Taenia&solium!Transmission!Dynamics! and!the!burden!of!neurocys5cercosis!

Transcription

1 Taenia&solium!Transmission!Dynamics! and!the!burden!of!neurocys5cercosis! ECWGmee*ng Ins*tuteofTropicalMedicineofAntwerp NicolasPraet April16 th 2012

2 ToC Presenta*onPlan Introduc*on TheburdenofNCC Whyisitimportanttostudythetransmission dynamicsoftaenia&solium?

3 Introduc*on Lifecycle Distribu*onandriskfactors Thediagnosisofcys*cercosisinpigsand humans

4 Human!cys5cercosis! eggs&accidentally&& consumed&by&humans& cysts&in&raw&or& undercooked&infected&& meat&consumed& by&humans& hip:// cys*cercosis.htm LifeCycle Taeniosis! eggs&in&human&faeces& consumed&by&pigs&& Porcine!cys5cercosis!

5 WhereisTaenia&solium? Source:hIp://

6 WhereisTaenia&solium? Human!to!pig!transmission:!free;roaming!pigs!

7 WhereisTaenia&solium? Human!to!pig!transmission:!no!sanita5ons,!open;air!defeca5on!

8 WhereisTaenia&solium? Human!to!pig!transmission:! latrines!inappropriately!built!!

9 WhereisTaenia&solium? Pig!to!human!transmission:!raw!undercooked!or! pork,!culinary!habits!!

10 WhereisTaenia&solium? Human!to!human!transmission:!direct!contact!or! food!or!water!contaminated!with!eggs! hip://

11 Howtodiagnosecys*cercosis? Lookingfortheparasiteinpigs INFECTION INFECTION TONGUE!INSPECTION! CARCASS!INSPECTION!

12 Lookingfortheparasiteinhumans INFECTION INFECTION hip:// IMAGING! SUB;CUTANEOUS!NODULES! ToC

13 Lookingforan*bodiesraisedagainstT.&soliumorcircula*ng an*gensoftheparasiteinporcineandhumanserum ELISA EITB ANTIBODYDETECTION (EnzymeQlinkedimmunosorbentassay) (EnzymeQlinkedimmunoelectrotransferblotassay) ANTIGENDETECTION SANDWICHELISA EXPOSURE INFECTION

14 ThediseaseburdenofNCC ToC

15 Theburdenofadisease Why!is!it!important!to!es5mate!the!burden!of!a!disease? 1. Se_ngpriori*esforpublichealthresearch,policyandservices 2. ComparingthecostQeffec*venessofdiseasecontrol programmes 3. Comparingtheimportanceofadiseasebetween countries/regionsoftheworld

16 How!to!es5mate!the!burden!of!a!disease? Monetaryburden Directcosts:medicaldoctor,diagnos*ctestsand treatments Indirectcosts:incapacitytogotoworkortoget ajob Animalproduc*on:carcasscondemna*onat slaughterhouseandmeatpricedecrease

17 HealthBurden:DisabilityAdjustedLifeYear(DALY) DALYs=numberofyearsoffullhealthlostduetothe disease =YearsofLifeLostduetoprematuredeath =YLLs =YearsofLifelivedwithDisability =YLDs DALYs=YLLs+YLDs ApproachusedbytheWorldHealthOrganiza*on toes*matetheglobalburdenofdiseases

18 Fullhealth Quality oflife YLDs YLLs Worthhealth stateordeath Ageatonset ofthedisease Ageatdeathdue tothedisease DALYs!=!YLLs!+!YLDs!

19 3comprehensivestudiesavailable Tropical Medicine and International Health doi: /j x volume 11 no 6 pp june 2006 Estimation of the cost of Taenia solium cysticercosis in Eastern Cape Province, South Africa H. Carabin 1, R. C. Krecek 2,3, L. D. Cowan 1, L. Michael 3, H. Foyaca-Sibat 4, T. Nash 5 and A. L. Willingham 6,7 1 Department of Biostatistics and Epidemiology, College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA 2 Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies 3 University of Johannesburg, Department of Zoology, Auckland Park, South Africa 4 Walter Sisulu University Faculty of Health Sciences, Mthathaa, Eastern Cape, South Africa 5 Gastrointestinal Parasites Section Laboratory of Parasitic Diseases, National Institute of Allergic and Infectious Diseases, Bethesda, MD, USA 6 International Cysticercosis Coordination Center, Royal Veterinary & Agricultural University, Frederiksberg, Denmark 7 People, Livestock and the Environment Thematic Programme, International Livestock Research Institute, Nairobi, Kenya

20 3comprehensivestudiesavailable The Disease Burden of Taenia solium Cysticercosis in Cameroon Nicolas Praet 1 *, Niko Speybroeck 1,2, Rafael Manzanedo 1, Dirk Berkvens 1, Denis Nsame Nforninwe 3, André Zoli 4, Fabrice Quet 5, Pierre-Marie Preux 5, Hélène Carabin 6, Stanny Geerts 1 1 Institute of Tropical Medicine, Antwerp, Belgium, 2 Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium, 3 Batibo District Hospital, Batibo, Cameroon, 4 University of Dschang, Dschang, Cameroon, 5 Institute of Neuroepidemiology and Tropical Neurology, Limoges, France, 6 College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America

21 3comprehensivestudiesavailable Estimating the Non-Monetary Burden of Neurocysticercosis in Mexico Rachana Bhattarai 1, Christine M. Budke 1 *, Hélène Carabin 2, Jefferson V. Proaño 3, Jose Flores-Rivera 4, Teresa Corona 4, Renata Ivanek 1, Karen F. Snowden 5, Ana Flisser 6 1 Department of Veterinary Integrative Biosciences, College of Veterinary Medicine, Texas A&M University, College Station, Texas, United States of America, 2 Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America, 3 Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México Distrito Federal, Mexico, 4 Clinical Laboratory of Neurodegenerative Diseases, National Institute ofneurology and Neurosurgery, México Distrito Federal, Mexico, 5 Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A&M University, College Station, Texas, United States of America, 6 Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México Distrito Federal, Mexico

22 Burdenes*ma*oncomponents Monetaryburden assessment Healthburden assessment Direct&indirectcosts linkedtohumanhealth Human!cys5cercosis! eggs&accidentally&& consumed&by&humans& DALYslost (YLLs+YLDs) cysts&in&raw&or& undercooked&infected&& meat&consumed& by&humans& Taeniosis! Costslinkedto pigmeatproduc*on (infectedmeat pricedecrease) Porcine!cys5cercosis! eggs&in&human&faeces& consumed&by&pigs&& X

23 Decisiontree Popula*onof WestQCameroon Epilepsy? No Epilep*cpa*ents NCC? No Numberofepilepsy duetoncc

24 Numberofepilepsy duetoncc Injuriesandhospitalisa*on? No Hospitalisa*on +an*qepilep*ctreatment? No Medicalcares? Tradi*onalhealer Medicaldoctor Both Consulta*onandtreatment Consulta*onandtreatment Number!of!individuals!in!terminal!nodes!(red)!X!costs!by!individual!

25 numberofepilepsy duetoncc Lossofjob No Joblost No Lossofworking*me Popula*onofpigs Cys*cercosis(tonguepalpa*on)? No 30%pricereduc*on Number!of!individuals!in!terminal!nodes!(red)!X!costs!by!individual!

26 Retrospec*vestudy Collec*onofexis*ngdatatoes*mate 1. howmanyindividualsaresufferingfromncc 2. HowmanypigsareinfectedwithT.&solium& Searchingforthenecessaryinforma*on: 1. Na*onalandinterna*onalhealthsta*s*cs 2. Scien*ficpublica*ons 3. Expertopinion Considertheuncertaintyaroundthisinforma*onbyusing probabilitydistribu*onsforalmosteachofaboveqmen*oned parameters

27 Monetaryburdencomparison Morecasesin Table 8. Comparison of the monetary burden of T. solium Cameroonbutlower cysticercosis in West Cameroon and Eastern Cape Province monetaryburden: (ECP), South Africa. mainlydueto differenceinindirect costs(lowersalary) Estimate West Cameroon (This study) ECP, South Africa [3] N Population 5,065,382 7,088,000 N No. (%) of NCC-associated cases of epilepsy N Overall monetary burden (610 6 Euro) 50,326* (1.0) 34,662 (0.5) u # % due to human cysticercosis # % due to porcine cysticercosis N Monetary burden per capita (Euro) * based on a prevalence of epilepsy of 3.6%. u different calculation methods were used (based on 2004 exchange rate of 1US = Euro). doi: /journal.pntd t008

28 DALYstudiescomparison Cameroon! 9DALYslostper1,000personQyears* Mexico! 0.25DALYslostper1,000personQyears* *yearsoflifeinperfecthealthyearlylostper1000inhabitantsofthearea HigherhealthburdeninCameroonmainlyduetohighermortality rate

29 Conclusions 1. BurdenofhumanandporcineCCmay benonnegligibleanddeservesamore globalassessment 2. Iden*fica*on and descrip*on of disease data gaps (epidemiological andclinical)

30 Conclusions 3. Comparison Monetary and Health burden approaches Monetary Burden Health (DALY) Burden Indicator monetary costs related to years lost due to morbidity AND morbidity mortality Zoonotic infections cost of animal production losses cost of animal production losses can may be included NOT be included Social impact not taken into account not taken into account Economic impact taken into account not taken into account depends on time- and regionspecific economical factors Comparison between world regions (difficulties in comparing poor possible throughout the whole world and rich countries) Interpretation for decisionmakers accessible needs a certain background Identification of decisiontree end component sometimes difficult to identify for each cost only mortality rate and incidence of each symptom to be identified Disability weighting not necessary disability weights rather subjective and not context specific ToC

31 Perspec*ves:towardstheassessmentofthe GlobalBurdenofNCC ToC GBD of NCC considered by WHO in the framework of the Foodborne Disease Burden Epidemiology Group(FERG)ini*a*ve: Q Systema*c review conducted Q % of NCCQassociated epilepsyavailable:29% Q DALY calcula*ons on going (es*mates expectedin2013)

32 Whyisitimportanttostudythe transmissiondynamicsoft.&solium? Accurateburdenes*mates/fillingdatagaps on: AgeQrelatedprevalence/incidence/mortality es*mates(pigsandhuman) Diseasedura*on CostQeffec*veinterven*onprogrammes

33 Whyisitimportanttostudythe transmissiondynamicsoft.&solium? International Journal for Parasitology xxx (2007) xxx xxx Simulating transmission and control of Taenia solium infections using a Reed-Frost stochastic model Niels C. Kyvsgaard a,c, *, Maria Vang Johansen b,c, Hélène Carabin d a Department of Veterinary Pathobiology, Faculty of Life Sciences, University of Copenhagen, Stigbøjlen 4, DK-1870 Frederiksberg C, Denmark b DBL-Institute for Health Research and Development, Charlottenlund, Denmark c WHO/FAO Collaborating Centre for Emerging and Other Parasitic Zoonoses, Danish Centre for Experimental Parasitology, Department of Veterinary Pathobiology, Faculty of Life Sciences, University of Copenhagen, Frederiksberg C, Denmark d Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, OK, USA Received 18 September 2006; received in revised form 24 November 2006; accepted 28 November 2006

34 Studyoftheeffectofageonthepropor*onofinfectedandexposed individuals International Journal for Parasitology 40 (2010) Contents lists available at ScienceDirect International Journal for Parasitology journal homepage: Age-related infection and transmission patterns of human cysticercosis N. Praet a,e, *, N. Speybroeck a,b, R. Rodriguez-Hidalgo c, W. Benitez-Ortiz c, D. Berkvens a,d, J. Brandt a, C. Saegerman e, P. Dorny a a Institute of Tropical Medicine, Animal Health Department, Antwerp, Belgium b Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium c Centro Internacional de Zoonosis, Quito, Ecuador d Department of Animal Production, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium e Department of Infectious and Parasitic Diseases, Epidemiology and Risk Analysis Applied to Veterinary Sciences, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium

35 Modellingasatool Availabledataandexpertopiniononthetransmission dynamicsandcontroloft.&solium&needtobe objec*velysynthesizeinordertobeobjec*vely interpreted Largescaleandmul*factorialstudiesareexpensive anddifficulttoimplement Modellingallowstouseavailableinforma*ontoes*matethe prevalence/incidenceandeffectofcontrolstrategiesonan objec*vemannerandindifferentse_ngs Modellingmayincludeseveraltechniquessucas: Q Bayesianapproach Q RuleQbasedmodelling Q Expertelicita*on Q Stochas*capproach(uncertainty) ToC

36 Conclusions 1. Burden of human and porcine CC may be non negligibleanddeservesamoreglobalassessment 2. Iden*fica*on and descrip*on of disease data gaps (epidemiologicalandclinical) 3. Transmission dynamics studies are essen*al to assesstheburdenoft.&solium&

37 Perspec*ves Assessment!of!the!global!burden!of!cys5cercosis! How!to!obtain!these!es5mates!when!only!fragmentary!data!are!available?!! 2!approaches! Prospec5ve!approach! ;!more!accurate!diagnos5c!tools! ;!standardise!data!collec5on! Longitudinal!age;related!immuno; epidemiological!and!clinical!data!to! es5mate:! Q!the!incidence!of!the!disease! Q!the!propor5on!of!CC;associate!!!!symptoms! Retrospec5ve!approach! ;!using!exis5ng!data!in!innova5ve!ways!!! Systema5c!literature!reviews! Meta;analyses! Simula5on!models! Bayesian!modeling! Expert!elicita5on! Stochas5c!models!

38 Burden!es5mates! Cost;effec5veness!of!preven5on!and!control!programs!can!be!tested!and!help! na5onal!and!interna5onal!policy;!and!decision;!makers!in!sexng!priori5es!in!public! health!and!veterinary!public!health!policies,!services!and!research!! CC!burden! Interven5on!! costs! hip://