Potential Risk Factors Associated with Human Cystic Echinococcosis: Systematic Review and Meta-analysis

BackgroundScientific literature on cystic echinococcosis (CE) reporting data on risk factors is limited and to the best of our knowledge, no global evaluation of human CE risk factors has to date been performed. This systematic review (SR) summarizes available data on statistically relevant potential risk factors (PRFs) associated with human CE.Methodology/Principal FindingsDatabase searches identified 1,367 papers, of which thirty-seven were eligible for inclusion. Of these, eight and twenty-nine were case-control and cross-sectional studies, respectively. Among the eligible papers, twenty-one were included in the meta-analyses. Pooled odds ratio (OR) were used as a measure of effect and separately analysed for the two study designs. PRFs derived from case-control studies that were significantly associated with higher odds of outcome were “dog free to roam” (OR 5.23; 95% CI 2.45–11.14), “feeding dogs with viscera” (OR 4.69; 95% CI 3.02–7.29), “slaughter at home” (OR 4.67; 95% CI 2.02–10.78) or at “slaughterhouses” (OR 2.7; 95% CI 1.15–6.3), “dog ownership” (OR 3.54; 95% CI 1.27–9.85), “living in rural areas” (OR 1.83; 95% CI 1.16–2.9) and “low income” (OR 1.68; 95% CI 1.02–2.76). Statistically significant PRFs from cross-sectional studies with higher odds of outcome were “age >16 years” (OR 6.08; 95% CI 4.05–9.13), “living in rural areas” (OR 2.26; 95% CI 1.41–3.61), “being female” (OR 1.38; 95% CI 1.06–1.8) and “dog ownership” (OR 1.37; 95% CI 1.01–1.86).Conclusions/SignificanceLiving in endemic rural areas, in which free roaming dogs have access to offal and being a dog-owner, seem to be among the most significant PRFs for acquiring this parasitic infection. Results of data analysed here may contribute to our understanding of the PRFs for CE and may potentially be useful in planning community interventions aimed at controlling CE in endemic areas.背景：目前关于囊型包虫病（cystic echinococcosis, CE）的危险因素相关科学文献较为有限，据我们所知，迄今为止尚未开展过全球范围内的人类囊型包虫病危险因素评估。本系统综述（systematic review, SR）汇总了与人类囊型包虫病相关的、具有统计学意义的潜在危险因素（potential risk factors, PRFs）的现有数据。 方法/主要结果：数据库检索共筛选出1367篇文献，其中37篇符合纳入标准。纳入的研究中，8项为病例对照研究，29项为横断面研究。符合纳入标准的文献中有21项被纳入荟萃分析（meta-analyses）。本研究采用合并比值比（pooled odds ratio, OR）作为效应量指标，并针对两种研究设计分别开展分析。 来自病例对照研究的、与感染风险升高显著相关的潜在危险因素包括：“犬自由活动”（合并OR=5.23；95%置信区间CI：2.45~11.14）、“用动物内脏饲喂犬只”（合并OR=4.69；95%CI：3.02~7.29）、“在家自行屠宰”（合并OR=4.67；95%CI：2.02~10.78）或“在屠宰场屠宰”（合并OR=2.7；95%CI：1.15~6.3）、“饲养犬只”（合并OR=3.54；95%CI：1.27~9.85）、“居住于农村地区”（合并OR=1.83；95%CI：1.16~2.9）以及“低收入水平”（合并OR=1.68；95%CI：1.02~2.76）。 来自横断面研究的、与感染风险升高具有统计学显著性的潜在危险因素包括：“年龄＞16岁”（合并OR=6.08；95%CI：4.05~9.13）、“居住于农村地区”（合并OR=2.26；95%CI：1.41~3.61）、“女性”（合并OR=1.38；95%CI：1.06~1.8）以及“饲养犬只”（合并OR=1.37；95%CI：1.01~1.86）。 结论/意义：居住于囊型包虫病流行区的农村地区、自由活动犬可接触动物内脏以及饲养犬只，似乎是感染该寄生虫病最显著的潜在危险因素之一。本研究的分析结果有助于加深我们对囊型包虫病潜在危险因素的认识，同时可为制定流行区囊型包虫病防控社区干预措施提供参考依据。