Giulia Paternoster1, Gianluca Boo2, Craig Wang3, Gulnara Minbaeva4, Jumagul Usubalieva4, Kursanbek Mamasalievich Raimkulov5, Abdykadyr Zhoroev4, Kubanychbek Kudaibergenovich Abdykerimov6, Philipp Andreas Kronenberg7, Beat Müllhaupt8, Reinhard Furrer9, Peter Deplazes10, Paul Robert Torgerson11. 1. Section of Epidemiology, University of Zurich, Zurich, Switzerland; Life Science Zurich Graduate School, ETH Zurich and University of Zurich, Zurich, Switzerland. 2. WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK. 3. Vetsuisse Faculty, Department of Mathematics, University of Zurich, Zurich, Switzerland; Life Science Zurich Graduate School, ETH Zurich and University of Zurich, Zurich, Switzerland. 4. Government Sanito-Epidemiology Unit, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan. 5. Center for Disease Prevention and Sanitary Epidemiological Surveillance of Osh region, Ministry of Health of the Kyrgyz Republic, Osh, Kyrgyzstan. 6. Section of Epidemiology, University of Zurich, Zurich, Switzerland; Institute of Parasitology, University of Zurich, Zurich, Switzerland; Kyrgyz Research Institute of Veterinary Science named after A Duisheev, Ministry of Education and Science of the Kyrgyz Republic, Bishkek, Kyrgyzstan. 7. Institute of Parasitology, University of Zurich, Zurich, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland. 8. Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 9. Vetsuisse Faculty, Department of Mathematics, University of Zurich, Zurich, Switzerland; Department of Computational Science, University of Zurich, Zurich, Switzerland. 10. Institute of Parasitology, University of Zurich, Zurich, Switzerland. 11. Section of Epidemiology, University of Zurich, Zurich, Switzerland. Electronic address: paul.torgerson@access.uzh.ch.
Abstract
BACKGROUND: 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. METHODS: 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. FINDINGS: 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. INTERPRETATION: 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. FUNDING: Swiss National Science Foundation.
BACKGROUND: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. METHODS: 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. FINDINGS: 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. INTERPRETATION: 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 humancystic echinococcosis and alveolar echinococcosis. FUNDING: Swiss National Science Foundation.
Authors: Philipp A Kronenberg; Ansgar Deibel; Bruno Gottstein; Felix Grimm; Beat Müllhaupt; Cordula Meyer Zu Schwabedissen; Sezdbek Aitbaev; Rakhatbek A Omorov; Kubanychbek K Abdykerimov; Gulnara Minbaeva; Jumagul Usubalieva; Mar Siles-Lucas; Paola Pepe; Laura Rinaldi; Markus Spiliotis; Junhua Wang; Norbert Müller; Paul R Torgerson; Peter Deplazes Journal: Pathogens Date: 2022-04-27
Authors: Cristian A Alvarez Rojas; Philipp A Kronenberg; Sezdbek Aitbaev; Rakhatbek A Omorov; Kubanychbek K Abdykerimov; Giulia Paternoster; Beat Müllhaupt; Paul Torgerson; Peter Deplazes Journal: PLoS Negl Trop Dis Date: 2020-05-13