Parasitology, Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway.
Emerging Pathogens Institute, Global Food Systems Institute, Animal Sciences Department, University of Florida, Gainesville, Florida, United States of America.
PLoS Negl Trop Dis. 2024 Feb 8;18(2):e0011898. doi: 10.1371/journal.pntd.0011898. eCollection 2024 Feb.
Chagas disease (ChD), caused by infection with the flagellated protozoan, Trypanosoma cruzi, has a complicated transmission cycle with many infection routes. These include vector-borne (via the triatomine (reduviid bug) vector defecating into a skin abrasion, usually following a blood meal), transplacental transmission, blood transfusion, organ transplant, laboratory accident, and foodborne transmission. Foodborne transmission may occur due to ingestion of meat or blood from infected animals or from ingestion of other foods (often fruit juice) contaminated by infected vectors or secretions from reservoir hosts. Despite the high disease burden associated with ChD, it was omitted from the original World Health Organization estimates of foodborne disease burden that were published in 2015. As these estimates are currently being updated, this review presents arguments for including ChD in new estimates of the global burden of foodborne disease. Preliminary calculations suggest a burden of at least 137,000 Disability Adjusted Life Years, but this does not take into account the greater symptom severity associated with foodborne transmission. Thus, we also provide information regarding the greater health burden in endemic areas associated with foodborne infection compared with vector-borne infection, with higher mortality and more severe symptoms. We therefore suggest that it is insufficient to use source attribution alone to determine the foodborne proportion of current burden estimates, as this may underestimate the higher disability and mortality associated with the foodborne infection route.
恰加斯病（Chagas disease，ChD）由鞭毛原生动物克氏锥虫感染引起，其传播周期复杂，有许多感染途径。这些途径包括媒介传播（通过在进食后排出粪便的三锥虫（吸血臭虫）媒介在皮肤擦伤处传播）、胎盘传播、输血、器官移植、实验室事故和食源性传播。食源性传播可能是由于摄入受感染动物的肉或血液，或摄入受感染媒介或储存宿主分泌物污染的其他食物（通常是果汁）而发生的。尽管 ChD 带来的疾病负担很高，但它在 2015 年发表的世界卫生组织最初的食源性疾病负担估计中被忽略了。随着这些估计值正在更新，本综述提出了将 ChD 纳入新的全球食源性疾病负担估计值的理由。初步计算表明，其残疾调整生命年（Disability Adjusted Life Years，DALY）负担至少为 137,000，但这并没有考虑到与食源性传播相关的更严重的症状严重程度。因此，我们还提供了与食源性感染相比，在流行地区与媒介传播感染相关的更大健康负担的信息，包括更高的死亡率和更严重的症状。因此，我们建议，仅使用来源归因来确定当前负担估计值的食源性比例是不够的，因为这可能低估了与食源性感染途径相关的更高残疾和死亡率。
