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Transmission modelling of emergent echinococcosis in Kyrgyzstan

English title Transmission modelling of emergent echinococcosis in Kyrgyzstan
Applicant Torgerson Paul
Number 173131
Funding scheme Project funding (Div. I-III)
Research institution Abteilung Veterinär Epidemiologie Vetsuisse-Fakultät Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Infectious Diseases
Start/End 01.04.2017 - 31.03.2022
Approved amount 553'926.00
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All Disciplines (2)

Discipline
Infectious Diseases
Methods of Epidemiology and Preventive Medicine

Keywords (8)

Epidemiology; Disease transmission; Echinococcus multilocularis; Modelling; Echinococcosis; Diagnosis; Zoonoses; Echinococcus granulosus

Lay Summary (German)

Lead
Die humane alveoläre und die cystische Echinococcose (AE, CE) sind chronische, oft letal verlaufende Parasitosen. Sie werden von den Bandwurmarten Echinococcus granulosus und E. multilocularis verursacht, die im Dünndarm von Caniden leben. Wenn Menschen Eier der Bandwürmer aus der kontaminierten Umgebung aufnehmen, entwickelt sich das tumorähnliche Larvengewebe in der Leber oder Lunge. Um einen vertieften Einblick in die Parasitenübertragung zu gewinnen, werden mathematische Modelle und geographische Informationssysteme eingesetzt, die auch quantitativ die Infektionsrisiken darstellen.
Lay summary

Inhalt und Ziele des Forschungsprojekts

Dieses Projekt soll die äusserst komplexe Parasitenübertragung zwischen Hunden als Endwirte und Pflanzenfressern als Zwischenwirte quantitativ erfassen und das zunehmende Infektionsrisiko für Menschen in Kirgistan beleuchten. Diagnostische Methoden sollen validiert werden um eine sensitive Diagnose beim Menschen zu erreichen, die eine frühe Behandlung ermöglicht. Das Projekt soll auch die genetische Diversität der Erreger untersuchen. Mögliche Bekämpfungs-Strategien sollen zudem mit Kostennutzen-Analysen auf ihre Machbarkeit und Wirtschaftlichkeit geprüft werden.

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungsprojekts

Das Projekt verbindet grundlagen- und anwendungs-orientierte Forschung. Kenntnisse über die genetische Diversität der Erreger stellen die Basis für die Beurteilung von Infektionsrisiken dar und ermöglichen die Beurteilung von Impfungen, zum Beispiel für Schafe. Die Frühdiagnose beim Menschen soll die Prognose der Behandlung verbessern. Die CE ist weit verbreitet in Europa und die AE gehört zu den wichtigsten Zoonosen der Schweiz, somit sind die Ergebnisse dieses Projektes auch für Europa von Bedeutung.

Direct link to Lay Summary Last update: 07.04.2017

Responsible applicant and co-applicants

Employees

Project partner

Publications

Publication
Intense Focus of Alveolar Echinococcosis, South Kyrgyzstan
Bebezov Bakhadyr, Mamashev Nurlan, Umetaliev Tilek, Ziadinov Iskender, Craig Philip S., Joekel Deborah E., Deplazes Peter, Grimm Felix, Torgerson Paul R. (2018), Intense Focus of Alveolar Echinococcosis, South Kyrgyzstan, in Emerging Infectious Diseases, 24(6), 1119-1122.
Epidemic cystic and alveolar echinococcosis in Kyrgyzstan—high resolution maps using national surveillance data identify disease hotspots
PaternosterGiulia, BooGianluca, WangCraig, MinbaevaGulnara, UsubalievaJumagul, RaimkulovKursanbek, ZhoroevAbdykadyr, MüllhauptBeat, KronenbergPhilipp, FurrerReinhard, AbdykerimovKubanychbek, DeplazesPeter, TorgersonPaul, Epidemic cystic and alveolar echinococcosis in Kyrgyzstan—high resolution maps using national surveillance data identify disease hotspots, in Lancet Global health.

Collaboration

Group / person Country
Types of collaboration
Department of Geography and Environment, University of Southampton Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
3 Department of Mathematics, University of Zurich Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
The Kyrgyz Scientific Institute of Animal Industries and Pastures Kyrgyzstan (Asia)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
City Clinical Hospital #1, Surgical Department, Faculty of Surgery of the Kyrgyz State Medical Acade Kyrgyzstan (Asia)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Department of disease prevention and sanitary - epidemiological surveillance, Ministry of Health of Kyrgyzstan (Asia)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Poster and Network Day, Vetsuisse Faculty Poster Human echinococcosis in Kyrgyzstan — Incidence and geographical distribution 05.12.2019 Zürich, Switzerland Deplazes Peter; Müllhaupt Beat; Torgerson Paul; Paternoster Giuia;
Vetsuisse Public Health conference 2019 Talk given at a conference Disease ecology—potential environmental drivers of human echinococcosis in Kyrgyzstan 27.11.2019 Bern, Switzerland Torgerson Paul; Müllhaupt Beat; Paternoster Giuia; Deplazes Peter;
28th World Congress on Echinococcsis Talk given at a conference Early serological diagnosis of human alveolar echinococcosis 29.10.2019 Lima, Peru Deplazes Peter; Kronenberg Philipp Andreas; Müllhaupt Beat; Torgerson Paul;
28th World Congress on Echinococcosis Talk given at a conference Control Programme, Kyrgyzstan 29.10.2019 Lima, Peru Torgerson Paul;
28th World Congress on Echinococcosis Talk given at a conference Spatial disease modelling to identify potential environmental determinants of human echinococcosis in Kyrgyzstan 29.10.2019 Lima, Peru Müllhaupt Beat; Deplazes Peter; Paternoster Giuia; Torgerson Paul;
Fortbildungsseminar Parasitologie, Vetsuisse Faculty Individual talk Epidemiology & geostatistical modelling of human echinococcosis in Kyrgyzstan 15.10.2019 Zürich, Switzerland Deplazes Peter; Müllhaupt Beat; Paternoster Giuia; Torgerson Paul;
SVEPM Conference Poster Human echinococcosis in Kyrgyzstan — Incidence and geographical distribution. 28.03.2019 Utrecht, Netherlands Müllhaupt Beat; Paternoster Giuia; Deplazes Peter; Torgerson Paul;
Vetsuisse Public Health Conference Talk given at a conference Spatial analysis reveals hotspots of human echinococcosis in Kyrgyzstan 29.11.2018 Zürich, Switzerland Torgerson Paul; Paternoster Giuia; Deplazes Peter; Müllhaupt Beat;
15 th International Symposium on Veterinary Epidemiology and Economics (ISVEE 15) Talk given at a conference Spatial analysis of human echinococcosis in Kyrgyzstan 12.11.2018 Chiang Mai, Thailand Paternoster Giuia;


Awards

Title Year
SSPH+ Global PhD Fellowship funded by Marie Skłodowska-Curie Actions (Horizon 2020 - COFUND) (https://ssphplus.ch/en/globalp3hs/) Awarded to Kubanychbek Abdykerimov to undertake a sandwhich PhD (time split between Kyrgyzstan and Zürich). He is now registered in the PhD programme Epidemiology and Biostatistics at the Univeristy of Zurich. It is a co funded programme, with the amount reported as the amount funded by the SSPH+ programme. Matching funds are provided by the University of Zürich 2019
"Oral Presentation Public Award" presented to Giulia Paternoster for the presentation entitled "Spatial analysis of human echinococcosis in Kyrgyzstan" at the 15th International Symposium of Veterinary Epidemiology and Economics (ISVEE15) 12-16 November 2018, Chiang Mai, Thailand. 2018

Associated projects

Number Title Start Funding scheme
152686 Risk factors for developing canine atopic dermatitis: A cohort study in West-Highland-White-Terriers 01.05.2014 Project funding (Div. I-III)
148417 The Swiss Hepatitis C Cohort Study 01.01.2014 Cohort Studies Large
132482 Development of transmission models for an emergent parasitic zoonosis 01.01.2011 Interdisciplinary projects
110928 Development of educational and research tools for the study of parasitic zoonoses in Kyrgyzstan 01.11.2005 SCOPES

Abstract

Alveolar and cystic echinococcosis is caused by Echinococcus multilocularis and E. granulosus, respectively. Both diseases are considered to be neglected zoonoses. Despite this, they cause substantial burden of disease and are amongst the leading causes of foodborne parasitic diseases. Both diseases cause extensive human morbidity whilst alveolar echinococcosis (AE) is usually fatal if not treated . Whilst the extent of cystic echinococcosis (CE) is becoming more recognized, AE appears to be an emerging disease in many European countries including Switzerland. Outside of Europe in Kyrgyzstan there is now evidence for a major epidemic of AE with exponential increases in cases every year .Echinococcus spp. have complex life cycles where carnivore hosts play an important role in the transmission in Kyrgyzstan. Because of a poor functioning veterinary and sanitation system emerging zoonoses, diseases in humans which are transmissible by animals, are an increasing problem . Both The World Bank and the World Organization for Animal Health (OIE) have therefore advised to develop national animal disease control strategies (World Bank, 2011). However, the exact interplay between hosts is not fully understood and holds a crucial role in effective control. In addition, as Echinococcus poses a global threat, and is an emerging zoonotic disease in Switzerland, knowledge on the epidemiology and transmission is essential to protect public health. The high incidence of both AE and CE provides an opportunity to provide studies for epidemiological data that would be more difficult in Europe where the disease is presently rare in humans. The results of the proposed research will help understand the epidemiological situation and explore control strategies in a limited resource setting. It will also add to an understanding of infectious disease dynamics not only specifically applied to echinococcosis, but other transmissible parasitic diseases with complex life cycles and thus be of fundamental scientific importance. The proposal will also explore the natural history of the disease in a setting where community surveillance can identify early lesions and this will provide important information both from the modelling of the disease (ie the proportion of exposed infected individuals who could progress to clinical disease) and optimal clinical management of cases. Finally, it is hypothesized that the genotypes of E. multilocularis may be associated with clinical disease and this will be explored using isolates from Kyrgyzstan.This proposal aims to address the specific hypotheses:1. There are specific individual patient as well as transmission risk factors that are driving the human CE and AE epidemics2. Can the transmission dynamics of E. multilocularis from foxes and dogs to humans be adequately explained by mathematical modelling?3. Can an understanding of the risk factors for transmission and a model of the transmission dynamics be used to analyse and optimize different control strategies to reduce E. multilocularis and E. granulosus transmission and can such control strategies be undertaken in a cost effective manner?4. That a substantial number of humans exposed to E. multilocularis fail to develop AE based on diagnostic imaging and serology.5. Early surveillance strategies in humans (US, serology) contribute to an understanding of the transmission dynamics from canids to humans and to a cost-efficient management of AE by surgery of chemotherapy6. There are specific genotypes of Echinococcus associated with a high incidence of disease in Kyrgyzstan.We seek to answer address these hypotheses by analysing the spatial distribution of reported surgical cases of both E. granulosus and E multilocularis. Furthermore, we will develop a sophisticated mathematical model to simulate the transmission between the different hosts, building on the models already developed and used by the principal investigator. This model will be used to simulate the effect of proposed control strategies and enables us to calculate the cost-utility.Understanding the spatial distribution of the parasite in these definitive hosts and being able to model transmission and control will enable us not only to gain new insights in the transmission but also provide applicable knowledge on prevention strategies.An important parameter in our modelling strategy is to estimate the number of individuals exposed to E. multilocularis who develop clinical disease. It has been proposed that humans are relatively resistant to oncosphere invasion compared to other accidental hosts such as rats and furthermore, that a unknown proportion of liver infections are self-limiting based on serological studies and detection of calcified dead liver lesions but much more data have to be generated to support these hypotheses.
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