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Detecting nested clusters of human alveolar echinococcosis

Published online by Cambridge University Press:  21 August 2013

ZEINABA SAID-ALI ,
FRÉDÉRIC GRENOUILLET ,
JENNY KNAPP ,
SOLANGE BRESSON-HADNI ,
DOMINIQUE ANGÈLE VUITTON ,
FRANCIS RAOUL ,
CARINE RICHOU ,
LAURENCE MILLON  and
PATRICK GIRAUDOUX
ZEINABA SAID-ALI
Affiliation:
Chrono-environment, University of Franche-Comté – CNRS, Besançon, France WHO-Collaborating Centre on Prevention and Treatment of Human Echinococcosis, Besançon, France
FRÉDÉRIC GRENOUILLET
Affiliation:
Chrono-environment, University of Franche-Comté – CNRS, Besançon, France WHO-Collaborating Centre on Prevention and Treatment of Human Echinococcosis, Besançon, France Centre National de Référence Echinococcose alvéolaire, Centre Hospitalier Régional Universitaire, Besançon, France
JENNY KNAPP
Affiliation:
Chrono-environment, University of Franche-Comté – CNRS, Besançon, France WHO-Collaborating Centre on Prevention and Treatment of Human Echinococcosis, Besançon, France Centre National de Référence Echinococcose alvéolaire, Centre Hospitalier Régional Universitaire, Besançon, France
SOLANGE BRESSON-HADNI
Affiliation:
Chrono-environment, University of Franche-Comté – CNRS, Besançon, France WHO-Collaborating Centre on Prevention and Treatment of Human Echinococcosis, Besançon, France Centre National de Référence Echinococcose alvéolaire, Centre Hospitalier Régional Universitaire, Besançon, France
DOMINIQUE ANGÈLE VUITTON
Affiliation:
WHO-Collaborating Centre on Prevention and Treatment of Human Echinococcosis, Besançon, France
FRANCIS RAOUL
Affiliation:
Chrono-environment, University of Franche-Comté – CNRS, Besançon, France WHO-Collaborating Centre on Prevention and Treatment of Human Echinococcosis, Besançon, France
CARINE RICHOU
Affiliation:
WHO-Collaborating Centre on Prevention and Treatment of Human Echinococcosis, Besançon, France Centre National de Référence Echinococcose alvéolaire, Centre Hospitalier Régional Universitaire, Besançon, France
LAURENCE MILLON
Affiliation:
Chrono-environment, University of Franche-Comté – CNRS, Besançon, France WHO-Collaborating Centre on Prevention and Treatment of Human Echinococcosis, Besançon, France
PATRICK GIRAUDOUX*
Affiliation:
Chrono-environment, University of Franche-Comté – CNRS, Besançon, France WHO-Collaborating Centre on Prevention and Treatment of Human Echinococcosis, Besançon, France Centre National de Référence Echinococcose alvéolaire, Centre Hospitalier Régional Universitaire, Besançon, France Institut Universitaire de France, Paris, France
*
*Corresponding author: Chrono-environment, University of Franche-Comté-CNRS, Place Leclerc, F-25030 Besançon, France. Tel: +33 381 665 745. Fax: +33 381 665 797. E-mail: patrick.giraudoux@univ-fcomte.fr
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Summary

Recent changes in the epidemiology of alveolar echinococcosis (AE) in Eurasia have led to increasing concerns about the risk of human AE and the need for a thorough evaluation of the epidemiological situation. The aim of this study was to explore the use of a National Register to detect complex distribution patterns on several scales. The data were human AE cases from the FrancEchino register, diagnosed in France from 1982 to 2011. We used the Kulldorff spatial scan analysis to detect non-random locations of cases. We proposed an exploratory method that was based on the successive detection of nested clusters inside each of the statistically significant larger clusters. This method revealed at least 4 levels of disease clusters during the study period. The spatial variations of cluster location over time were also shown. We conclude that National Human AE registers, although not exempted from epidemiological biases, are currently the best way to achieve an accurate representation of human AE distribution on various scales. Finally, we confirm the multi-scale clustered distribution of human AE, and we hypothesize that our study may be a reasonable starting point from which to conduct additional research and explore the processes that underlie such distributions.

Keywords

Echinococcus multilocularisnational registrynested clustersspatial scan analysisepidemiosurveillanceearly warning systems
Type
Research Article
Information
Parasitology , Volume 140 , Special Issue 13: Control of cestode zoonoses in Asia: role of basic and applied science , November 2013 , pp. 1693 - 1700
Copyright
Copyright © Cambridge University Press 2013 

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