幼虫，然后在整个体内形成囊肿。大脑中的囊肿是发展中国家30％的癫痫发作的原因。在拉丁美洲，所有年龄段的超过40万人和社会经济阶层有症状的NCC。控制努力的可持续性受到人类tape虫载体的迁移，传播的持续条件以及tap虫的巨大生殖能力的限制。我们的长期目标是两个方面。 1）为在流行地区制定一种有效，负担得起和可持续的策略，以及2）提高秘鲁农村地区神经系统疾病周围的基于人群的研究能力。在这笔R21赠款中，我们首先将目标筛查作为控制策略的可行性研究，并利用现有财团的资源来扩展研究和MPH培训，现场经验和指导，向秘鲁普诺的两名医生提供指导。现场数据显示了tape虫载体周围感染猪的空间聚类。随着猪的寿命短，可以消费，这表明被感染的猪可能标志着附近的tape虫载体的存在。我们的具体目的包括：1）在受感染猪周围的家用簇中实施和评估人类T. solium tapeworm载体的有针对性筛查，以及2）在有针对性的筛查的背景下确定tapee虫载体的最有效筛选工具。我们提出了一个带有两个研究臂的干预队列。干预组的社区使用所有可用的筛查工具（通过蠕虫段，O＆P，Coproantigen ELISA，EITB和PCR）接受了受感染猪周围家庭簇中的TapeWorm携带者的有针对性筛查。对照组的社区接受有关T. solium生命周期以及如何防止感染的教育。我们每5个月每5个月一次进行猪的血清养护，使用猪的血清阳性来衡量整体传播，并在研究结束时提供质量tape虫筛查和治疗。我们的主要假设是，通过连续猪血清阳性测量的特有区域中，持续的靶向筛查和治疗tape虫载体将降低特有区域中T. solium感染的传播。我们的次要假设是，与流行地区的广义筛查相比，囊性尾copisosis的猪周围的靶向筛查将增加对th虫的检测。我们使用所有筛查结果的潜在级别分析来估计家庭簇之间感染的患病率。最后，我们使用决策分析来确定针对目标筛查的最有效筛选工具，考虑到测试绩效，成本和相对可访问性。我们的结果将使用本研究中确定的最有前途的方法来指导随后的大规模T. solium控制干预措施的设计。公共卫生相关性：在发展中国家的大部分地区，囊肿是一个新兴的公共卫生问题，这是可预防癫痫的主要原因。该提案研究了针对猪肉tape虫载体的目标筛查，这是一种潜在的有效，负担得起和可持续的控制策略。