León Tomás M, Porco Travis C, Kim Christina S, Kaewkes Sasithorn, Kaewkes Wanlop, Sripa Banchob, Spear Robert C
School of Public Health, University of California, Berkeley, USA; Tropical Disease Research Center, Khon Kaen University, Thailand.
University of California, San Francisco, USA.
Acta Trop. 2018 Dec;188:101-107. doi: 10.1016/j.actatropica.2018.08.008. Epub 2018 Aug 24.
Human infection with the Southeast Asian liver fluke Opisthorchis viverrini and liver fluke-associated cholangiocarcinoma cause significant disease burden in Southeast Asia. While there has been considerable work to understand liver fluke pathology and to reduce infection prevalence, there remains a limited understanding of the environmental determinants of parasite transmission dynamics to inform treatment and control programs. A particular setting where targeted control efforts have taken place is the Lawa Lake complex in northeast Thailand. Here, we describe the recent history of host infections, as well as the hydrologic characteristics of this floodplain ecosystem that influence the extent of snail habitat and fish mobility and the transport of human waste and parasite cercariae. Using mathematical modeling, we outline a framework for reconstructing environmental transmission of O. viverrini over the course of the Lawa Project control program from its inception in 2008 until 2016, using locally acquired but fragmentary longitudinal infection data for both humans and environmental hosts. The role of water flow in facilitating movement between snail, fish, human, and reservoir hosts is a particular focus with respect to its relevant scales and its impact on success of interventions. In this setting, we argue that an understanding of the key environmental drivers of disease transmission processes is central to the effectiveness of any environmental intervention.
人类感染东南亚肝吸虫——猫后睾吸虫，以及与肝吸虫相关的胆管癌，在东南亚造成了严重的疾病负担。尽管在了解肝吸虫病理学和降低感染率方面已经开展了大量工作，但对于寄生虫传播动态的环境决定因素，以便为治疗和控制计划提供信息，仍了解有限。泰国东北部的拉瓦湖综合体是进行有针对性控制努力的一个特定地点。在此，我们描述了宿主感染的近期历史，以及这个洪泛平原生态系统的水文特征，这些特征影响着蜗牛栖息地的范围、鱼类的活动以及人类排泄物和寄生虫尾蚴的传播。通过数学建模，我们勾勒出一个框架，用于重建2008年至2016年拉瓦项目控制计划实施过程中猫后睾吸虫的环境传播情况，使用的是当地获取的但不完整的人类和环境宿主纵向感染数据。水流在促进蜗牛、鱼类、人类和水库宿主之间移动方面的作用，就其相关尺度及其对干预措施成功的影响而言，是一个特别关注的焦点。在这种情况下，我们认为，了解疾病传播过程的关键环境驱动因素对于任何环境干预措施的有效性至关重要。
