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Zoonotic risk of Hansen's disease from community contact with wild armadillos: A systematic review and meta‐analysis
Author(s) -
Deps Patrícia,
Antunes João Marcelo Azevedo de Paula,
Collin Simon M.
Publication year - 2021
Publication title -
zoonoses and public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.87
H-Index - 65
eISSN - 1863-2378
pISSN - 1863-1959
DOI - 10.1111/zph.12783
Subject(s) - armadillo , odds ratio , meta analysis , demography , transmission (telecommunications) , medicine , scopus , veterinary medicine , confidence interval , environmental health , medline , geography , biology , ecology , biochemistry , sociology , electrical engineering , engineering
Understanding and quantifying the risk of Hansen's disease (HD) through zoonotic transmission of Mycobacterium leprae infection from wild armadillos is important because hunting, handling and consumption of these animals is widespread in communities where HD is endemic, posing a potential threat to the health of individuals and to HD elimination. We conducted a systematic review (PROSPERO CRD42019159891) of publications in MEDLINE, EMBASE, Global Health, Scopus, LILACS, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses e Dissertações de CAPES, and Biblioteca Virtual em Saúde up to 09/05/2020 using Mesh and text terms in English, Portuguese, Spanish and French. Random effects meta‐analyses were performed including of subgroups by endemicity and type of exposure. Seven of the nine included studies were case‐control, four from Brazil and three from the USA, comprising 1,124 cases and 2,023 controls in total. The other two studies, one from Brazil and one from Colombia, were cross‐sectional. The overall summary estimate (odds ratio, OR) for the relative odds of HD comparing people who had direct contact with armadillos and/or had eaten armadillo meat with those who had not was OR = 2.60 (95% CI 1.78–3.80, p < .001) with a predictive interval of OR = 1.10–6.17. Summary odds ratios for specific exposures were as follows: indirect contact, OR = 1.39 (95% CI 1.02, 1.89) ( p = .04); eating, OR = 2.29 (95% CI 1.13, 4.66) ( p = .02); hunting, OR = 2.54 (95% CI 1.21, 5.33) ( p = .01). Most of the included studies had moderate risk of bias. Crude estimates were reduced by up to 24% when adjusted for confounders (where reported). Direct contact with wild armadillos was strongly associated with an increased risk of HD, whilst evidence for an increased risk of HD from indirect contact was weaker. The fraction of HD in endemic countries attributable to zoonotic transmission from armadillos remains unknown, but the precautionary principle needs to be adopted to protect public health.