Control and prevention of emerging parasitic zoonoses

Emerging zoonoses have been defined as zoonoses that are newly recognised or newly evolved, or that have occurred previously but show an increase in incidence or expansion in geographical, host or vector range. Among parasitic zoonoses, protozoa are particularly likely to emerge. Control and prevention of emerging parasitic zoonoses are complex tasks that require an integrative and multidisciplinary approach. Reduction of parasite burden is certainly a major objective but cannot be set alone. Therefore, environmental and ecological modifications need to be implemented to reduce not only the parasitic load, but also the risk of parasite transmission. Finally, education and behavioral changes are critical for the success of both control and prevention of these diseases. However, without appropriate financial resources specifically allocated at the local and national levels as well as through international cooperation, control and prevention of these emerging parasitic diseases will not be possible.     

Fish-borne parasitic zoonoses: status and issues

The fish-borne parasitic zoonoses have been limited for the most part to populations living in low- and middle-income countries, but the geographical limits and populations at risk are expanding because of growing international markets, improved transportation systems, and demographic changes such as population movements. While many in developed countries will recognize meat-borne zoonoses such as trichinellosis and cysticercosis, far fewer are acquainted with the fish-borne parasitic zoonoses which are mostly helminthic diseases caused by trematodes, cestodes and nematodes. Yet these zoonoses are responsible for large numbers of human infections around the world. The list of potential fish-borne parasitic zoonoses is quite large. However, in this review, emphasis has been placed on liver fluke diseases such as clonorchiasis, opisthorchiasis and metorchiasis, as well as on intestinal trematodiasis (the heterophyids and echinostomes), anisakiasis (due to Anisakis simplex larvae), and diphyllobothriasis. The life cycles, distributions, epidemiology, clinical aspects, and, importantly, the research needed for improved risk assessments, clinical management and prevention and control of these important parasitic diseases are reviewed.     

The use of wildlife to monitor zoonoses

Wildlife are usually considered vectors, reservoirs or primary targets of infectious disease. A seldom considered epidemiological role which they can play involves their use as disease sentinels for the detection and monitoring of zoonoses. Their potential for such utilization has been demonstrated with the wild turkey (Meleagris gallopava intermedia) and St. Louis encephalitis in Texas and the white-tailed deer (Odocoileus virginianus) and California encephalitis in North America. The limitations and criteria which are important in the use of wild populations for "sentinel" duty are discussed.     

Population biology of emerging and re-emerging pathogens

Emerging and re-emerging pathogens present a huge challenge to human and veterinary medicine. Emergence is most commonly associated with ecological change, and specific risk factors are related to the type of pathogen, route of transmission and host range. The biological determinants of host range remain poorly understood but most pathogens can infect multiple hosts, and three-quarters of emerging human pathogens are zoonotic. Surveillance is a key defence against emerging pathogens but will often need to be integrated across human, domestic animal and wildlife populations.     

Coronaviruses: emerging and re-emerging pathogens in humans and animals

The severe acute respiratory syndrome coronavirus (SARS-CoV) and recently emerged Middle East respiratory syndrome coronavirus (MERS-CoV) epidemics have proven the ability of coronaviruses to cross species barrier and emerge rapidly in humans. Other coronaviruses such as porcine epidemic diarrhea virus (PEDV) are also known to cause major disease epidemics in animals wiith huge economic loss. This special issue in Virology Journal aims to highlight the advances and key discoveries in the animal origin, viral evolution, epidemiology, diagnostics and pathogenesis of the emerging and re-emerging coronaviruses in both humans and animals.     

Emerging parasite zoonoses: the role of host-parasite relationship

Human-parasite relationships have played an essential role in the emergence or re-emergence of some parasitic diseases. These interactions are due to numerous causes. Some are linked to humans (immunodeficiencies due to AIDS among other causes, treatments, nosocomial contaminations, genetic predisposition), others concern the parasite (particular genotypes having modified their parasitic specificity). Several of these causes were predominant in the emergence of parasitoses such as cryptosporidiasis, microsporidioses or, to a certain point, pneumocystosis, the transmission of which has become zoonotic or even anthroponotic, inter-human. Re-emergent diseases (toxoplasmosis, leishmaniasis, giardiasis, strongyloidiasis, scabies) had already been described in human pathology, but their frequency or symptomatology have been drastically modified. In this case also, the unbalanced host-parasite relationship is largely responsible but it can not be dissociated from other causes, especially environmental and nutritional.     

Human behaviour and the epidemiology of parasitic zoonoses

The behaviour of Homo sapiens has a pivotal role to play in the macro and microepidemiology of emerging or re-emerging parasitic zoonoses. Changing demographics and the concomitant alterations to the environment, climate, technology, land use and changes in human behavior, converge to favour the emergence and spread of parasitic zoonoses. The recent unprecedented movements of people, their animals and their parasites around the world, introduce and mix genes, cultural preferences, customs, and behavioral patterns. The increasing proclivity for eating meat, fish, crabs, shrimp, molluscs raw, undercooked, smoked, pickled or dried facilitates a number of protozoan (Toxoplasma), trematode (Fasciola sp., Paragonimus spp., Clonorchis sp., Opisthorchis spp., Heterophyes sp., Metagonimus sp., Echinostoma spp., Nanophyetus sp.) cestode (Taenia spp, Diphyllobothrum sp.) and nematode (Trichinella spp., Capillaria spp., Gnathostoma spp., Anisakis sp., Parastrongylus spp.) caused zoonoses. The increasing world population and the inability to keep pace with the provision of adequate sanitation and clean, safe drinking water, has led to an increased importance of waterborne zoonoses, such as those caused by Giardia, Cryptosporidium and Toxoplasma. Our close relationship with and the numerous uses to which we put companion animals and their ubiquitous distribution has resulted in dogs and cats unwitting participation in sharing over 60 parasite species including: Giardia, Cryptosporidium, Toxoplasma, most foodborne trematode species, Diphyllobothrum, Echinococcus spp., Ancylostoma and Toxocara. Changing human behaviour through education, to encourage the proper cooking of food, which may have cultural and social significance, will remain as challenging as controlling stray and feral pet populations, improving hygiene levels and the provision of safe drinking water and the proper use of sanctuary facilities. Long pre-patent periods and the normally insidious sub-clinical nature of most zoonoses makes advice requiring behavioural change for their control a difficult task. Our clearer understanding of the heterogeneity of susceptibility to infection, the complex genetic variations of people and parasite species and the development of molecular epidemiological tools is shedding more light on transmission routes and the spectrum of disease that is observed. Improved and new serological, molecular and imaging diagnostic tests and the development of broad spectrum chemotherapeutic agents has led to the attenuation of morbidity and mortality due to parasitic zoonoses in economically advantaged regions. Such advancements, in partnership with supportive behavioural change, has the potential for a sustainable global reduction in the burden of ill health due to parasitic zoonoses. Whether this will materialise is a challenge for us all.     

Enteric parasitic zoonoses of domesticated dogs and cats

Dogs and cats are important members of many families; however, they can harbour gastrointestinal parasites that may infect their owners. Some of these parasites, e.g. Echinococcus sp., can have a significant impact on human health. However, with appropriate education, management and anthelmintic regimes, zoonotic transmission of these parasites can be minimised.     

Food-borne parasitic zoonoses in China: perspective for control

Food-borne parasitic zoonoses (FBPZs) cause death and serious diseases in humans and animals worldwide, and are of both public health significance and socioeconomic importance. The FBPZ problem is severe in mainland China, where approximately 150 million people are suffering from FBPZs and more people are at risk. Here, the current status of the FBPZ problem in mainland China is reviewed and strategies and measures for effective control of FBPZs are proposed. Major parasitic zoonoses transmitted through consumption of infected or contaminated meat, fish, plants and/or water will be discussed.     

Parasite zoonoses and wildlife: One health,spillover and human activity

This review examines parasite zoonoses and wildlife in the context of the One Health triad that encompasses humans, domestic animals, wildlife and the changing ecosystems in which they live. Human (anthropogenic) activities influence the flow of all parasite infections within the One Health triad and the nature and impact of resulting spillover events are examined. Examples of spillover from wildlife to humans and/or domestic animals, and vice versa, are discussed, as well as emerging issues, particularly the need for parasite surveillance of wildlife populations. Emphasis is given to Trypanosoma cruzi and related species in Australian wildlife, Trichinella, Echinococcus, Giardia, Baylisascaris, Toxoplasma and Leishmania.     

Determinants of emerging and re-emerging infectious diseases.

In the 1960s and 1970s, many public health experts assumed that infectious diseases could at long last be conquered as had occurred with smallpox. In the last two decades, reports warned that infectious diseases were clearly not a problem of the past. They could not be considered as a unique or isolated event of wild and faraway regions, but penetrated every corner of the globe. Emerging infectious diseases have been recently described as clinically distinct conditions whose incidence in humans has increased regionally or worldwide within the past two decades. Emergence may be due to the introduction of new agents to or the recognition of an existing disease that has gone undetected, and re-emergence may describe the re-appearance of known diseases after a decline in incidence. In this article a global, multidisciplinary and integrated approach in different fields of demography, epidemiology, economy, ecology, anthropology and environment at science has been considered to describe the different determinants responsible for the emergence and re-emergence of infectious diseases.     

The leishmaniases as emerging and reemerging zoonoses

The 20 or so species of Leishmania which have been recorded as human infections are all either zoonotic, or have recent zoonotic origins. Their distribution is determined by that of their vector, their reservoir host, or both, so is dependent on precise environmental features. This concatenation of limiting factors leads to specific environmental requirements and focal distribution of zoonotic or anthroponotic sources. Human infection is dependent on the ecological relationship between human activity and reservoir systems. Examples are available of the emergence of leishmaniasis from the distant past to the present, and can be postulated for the future. These emergences have been provoked by the adoption of new, secondary reservoir hosts, the adoption of new vector species, transport of infection in humans or domestic animals, invasion by humans of zoonotic foci, and irruption of reservoir hosts beyond their normal range. The leishmaniases therefore present an excellent model for emerging disease in general, and for the generation of the principles governing emergence. The model is, however, limited by gaps in our knowledge, usually quantitative, sometimes qualitative, of the structure of reservoir systems.     

Detection and characterisation of parasites causing emerging zoonoses

Understanding the epidemiology of zoonotic parasitic infections is dependent upon the availability of accurate and sensitive diagnostic techniques. The development of molecular diagnostic methods, particularly those utilising PCR for the detection of zoonoses will contribute greatly to the identification and control of these pathogens, by increasing the speed of diagnosis, specificity and sensitivity, reproducibility and ease of interpretation. Molecular characterisation studies allow us to distinguish between closely related infectious agents and to document the patterns of transmission of 'strains' and species within populations. This will allow precise determinations to be made about the aetiological agent, its characteristics and the source of infection. This review focuses on recent detection and characterisation techniques for both emerging and re-emerging parasite zoonoses.     

Emerging parasite zoonoses associated with water and food

The environmental route of transmission is important for many protozoan and helminth parasites, with water, soil and food being particularly significant. Both the potential for producing large numbers of transmissive stages and their environmental robustness, being able to survive in moist microclimates for prolonged periods of time, pose a persistent threat to public and veterinary health. The increased demands on natural resources increase the likelihood of encountering environments and produce contaminated with parasites. For waterborne diseases, the protozoa, Cryptosporidium, Giardia and Toxoplasma, are the most significant causes, yet, with the exception of Toxoplasma, the contribution of zoonotic transmission remains unclear due to the absence of 'standardised' methods. The microsporidia have been documented in one waterborne outbreak, but the role of animals as the cause of contamination was not elucidated. In foods, surface contamination is associated with the faecal-oral pathogens, and some data are available to indicate that animal wastes remain an important source of contamination (e.g. cattle faeces and apple cider outbreaks), however, further work should focus on examining the source of contamination on fruit and vegetables. Increasing recognition of the burden of human fascioliasis has occurred; it is now recognised as an emerging zoonosis by the WHO. Toxoplasma, Trichinella and Taenia spp. remain important meatborne parasites, however, others, including Pleistophora-like microsporidians may be acquired from raw or lightly cooked fish or crustaceans. With increased international travel, the public health importance of the foodborne trematodiases must also be realised. Global sourcing of food, coupled with changing consumer vogues, including the consumption of raw vegetables and undercooking to retain the natural taste and preserve heat-labile nutrients, can increase the risk of foodborne transmission. A greater awareness of parasite contamination of our environment and its impact on health has precipitated the development of better detection methods. Robust, efficient detection, viability and typing methods are required to assess risks and to further epidemiological understanding.     

Molecular epidemiology: a multidisciplinary approach to understanding parasitic zoonoses

Sound application of molecular epidemiological principles requires working knowledge of both molecular biological and epidemiological methods. Molecular tools have become an increasingly important part of studying the epidemiology of infectious agents. Molecular tools have allowed the aetiological agent within a population to be diagnosed with a greater degree of efficiency and accuracy than conventional diagnostic tools. They have increased the understanding of the pathogenicity, virulence, and host-parasite relationships of the aetiological agent, provided information on the genetic structure and taxonomy of the parasite and allowed the zoonotic potential of previously unidentified agents to be determined. This review describes the concept of epidemiology and proper study design, describes the array of currently available molecular biological tools and provides examples of studies that have integrated both disciplines to successfully unravel zoonotic relationships that would otherwise be impossible utilising conventional diagnostic tools. The current limitations of applying these tools, including cautions that need to be addressed during their application are also discussed.     

Immunity and genetics: their relation to control of parasitic zoonoses.

Effective control of parasitic zoonoses will ultimately require a combination of several approaches, including hygiene/sanitation, pasture management, chemotherapy and immunoprophylaxis. Development of vaccines, and other approaches to improving protective immunity, require a detailed understanding of parasite immunogenicity and host immune responsiveness. It is increasingly recognized that there is considerable variation in both of these parameters, and that this variation is genetically determined. Recent studies in this area and the consequences for control are discussed.