TY - JOUR
T1 - Epidemiological factors associated with human cystic echinococcosis
T2 - a semi-structured questionnaire from a large population-based ultrasound cross-sectional study in eastern Europe and Turkey
AU - Tamarozzi, Francesca
AU - Akhan, Okan
AU - Cretu, Carmen Michaela
AU - Vutova, Kamenna
AU - Fabiani, Massimo
AU - Orsten, Serra
AU - Pezzotti, Patrizio
AU - Popa, Gabriela Loredana
AU - Velev, Valeri
AU - Siles-Lucas, Mar
AU - Brunetti, Enrico
AU - Casulli, Adriano
PY - 2019/7/29
Y1 - 2019/7/29
N2 - BACKGROUND: Cystic echinococcosis (CE) is a neglected parasitic zoonosis prioritized by the WHO for control. Several studies have investigated potential risk factors for CE through questionnaires, mostly carried out on small samples, providing contrasting results. We present the analysis of risk factor questionnaires administered to participants to a large CE prevalence study conducted in Bulgaria, Romania and Turkey.METHODS: A semi-structured questionnaire was administered to 24,687 people from rural Bulgaria, Romania and Turkey. CE cases were defined as individuals with abdominal CE cysts detected by ultrasound. Variables associated with CE at P < 0.20 in bivariate analysis were included into a multivariable logistic model, with a random effect to account for clustering at village level. Adjusted odds ratios (AOR) with 95% CI were used to describe the strength of associations. Data were weighted to reflect the relative distribution of the rural population in the study area by country, age group and sex.RESULTS: Valid records from 22,027 people were analyzed. According to the main occupation in the past 20 years, "housewife" (AOR: 3.11; 95% CI: 1.51-6.41) and "retired" (AOR: 2.88; 95% CI: 1.09-7.65) showed significantly higher odds of being infected compared to non-agricultural workers. "Having relatives with CE" (AOR: 4.18; 95% CI: 1.77-9.88) was also associated with higher odds of infection. Interestingly, dog-related and food/water-related factors were not associated with infection.CONCLUSIONS: Our results point toward infection being acquired in a "domestic" rural environment and support the view that CE should be considered more a "soil-transmitted" than a "food-borne" infection. This result helps delineating the dynamics of infection transmission and has practical implications in the design of specific studies to shed light on actual sources of infection and inform control campaigns.
AB - BACKGROUND: Cystic echinococcosis (CE) is a neglected parasitic zoonosis prioritized by the WHO for control. Several studies have investigated potential risk factors for CE through questionnaires, mostly carried out on small samples, providing contrasting results. We present the analysis of risk factor questionnaires administered to participants to a large CE prevalence study conducted in Bulgaria, Romania and Turkey.METHODS: A semi-structured questionnaire was administered to 24,687 people from rural Bulgaria, Romania and Turkey. CE cases were defined as individuals with abdominal CE cysts detected by ultrasound. Variables associated with CE at P < 0.20 in bivariate analysis were included into a multivariable logistic model, with a random effect to account for clustering at village level. Adjusted odds ratios (AOR) with 95% CI were used to describe the strength of associations. Data were weighted to reflect the relative distribution of the rural population in the study area by country, age group and sex.RESULTS: Valid records from 22,027 people were analyzed. According to the main occupation in the past 20 years, "housewife" (AOR: 3.11; 95% CI: 1.51-6.41) and "retired" (AOR: 2.88; 95% CI: 1.09-7.65) showed significantly higher odds of being infected compared to non-agricultural workers. "Having relatives with CE" (AOR: 4.18; 95% CI: 1.77-9.88) was also associated with higher odds of infection. Interestingly, dog-related and food/water-related factors were not associated with infection.CONCLUSIONS: Our results point toward infection being acquired in a "domestic" rural environment and support the view that CE should be considered more a "soil-transmitted" than a "food-borne" infection. This result helps delineating the dynamics of infection transmission and has practical implications in the design of specific studies to shed light on actual sources of infection and inform control campaigns.
KW - Abdomen/diagnostic imaging
KW - Animals
KW - Cross-Sectional Studies
KW - Echinococcosis/diagnostic imaging
KW - Europe, Eastern/epidemiology
KW - Female
KW - Humans
KW - Logistic Models
KW - Male
KW - Odds Ratio
KW - Prevalence
KW - Risk Factors
KW - Rural Population/statistics & numerical data
KW - Surveys and Questionnaires
KW - Turkey/epidemiology
KW - Ultrasonography
KW - Zoonoses/epidemiology
U2 - 10.1186/s13071-019-3634-1
DO - 10.1186/s13071-019-3634-1
M3 - Article
C2 - 31358039
SN - 1756-3305
VL - 12
SP - 371
JO - Parasites and Vectors
JF - Parasites and Vectors
IS - 1
ER -