Section of Epidemiology, University of Zurich, Zurich, Switzerland; Life Science Zurich Graduate School, ETH Zurich and University of Zurich, Zurich, Switzerland.
WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK.
Lancet Glob Health. 2020 Apr;8(4):e603-e611. doi: 10.1016/S2214-109X(20)30038-3.
Human cystic and alveolar echinococcosis are among the priority neglected zoonotic diseases for which WHO advocates control. The incidence of both cystic echinococcosis and alveolar echinococcosis has increased substantially in the past 30 years in Kyrgyzstan. Given the scarcity of adequate data on the local geographical variation of these focal diseases, we aimed to investigate within-country incidence and geographical variation of cystic echinococcosis and alveolar echinococcosis at a high spatial resolution in Kyrgyzstan.
We mapped all confirmed surgical cases of cystic echinococcosis and alveolar echinococcosis reported through the national echinococcosis surveillance system in Kyrgyzstan between Jan 1, 2014, and Dec 31, 2016, from nine regional databases. We then estimated crude surgical incidence, standardised incidence, and standardised incidence ratios (SIRs) of primary cases (ie, excluding relapses) based on age and sex at country, region, district, and local community levels. Finally, we tested the SIRs for global and local spatial autocorrelation to identify disease hotspots at the local community level. All incidence estimates were calculated per 100 000 population and averaged across the 3-year study period to obtain annual estimates.
The surveillance system reported 2359 primary surgical cases of cystic echinococcosis and 546 primary surgical cases of alveolar echinococcosis. Country-level crude surgical incidence was 13·1 per 100 000 population per year for cystic echinococcosis and 3·02 per 100 000 population per year for alveolar echinococcosis. At the local community level, we found annual crude surgical incidences up to 176 per 100 000 population in Sary-Kamysh (Jalal-Abad region) for cystic echinococcosis and 246 per 100 000 population in Uch-Dobo (Alay district, Osh region) for alveolar echinococcosis. Significant hotspots of cystic echinococcosis were found in four regions: Osh (five local communities in Uzgen district and four in Alay district), Naryn (three local communities in Jumgal district and one in Naryn district), Talas (three local communities in Talas district), and Chuy (one local community in Jayyl district). Significant alveolar echinococcosis hotspots were detected in the Osh region (11 communities in Alay district, including the local community of Sary Mogol, and one in Chong-Alay district) and in the Naryn region (five communities in Jumgal district and three in At-Bashy district), in the southwest and centre of the country.
Our analyses reveal remarkable within-country variation in the surgical incidence of cystic echinococcosis and alveolar echinococcosis in Kyrgyzstan. These high-resolution maps identify precise locations where interventions and epidemiological research should be targeted to reduce the burden of human cystic echinococcosis and alveolar echinococcosis.
Swiss National Science Foundation.
人类包虫病（cystic echinococcosis）和泡型包虫病（alveolar echinococcosis）是世界卫生组织（WHO）主张控制的重点被忽视的人畜共患疾病之一。在过去 30 年中，吉尔吉斯斯坦的囊性包虫病和泡型包虫病的发病率都大幅上升。鉴于有关这些局部疾病的局部地理变化的充分数据稀缺，我们旨在以高空间分辨率调查吉尔吉斯斯坦囊性包虫病和泡型包虫病的全国发病情况和地理变化。
我们从九个地区数据库中绘制了 2014 年 1 月 1 日至 2016 年 12 月 31 日期间通过吉尔吉斯斯坦国家包虫病监测系统报告的所有经手术证实的囊性包虫病和泡型包虫病的病例。然后，我们根据年龄和性别，在国家、地区、区和当地社区层面，估算了原发性病例（即不包括复发）的粗手术发病率、标准化发病率和标准化发病率比（SIR）。最后，我们对 SIR 进行了全局和局部空间自相关检验，以确定当地社区层面的疾病热点。所有发病率估计均按每 10 万人计算，并在 3 年研究期间平均计算，以获得年度估计值。
监测系统报告了 2359 例原发性囊性包虫病和 546 例原发性泡型包虫病手术病例。囊性包虫病的全国粗手术发病率为每年每 10 万人 13.1 例，泡型包虫病为每年每 10 万人 3.02 例。在当地社区层面，我们发现囊性包虫病的年粗手术发病率高达每 10 万人 176 例，在泡型包虫病中为每 10 万人 246 例，地点均在 Sary-Kamysh（Jalal-Abad 地区）。囊性包虫病的显著热点在四个地区发现：奥什（Uzgen 区五个地方社区和 Alay 区四个地方社区）、纳伦（Jumgal 区三个地方社区和 Naryn 区一个地方社区）、塔拉斯（Talas 区三个地方社区）和楚伊（Jayyl 区一个地方社区）。在奥什地区（Alay 区 11 个社区，包括 Sary Mogol 当地社区，以及 Chong-Alay 区一个社区）和纳伦地区（Jumgal 区 5 个社区和 At-Bashy 区 3 个社区）以及该国西南部和中部发现了显著的泡型包虫病热点。
我们的分析显示，吉尔吉斯斯坦囊性包虫病和泡型包虫病的手术发病率存在显著的国内差异。这些高分辨率地图确定了需要干预和进行流行病学研究的精确位置，以减轻人类囊性包虫病和泡型包虫病的负担。
瑞士国家科学基金会。
