ABSTRACT

Understanding the interactions of ecosystems, humans and pathogens is important for disease risk estimation. This is particularly true for neglected and newly emerging diseases where modes and efficiencies of transmission leading to epidemics are not well understood. Using a model for other emerging diseases, the neglected tropical skin disease Buruli ulcer (BU), we systematically review the literature on transmission of the etiologic agent, Mycobacterium ulcerans (MU), within a One Health/EcoHealth framework and against Hill's nine criteria and Koch's postulates for making strong inference in disease systems. Using this strong inference approach, we advocate a null hypothesis for MU transmission and other understudied disease systems. The null should be tested against alternative vector or host roles in pathogen transmission to better inform disease management. We propose a re-evaluation of what is necessary to identify and confirm hosts, reservoirs and vectors associated with environmental pathogen replication, dispersal and transmission; critically review alternative environmental sources of MU that may be important for transmission, including invertebrate and vertebrate species, plants and biofilms on aquatic substrates; and conclude with placing BU within the context of other neglected and emerging infectious diseases with intricate ecological relationships that lead to disease in humans, wildlife and domestic animals.

中文翻译：

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理解疾病传播需要零模型：溃疡分枝杆菌（布鲁里溃疡病）的例子

摘要

了解生态系统、人类和病原体之间的相互作用对于疾病风险评估非常重要。对于被忽视的疾病和新出现的疾病尤其如此，这些疾病导致流行病的传播方式和效率尚不清楚。使用其他新发疾病，即被忽视的热带皮肤病布鲁里溃疡 (BU) 的模型，我们在 One Health/EcoHealth 框架内，根据 Hill 的九项标准，系统地回顾了有关病原体溃疡分枝杆菌 (MU) 传播的文献。科赫的假设可以对疾病系统做出强有力的推断。使用这种强推理方法，我们主张对 MU 传播和其他未充分研究的疾病系统进行零假设。应针对病原体传播中的替代载体或宿主作用来测试无效值，以便更好地为疾病管理提供信息。我们建议重新评估识别和确认与环境病原体复制、传播和传播相关的宿主、宿主和载体的必要性；严格审查可能对传播很重要的 MU 替代环境来源，包括无脊椎动物和脊椎动物物种、植物和水生基质上的生物膜；最后将 BU 置于其他被忽视和新出现的传染病的背景下，这些疾病具有复杂的生态关系，导致人类、野生动物和家畜患病。