Waddell Lisa, Rajić Andrijana, Stärk Katharina, McEwen Scott A
University of Guelph, Department of Population Medicine, Guelph, ON, Canada; Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, Ontario N1G 5B2, Canada.
Food Safety and Quality, Agriculture and Consumer Protection Department, Food and Agriculture Organization, Viale delle Terme di Caracalla, Rome, Italy.
Prev Vet Med. 2016 Sep 15;132:32-48. doi: 10.1016/j.prevetmed.2016.08.003. Epub 2016 Aug 18.
Mycobacterium avium ssp. paratuberculosis is the etiologic agent of Johne's disease in ruminants and is hypothesized to be an infectious cause of Crohn's disease, as well as some other human diseases. Due to key knowledge gaps, the potential public health impact of M. paratuberculosis is unknown. This scoping review aims to identify and characterised the evidence on potential sources and vehicles of M. paratuberculosis exposure for humans to better understand how exposure is likely to occur. Evidence from 255 primary research papers is summarized; most examined the prevalence or concentration of M. paratuberculosis in animals (farmed domestic, pets and wildlife) (n=148), food for human consumption (62) (milk, dairy, meat, infant formula) or water (drinking and recreational) and the environment (farm, pasture and areas affected by runoff water) (20). The majority of this research has been published since 2000 (Figure- abstract). Nine case-control studies examining risk factors for Crohn's disease highlighted significant associations with the consumption of processed meats and cheese, while direct contact with ruminants, high risk occupations (farmer, veterinarian), milk consumption and water source were factors not associated with the disease and/or M. paratuberculosis exposure status. Molecular epidemiology studies demonstrated strain-sharing between species. Produce and seafood were the only previously suggested sources of human exposure for which there was no supporting evidence identified in this scoping review. The results of this review indicate that ruminant populations from around the globe are infected with M. paratuberculosis and many non-ruminant species have also been found to carry or be infected with M. paratuberculosis. Several potential sources for human exposure to M. paratuberculosis were identified; however there remain important gaps in quantitative information on the prevalence and concentration of M. paratuberculosis in contaminated sources of exposure. This information is critical to understanding the risk of exposure, opportunities for risk mitigation interventions and modelling exposures to distill the importance of various sources of human exposure to M. paratuberculosis including direct contact with animals and the environment as well as consumption of contaminated foods and water. Results of this study may be used to prioritize future research and to support evidence-informed decision-making on the M. paratuberculosis issue.
副结核分枝杆菌鸟亚种是反刍动物约翰氏病的病原体，据推测也是克罗恩病以及其他一些人类疾病的感染病因。由于关键知识存在空白，副结核分枝杆菌对公众健康的潜在影响尚不清楚。本综述旨在识别和描述人类接触副结核分枝杆菌的潜在来源和传播媒介的证据，以便更好地了解接触可能如何发生。总结了来自255篇原始研究论文的证据；大多数研究调查了副结核分枝杆菌在动物（养殖家畜、宠物和野生动物）（n = 148）、供人类食用的食物（62）（牛奶、乳制品、肉类、婴儿配方奶粉）或水（饮用水和娱乐用水）以及环境（农场、牧场和受径流影响的区域）（20）中的流行率或浓度。这项研究的大部分是自2000年以来发表的（图 - 摘要）。九项关于克罗恩病危险因素的病例对照研究强调了与食用加工肉类和奶酪之间的显著关联，而与反刍动物的直接接触、高风险职业（农民、兽医）、牛奶消费和水源是与疾病和/或副结核分枝杆菌接触状态无关的因素。分子流行病学研究表明不同物种之间存在菌株共享。农产品和海鲜是此前唯一被认为的人类接触来源，但在本综述中未发现支持证据。本综述结果表明，全球的反刍动物种群感染了副结核分枝杆菌，并且还发现许多非反刍动物物种携带或感染了副结核分枝杆菌。确定了人类接触副结核分枝杆菌的几个潜在来源；然而，关于受污染接触源中副结核分枝杆菌的流行率和浓度的定量信息仍存在重要空白。这些信息对于理解接触风险、减轻风险干预措施的机会以及模拟接触情况以提炼人类接触副结核分枝杆菌的各种来源（包括与动物和环境的直接接触以及食用受污染的食物和水）的重要性至关重要。本研究结果可用于确定未来研究的优先事项，并支持关于副结核分枝杆菌问题的循证决策。
