Simpson Hope, Trueba Mei, Mendizábal-Cabrera Renata, George Sobha, Tomy Chitra, Sasi Silpa T, Kartal Aran, Deribe Kebede, Parameswara Panicker Kottarathil Narayanpillai, Davey Gail
Brighton and Sussex Medical School, Brighton, UK.
London School of Hygiene and Tropical Medicine, London, UK.
BMC Glob Public Health. 2024 Nov 13;2:75. doi: 10.1186/s44263-024-00104-y.
Podoconiosis is an underreported lymphoedema whose distribution is uncertain at global level and within endemic countries. Previous work has identified countries with historical evidence of podoconiosis, but which do not currently report cases. Podoconiosis may persist in these countries or have been eliminated due to socioeconomic development. Here we describe two different approaches used to clarify podoconiosis endemicity status in Guatemala and in Idukki District (Kerala State, India).
Two different epidemiological approaches were used by different research teams, determined by the available resources and contextual factors in the two settings. In Guatemala, where lymphoedema cases are routinely recorded in the health information system, 102 municipalities with suspected cases, historical evidence of podoconiosis, high poverty rates, or environmental suitability for the disease were visited. Active case searches were conducted from July 2016 to October 2018, and suspected cases were clinically examined to confirm or rule out podoconiosis. In Idukki, where lymphoedema cases were not routinely recorded, a population-based prevalence survey for lymphoedema was conducted from September to December 2022, covering 13,664 individuals aged 15 years and older.
Both approaches were effective at clarifying podoconiosis endemicity. In Guatemala, 20 cases with lower limb swelling were investigated. Podoconiosis was ruled out in all cases, and filarial lymphoedema was suspected in three. In Idukki District, 105 cases of lower limb swelling were identified. None was confirmed to have podoconiosis, with post-surgical lymphoedema and hypertension being the most common diagnoses. Active filarial infection was identified in two cases in Idukki District.
These investigations provide evidence that podoconiosis is currently non-endemic in Guatemala and in Idukki District in India. They also demonstrate that population-based surveys and targeted case searches both provide effective ways to explore disease endemicity in areas where this is uncertain. The most appropriate approach depends on a combination of contextual and research-based factors, including evidence for endemicity, resources available, and geographical, population, and health system factors.
地方性丝虫病是一种报告不足的淋巴水肿，其在全球范围内以及流行国家内的分布情况尚不确定。先前的研究已经确定了有地方性丝虫病历史证据的国家，但这些国家目前并未报告病例。地方性丝虫病可能在这些国家持续存在，也可能由于社会经济发展而被消除。在此，我们描述了两种不同的方法，用于阐明危地马拉和印度伊杜基区（喀拉拉邦）的地方性丝虫病流行状况。
不同的研究团队采用了两种不同的流行病学方法，这取决于两个地区的可用资源和背景因素。在危地马拉，卫生信息系统中常规记录淋巴水肿病例，对102个有疑似病例、地方性丝虫病历史证据、高贫困率或该病环境适宜性的市镇进行了走访。2016年7月至2018年10月开展了主动病例搜索，并对疑似病例进行临床检查以确诊或排除地方性丝虫病。在伊杜基，由于未常规记录淋巴水肿病例，于2022年9月至12月开展了一项基于人群的淋巴水肿患病率调查，覆盖了13664名15岁及以上的个体。
两种方法都有效地阐明了地方性丝虫病的流行情况。在危地马拉，对20例下肢肿胀病例进行了调查。所有病例均排除了地方性丝虫病，3例疑似为丝虫性淋巴水肿。在伊杜基区，发现了105例下肢肿胀病例。无一例确诊为地方性丝虫病，最常见的诊断是术后淋巴水肿和高血压。在伊杜基区的2例病例中发现了活动性丝虫感染。
这些调查提供了证据，表明地方性丝虫病目前在危地马拉和印度的伊杜基区并非地方病。它们还表明，基于人群的调查和有针对性的病例搜索都是在疾病流行情况不确定的地区探索疾病流行情况的有效方法。最合适的方法取决于背景因素和基于研究的因素的综合，包括流行证据、可用资源以及地理、人口和卫生系统因素。
