Menon Sonia S, Rossi Rodolfo, Nshimyumukiza Leon, Zinszer Kate
International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 P3, 9000 Ghent, Belgium ; Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
LSHTM alumni, Beirut, Lebanon.
Trop Med Health. 2016 Apr 21;44:9. doi: 10.1186/s41182-016-0011-z. eCollection 2016.
Human migration and concomitant HIV infections are likely to bring about major changes in the epidemiology of some parasitic infections in Brazil. Human visceral leishmaniasis (HVL) control is particularly fraught with intricacies. It is against a backdrop of decentralized health care that the complex HVL control initiatives are brought to bear. This comprehensive review aims to explore the obstacles facing decentralized HVL control in urban endemic areas in Brazil.
A literature search was carried out in December 2015 by means of three databases: MEDLINE, Google Scholar, and Web of Science.
Although there have been many strides that have been made in elucidating the eco-epidemiology of Leishmania infantum, which forms the underpinnings of the national control program, transmission risk factors for HVL are still insufficiently elucidated in urban settings. Decentralized HVL epidemiological surveillance and control for animal reservoirs and vectors may compromise sustainability. In addition, it may hamper timely human HVL case management. With the burgeoning of the HIV-HVL co-infection, the potential human transmission may be underestimated.
HVL is a disease with focal transmission at a critical juncture, which warrants that the bottlenecks facing the control program within contexts of decentralized healthcare systems be taken into account. In addition, HIV-driven HVL epidemics may substantially increase the transmission potential of the human reservoir. Calculating the basic reproductive number to fine-tune interventions will have to take into consideration the specific socio-economic development context.
人类迁移以及随之而来的艾滋病毒感染可能会给巴西一些寄生虫感染的流行病学带来重大变化。人类内脏利什曼病（HVL）的控制尤其充满复杂性。复杂的HVL控制举措正是在医疗保健分散化的背景下实施的。本全面综述旨在探讨巴西城市流行地区分散式HVL控制所面临的障碍。
2015年12月通过三个数据库进行了文献检索：医学文献数据库（MEDLINE）、谷歌学术和科学网。
尽管在阐明构成国家控制计划基础的婴儿利什曼原虫生态流行病学方面已经取得了许多进展，但城市环境中HVL的传播风险因素仍未得到充分阐明。对动物宿主和病媒进行分散式HVL流行病学监测和控制可能会损害可持续性。此外，这可能会妨碍对人类HVL病例的及时管理。随着艾滋病毒与HVL合并感染的迅速增加，潜在的人际传播可能被低估。
HVL是一种在关键时刻呈局灶性传播的疾病，这就要求考虑到分散式医疗系统背景下控制计划所面临的瓶颈。此外，由艾滋病毒引发的HVL流行可能会大幅增加人类宿主的传播潜力。计算基本繁殖数以微调干预措施将不得不考虑具体的社会经济发展背景。
