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PLoS Medicine Mar 2014Preventive chemotherapy represents a powerful but short-term control strategy for soil-transmitted helminthiasis. Since humans are often re-infected rapidly, long-term... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Preventive chemotherapy represents a powerful but short-term control strategy for soil-transmitted helminthiasis. Since humans are often re-infected rapidly, long-term solutions require improvements in water, sanitation, and hygiene (WASH). The purpose of this study was to quantitatively summarize the relationship between WASH access or practices and soil-transmitted helminth (STH) infection.
METHODS AND FINDINGS
We conducted a systematic review and meta-analysis to examine the associations of improved WASH on infection with STH (Ascaris lumbricoides, Trichuris trichiura, hookworm [Ancylostoma duodenale and Necator americanus], and Strongyloides stercoralis). PubMed, Embase, Web of Science, and LILACS were searched from inception to October 28, 2013 with no language restrictions. Studies were eligible for inclusion if they provided an estimate for the effect of WASH access or practices on STH infection. We assessed the quality of published studies with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. A total of 94 studies met our eligibility criteria; five were randomized controlled trials, whilst most others were cross-sectional studies. We used random-effects meta-analyses and analyzed only adjusted estimates to help account for heterogeneity and potential confounding respectively. Use of treated water was associated with lower odds of STH infection (odds ratio [OR] 0.46, 95% CI 0.36-0.60). Piped water access was associated with lower odds of A. lumbricoides (OR 0.40, 95% CI 0.39-0.41) and T. trichiura infection (OR 0.57, 95% CI 0.45-0.72), but not any STH infection (OR 0.93, 95% CI 0.28-3.11). Access to sanitation was associated with decreased likelihood of infection with any STH (OR 0.66, 95% CI 0.57-0.76), T. trichiura (OR 0.61, 95% CI 0.50-0.74), and A. lumbricoides (OR 0.62, 95% CI 0.44-0.88), but not with hookworm infection (OR 0.80, 95% CI 0.61-1.06). Wearing shoes was associated with reduced odds of hookworm infection (OR 0.29, 95% CI 0.18-0.47) and infection with any STH (OR 0.30, 95% CI 0.11-0.83). Handwashing, both before eating (OR 0.38, 95% CI 0.26-0.55) and after defecating (OR 0.45, 95% CI 0.35-0.58), was associated with lower odds of A. lumbricoides infection. Soap use or availability was significantly associated with lower infection with any STH (OR 0.53, 95% CI 0.29-0.98), as was handwashing after defecation (OR 0.47, 95% CI 0.24-0.90). Observational evidence constituted the majority of included literature, which limits any attempt to make causal inferences. Due to underlying heterogeneity across observational studies, the meta-analysis results reflect an average of many potentially distinct effects, not an average of one specific exposure-outcome relationship.
CONCLUSIONS
WASH access and practices are generally associated with reduced odds of STH infection. Pooled estimates from all meta-analyses, except for two, indicated at least a 33% reduction in odds of infection associated with individual WASH practices or access. Although most WASH interventions for STH have focused on sanitation, access to water and hygiene also appear to significantly reduce odds of infection. Overall quality of evidence was low due to the preponderance of observational studies, though recent randomized controlled trials have further underscored the benefit of handwashing interventions. Limited use of the Joint Monitoring Program's standardized water and sanitation definitions in the literature restricted efforts to generalize across studies. While further research is warranted to determine the magnitude of benefit from WASH interventions for STH control, these results call for multi-sectoral, integrated intervention packages that are tailored to social-ecological contexts.
Topics: Adolescent; Adult; Animals; Child; Child, Preschool; Hand Disinfection; Humans; Hygiene; Infant; Infant, Newborn; Nematoda; Nematode Infections; Sanitation; Soil
PubMed: 24667810
DOI: 10.1371/journal.pmed.1001620 -
PloS One 2014Research regarding zoonotic diseases often focuses on infectious diseases animals have given to humans. However, an increasing number of reports indicate that humans are... (Review)
Review
BACKGROUND
Research regarding zoonotic diseases often focuses on infectious diseases animals have given to humans. However, an increasing number of reports indicate that humans are transmitting pathogens to animals. Recent examples include methicillin-resistant Staphylococcus aureus, influenza A virus, Cryptosporidium parvum, and Ascaris lumbricoides. The aim of this review was to provide an overview of published literature regarding reverse zoonoses and highlight the need for future work in this area.
METHODS
An initial broad literature review yielded 4763 titles, of which 4704 were excluded as not meeting inclusion criteria. After careful screening, 56 articles (from 56 countries over three decades) with documented human-to-animal disease transmission were included in this report.
FINDINGS
In these publications, 21 (38%) pathogens studied were bacterial, 16 (29%) were viral, 12 (21%) were parasitic, and 7 (13%) were fungal, other, or involved multiple pathogens. Effected animals included wildlife (n = 28, 50%), livestock (n = 24, 43%), companion animals (n = 13, 23%), and various other animals or animals not explicitly mentioned (n = 2, 4%). Published reports of reverse zoonoses transmission occurred in every continent except Antarctica therefore indicating a worldwide disease threat.
INTERPRETATION
As we see a global increase in industrial animal production, the rapid movement of humans and animals, and the habitats of humans and wild animals intertwining with great complexity, the future promises more opportunities for humans to cause reverse zoonoses. Scientific research must be conducted in this area to provide a richer understanding of emerging and reemerging disease threats. As a result, multidisciplinary approaches such as One Health will be needed to mitigate these problems.
Topics: Animals; Animals, Domestic; Animals, Wild; Communicable Diseases; Humans; Influenza A virus; Methicillin-Resistant Staphylococcus aureus; Zoonoses
PubMed: 24586500
DOI: 10.1371/journal.pone.0089055 -
Medicina 2014A systematic review of surveys performed between 1980 and 2011 (published in MEDLINE/Pubmed and/or LILACS indexed journals, available in the baseline data from a Mass... (Review)
Review
A systematic review of surveys performed between 1980 and 2011 (published in MEDLINE/Pubmed and/or LILACS indexed journals, available in the baseline data from a Mass Deworming National Program (MDNP, 2005) was used to identify the prevalence, distribution and detection of risk areas for soil transmitted helminth infections (STH) in Argentina. We found 310 publications in the database using the pre-defined key-words (medical subject headings) for research purposes. Only 24 articles with 26 surveillance sites in 8 provinces and a total of 5495 surveyed individuals fulfilled the inclusion criteria. Frequency rates for STH had a wide range: Ascaris lumbricoides: 0-67%, hookworms: 0-90%, Trichuris trichiura: 0-24.6 and Strongyloides stercoralis: 0-83%. The estimated combined incidence varied from 0.8% to 88.6%. Baseline surveys from the MDNP reporting on 1943 children from 12 provinces confirmed the heterogeneity, with combined STH frequency rates ranging from 0 to 42.7%. Surveys included in this review showed that the distribution of STH in Argentina is not homogeneous, with areas of high incidence (> 20%) in the northeastern and northwestern provinces where mass deworming activities would be highly beneficial. In several surveys, the high overall incidence was mostly due to hookworms and S. stercoralis, a situation to be considered when selecting diagnostic and therapeutic control strategies. The scarcity or absence of data from various provinces and the availability of less than 8000 surveyed individuals should be considered.
Topics: Adolescent; Adult; Animals; Argentina; Ascariasis; Ascaris lumbricoides; Child; Child, Preschool; Helminthiasis; Humans; Prevalence; Soil; Strongyloides stercoralis; Strongyloidiasis; Trichuriasis; Trichuris
PubMed: 24561837
DOI: No ID Found -
PLoS Neglected Tropical Diseases 2012Soil-transmitted helminth (STH) infections (i.e., Ascaris lumbricoides, hookworm, and Trichuris trichiura) affect more than a billion people. Preventive chemotherapy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Soil-transmitted helminth (STH) infections (i.e., Ascaris lumbricoides, hookworm, and Trichuris trichiura) affect more than a billion people. Preventive chemotherapy (i.e., repeated administration of anthelmintic drugs to at-risk populations), is the mainstay of control. This strategy, however, does not prevent reinfection. We performed a systematic review and meta-analysis to assess patterns and dynamics of STH reinfection after drug treatment.
METHODOLOGY
We systematically searched PubMed, ISI Web of Science, EMBASE, Cochrane Database of Systematic Reviews, China National Knowledge Infrastructure, WanFang Database, Chinese Scientific Journal Database, and Google Scholar. Information on study year, country, sample size, age of participants, diagnostic method, drug administration strategy, prevalence and intensity of infection pre- and posttreatment, cure and egg reduction rate, evaluation period posttreatment, and adherence was extracted. Pooled risk ratios from random-effects models were used to assess the risk of STH reinfection after treatment. Our protocol is available on PROSPERO, registration number: CRD42011001678.
PRINCIPAL FINDINGS
From 154 studies identified, 51 were included and 24 provided STH infection rates pre- and posttreatment, whereas 42 reported determinants of predisposition to reinfection. At 3, 6, and 12 months posttreatment, A. lumbricoides prevalence reached 26% (95% confidence interval (CI): 16-43%), 68% (95% CI: 60-76%) and 94% (95% CI: 88-100%) of pretreatment levels, respectively. For T. trichiura, respective reinfection prevalence were 36% (95% CI: 28-47%), 67% (95% CI: 42-100%), and 82% (95% CI: 62-100%), and for hookworm, 30% (95% CI: 26-34%), 55% (95% CI: 34-87%), and 57% (95% CI: 49-67%). Prevalence and intensity of reinfection were positively correlated with pretreatment infection status.
CONCLUSION
STH reinfections occur rapidly after treatment, particularly for A. lumbricoides and T. trichiura. Hence, there is a need for frequent anthelmintic drug administrations to maximize the benefit of preventive chemotherapy. Integrated control approaches emphasizing health education and environmental sanitation are needed to interrupt transmission of STH.
Topics: Animals; Anthelmintics; Ascariasis; Drug Therapy; Helminthiasis; Hookworm Infections; Humans; Recurrence; Trichuriasis
PubMed: 22590656
DOI: 10.1371/journal.pntd.0001621 -
PLoS Medicine Jan 2012In countries of high endemicity of the soil-transmitted helminth parasites Ascaris lumbricoides, Trichuris trichiura, and hookworm, preventive chemotherapy (i.e.,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In countries of high endemicity of the soil-transmitted helminth parasites Ascaris lumbricoides, Trichuris trichiura, and hookworm, preventive chemotherapy (i.e., repeated administration of anthelmintic drugs to at-risk populations) is the main strategy to control morbidity. However, rapid reinfection of humans occurs after successful deworming, and therefore effective preventive measures are required to achieve public health goals with optimal efficiency and sustainability.
METHODS AND FINDINGS
We conducted a systematic review and meta-analysis to assess the effect of sanitation (i.e., access and use of facilities for the safe disposal of human urine and feces) on infection with soil-transmitted helminths. PubMed, Embase, ISI Web of Science, and the World Health Organization Library Database were searched without language restrictions and year of publication (search performed until December 31, 2010). Bibliographies of identified articles were hand-searched. All types of studies reporting data on sanitation availability (i.e., having access at own household or living in close proximity to sanitation facility), or usage, and soil-transmitted helminth infections at the individual level were considered. Reported odds ratios (ORs) of the protective effect of sanitation on soil-transmitted helminth infections were extracted from the papers or calculated from reported numbers. The quality of published studies was assessed with a panel of criteria developed by the authors. Random effects meta-analyses were used to account for observed heterogeneity. Thirty-six publications, consisting of 39 datasets, met our inclusion criteria. Availability of sanitation facilities was associated with significant protection against infection with soil-transmitted helminths (OR = 0.46 to 0.58). Regarding the use of sanitation, ORs of 0.54 (95% confidence interval [CI] 0.28-1.02), 0.63 (95% CI 0.37-1.05), and 0.78 (95% CI 0.60-1.00) were determined for T. trichiura, hookworm, and A. lumbricoides, respectively. The overall ORs, combining sanitation availability and use, were 0.51 (95% CI 0.44-0.61) for the three soil-transmitted helminths combined, 0.54 (95% CI 0.43-0.69) for A. lumbricoides, 0.58 (95% CI 0.45-0.75) for T. trichiura, and 0.60 (95% CI 0.48-0.75) for hookworm.
CONCLUSIONS
Despite a number of limitations (e.g., most studies used a cross-sectional design and were of low quality, with potential biases and considerable heterogeneity), our results reveal that sanitation is associated with a reduced risk of transmission of helminthiases to humans. Access to improved sanitation should be prioritized alongside preventive chemotherapy and health education to achieve a durable reduction of the burden of helminthiases.
Topics: Ancylostomatoidea; Animals; Ascariasis; Ascaris lumbricoides; Hookworm Infections; Humans; Nematoda; Nematode Infections; Sanitation; Soil; Trichuriasis; Trichuris
PubMed: 22291577
DOI: 10.1371/journal.pmed.1001162 -
The American Journal of Tropical... Oct 2011The epidemiology of soil-transmitted helminth infections (hookworm, Trichuris trichiura, Ascaris lumbricoides, and Strongyloides stercoralis) in the United States is... (Review)
Review
The epidemiology of soil-transmitted helminth infections (hookworm, Trichuris trichiura, Ascaris lumbricoides, and Strongyloides stercoralis) in the United States is poorly understood. To gain understanding of the status of disease, a systematic review was performed to assess the prevalence of soil-transmitted helminth infections in the United States. Of all studies reviewed, 14 were designated as high-quality. High-quality studies were published from 1942 to 1982 and showed that infection was prevalent throughout the southern United States and Appalachia as recently as 1982, finding that hookworm (19.6%), T. trichiura (55.2%), A. lumbricoides (49.4%), and S. stercoralis (3.8%) affected significant percentages of the population. However, because the most recent high-quality studies were published over 25 years ago, the literature does not provide sufficient data to assess current endemic transmission. Because the status of disease remains unclear, there is a need for additional studies to determine if soil-transmitted helminths remain endemic in the United States.
Topics: Helminthiasis; Humans; Soil; United States
PubMed: 21976572
DOI: 10.4269/ajtmh.2011.11-0214 -
Parasitology Oct 2011In sub-Saharan Africa, over 22 million people are estimated to be co-infected with both helminths and HIV-1. Several studies have suggested that de-worming individuals... (Meta-Analysis)
Meta-Analysis Review
In sub-Saharan Africa, over 22 million people are estimated to be co-infected with both helminths and HIV-1. Several studies have suggested that de-worming individuals with HIV-1 may delay HIV-1 disease progression, and that the benefit of de-worming may vary by individual helminth species. We conducted a systematic review and meta-analysis of the published literature to determine the effect of treatment of individual helminth infections on markers of HIV-1 progression (CD4 count and HIV viral load). There was a trend towards an association between treatment for Schistosoma mansoni and a decrease in HIV viral load (Weighted mean difference (WMD)=-0·10; 95% Confidence interval (CI): -0·24, 0·03), although this association was not seen for Ascaris lumbricoides, hookworm or Trichuris trichiura. Treatment of A. lumbricoides, S. mansoni, hookworm or T. trichiura was not associated with a change in CD4 count. While pooled data from randomized trials suggested clinical benefit of de-worming for individual helminth species, these effects decreased when observational data were included in the pooled analysis. While further trials are needed to confirm the role of anthelmintic treatment in HIV-1 co-infected individuals, providing anthelmintics to individuals with HIV-1 may be a safe, inexpensive and practical intervention to slow progression of HIV-1.
Topics: Animals; Anthelmintics; CD4 Lymphocyte Count; Cohort Studies; Coinfection; Confidence Intervals; Disease Progression; HIV Infections; HIV-1; Helminthiasis; Humans; Prospective Studies; RNA, Viral; Randomized Controlled Trials as Topic; Viral Load
PubMed: 21729353
DOI: 10.1017/S0031182011000357 -
PLoS Neglected Tropical Diseases Mar 2008Pre-school age children account for 10%-20% of the 2 billion people worldwide who are infected with soil-transmitted helminths (STHs): Ascaris lumbricoides (roundworm),... (Review)
Review
Pre-school age children account for 10%-20% of the 2 billion people worldwide who are infected with soil-transmitted helminths (STHs): Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and Ancylostoma duodenale/Necator americanus (hookworms). Through a systematic review of the published literature and using information collated at World Health Organization headquarters, this paper summarizes the available evidence to support the recommendation that pre-school children should be included in regular deworming programmes. The first section describes the burden of STH disease in this age group, followed by a summary of how infection impacts iron status, growth, vitamin A status, and cognitive development and how STHs may exacerbate other high mortality infections. The second section explores the safety of the drugs themselves, given alone or co-administered, drug efficacy, and the importance of safe administration. The third section provides country-based evidence to demonstrate improved health outcomes after STH treatment. The final section provides country experiences in scaling up coverage of pre-school children by using other large scale public health interventions, including vitamin A programmes, immunization campaigns, and Child Health days. The paper concludes with a number of open research questions and a summary of some of the operational challenges that still need to be addressed.
Topics: Ancylostoma; Animals; Anthelmintics; Ascaris lumbricoides; Child; Child, Preschool; Female; Helminthiasis; Humans; Infant; Male; Necator americanus; Preventive Medicine; Soil; Trichuris
PubMed: 18365031
DOI: 10.1371/journal.pntd.0000126