Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Institute of Ecology and Biological Resources, Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Hanoi, Vietnam.
Infect Dis Poverty. 2023 Sep 13;12(1):83. doi: 10.1186/s40249-023-01138-4.
Strongyloidiasis, caused by the nematodes Strongyloides stercoralis and Strongyloides fuelleborni, is estimated to affect over 600 million individuals worldwide. The disease is endemic in Southeast Asia, where a warm-humid climate and socio-economic conditions maintain the parasite's life cycle and transmission. However, the current diagnostic methods may not be sufficiently sensitive, suggesting that the true prevalence of strongyloidiasis could be seriously underestimated in this. This study aims to determine the prevalence of strongyloidiasis in Southeast Asia through a systematic review and meta-analysis and to discuss the implications of the estimated prevalence on diagnostic approaches and control strategies.
Following PRISMA guidelines, we conducted a systematic literature search in PubMed and Google Scholar databases to identify studies reporting Strongyloides prevalence data in the 11 Southeast Asian countries up to December 2022. A random effects model was employed to estimate the pooled prevalence of S. stercoralis at both regional and country levels.
Out of 3722 articles identified, 224 met our inclusion criteria. For S. stercoralis specifically, we found 187 articles, of which 52.4% were from Thailand. All Southeast Asian countries, except Brunei, had at least one study on Strongyloides prevalence. The estimated pooled prevalence of S. stercoralis regionally was 12.7% (95% CI 10.70-14.80%), ranging from 0.4 to 24.9% at the country level. Cambodia had the highest pooled prevalence (24.9%, 95% CI 15.65-35.38%), followed by Lao PDR (16.5%, 95% CI 9.50-24.95%). Moreover, we obtained a pooled prevalence of 10% (95% CI 7.06-13.52%) in a group comprising immigrants, workers, and veterans from Southeast Asian countries. S. stercoralis infects various host types, including nonhuman primates, domestic dogs and cats, rodents, and transport carriers such as cockroaches and vegetables.
A high prevalence of strongyloidiasis in Southeast Asia was revealed, highlighting the importance of the region's ongoing research, surveillance, and control efforts. Factors contributing to the strongyloidiasis transmission include the role of animal hosts, the impact of global connectivity, and the significance of the co-endemicity of other Strongyloides species. Based on these findings, a multi-pronged One-Health approach is essential for sustainable intervention and control.
由旋毛线虫属的 Strongyloides stercoralis 和 Strongyloides fuelleborni 引起的 Strongyloidiasis 估计影响全球超过 6 亿人。该疾病在东南亚流行，温暖潮湿的气候和社会经济条件维持着寄生虫的生命周期和传播。然而，目前的诊断方法可能不够敏感，这表明该地区的 Strongyloidiasis 实际患病率可能被严重低估。本研究旨在通过系统评价和荟萃分析来确定东南亚的 Strongyloidiasis 患病率，并讨论估计的患病率对诊断方法和控制策略的影响。
根据 PRISMA 指南，我们在 PubMed 和 Google Scholar 数据库中进行了系统文献检索，以确定截至 2022 年 12 月报告东南亚 11 个国家 Strongyloides 患病率数据的研究。采用随机效应模型估计 S. stercoralis 在区域和国家层面的汇总患病率。
在确定的 3722 篇文章中，有 224 篇符合纳入标准。对于 S. stercoralis，我们找到了 187 篇文章，其中 52.4%来自泰国。除文莱外，所有东南亚国家都至少有一项关于 Strongyloides 患病率的研究。区域内 S. stercoralis 的估计汇总患病率为 12.7%（95%CI 10.70-14.80%），国家层面的患病率范围为 0.4%-24.9%。柬埔寨的患病率最高（24.9%，95%CI 15.65-35.38%），其次是老挝人民民主共和国（16.5%，95%CI 9.50-24.95%）。此外，我们在一组来自东南亚国家的移民、工人和退伍军人中获得了 10%（95%CI 7.06-13.52%）的汇总患病率。S. stercoralis 感染各种宿主类型，包括非人类灵长类动物、家养犬和猫、啮齿动物以及蟑螂和蔬菜等运输载体。
东南亚的 Strongyloidiasis 患病率很高，突显了该地区持续开展研究、监测和控制工作的重要性。导致 Strongyloidiasis 传播的因素包括动物宿主的作用、全球联系的影响以及其他 Strongyloides 物种共同流行的意义。基于这些发现，需要采取多部门的“同一健康”方法来进行可持续的干预和控制。
