ZooTRIP. Zoonotic transmission of intestinal parasites: implications for control and elimination

Lead Research Organisation: University of Surrey
Department Name: Veterinary Medicine & Science

Abstract

Gut parasites, in particular parasitic worms, are extremely widespread in rural and poor urban areas of low and middle-income countries. Gut worms have chronic and often insidious effects on human health and child development including abdominal problems, anaemia, stunting and wasting. The spread of many gut worms involves a faecal-oral route: worm eggs are shed into the environment by human or animal defecation and individuals become infected through ingestion of these eggs, for example when children play in contaminated dirt. In other instances, infection occurs through ingestion of meat from infected animals. However, there is a poor understanding of the overall role played by animals in the spread of gut worms to humans. This information is very important in order to design effective and sustainable strategies for control of gut worms and ultimately to stop them infecting humans.

This project will take place in the Philippines where gut worm infections are widespread, particularly in rural communities. Backyard farming is extremely common, bringing people in close proximity to their livestock. In addition, the country has one of the highest rates of dog ownership in the world and there are many stray dogs and cats. Thus, there is likely significant transmission of gut worms from animals to people. The project will bring together a team of internationally respected researchers, with expertise in different disciplines, to assess the contribution of animals and environmental contamination to human gut worm infection in the Philippines. As a first step, a field study will be carried out in two distinct areas on the island of Mindanao to investigate gut worms circulating in humans, animals and the environment. For some gut worms it is difficult to determine whether they originated in animals or humans. Therefore DNA sequencing of gut worms collected in the Philippines will be carried out to identify genetic markers which can be used to distinguish between worms of human and animal origin and to detect their resistance to deworming drugs. This will allow genetic characterisation of gut worm samples collected during the field study. Mathematical models incorporating information from the field study and genetic data from the worm samples will then be developed to quantify the contribution of animals and environmental contamination to spread of gut worms to humans and predict the effects of different control strategies. Finally, an evaluation of the socio-economic and health impacts of gut worm infections in the Philippines will be conducted together with development of a set of recommendations for policy makers.

By embracing a One Health approach this project will shed new light on the epidemiology of gut worms in humans and animals in the Philippines and quantify the contribution of animals to human infection. Project findings will enable development of novel control strategies, leading to increased effectiveness and sustainability of gut worm control in the Philippines and worldwide, and ultimately to improvements in health in endemic areas. The assessment of socio-economic impacts of intestinal helminths in humans and animals will provide crucial evidence for policy-makers and funders.

Technical Summary

This interdisciplinary project will assess the contribution of zoonotic transmission and environmental reservoirs to the burden of human intestinal helminth infection in the Philippines, and determine the most effective strategies for intestinal helminth control and elimination. Objective 1 will investigate the epidemiology of intestinal helminths circulating in humans, animals and the environment through a cross-sectional community-based field study, involving parasitological and molecular diagnosis of intestinal helminths in participants and their animals, detection of helminth eggs in soil and crop samples and a questionnaire to gather demographic, socio-economic and environmental data. Objective 2 will use genome sequencing to characterise Filipino helminth isolates, identify markers for molecular epidemiology and establish a multi-locus sequence typing scheme. Genotyping assays will be used to detect zoonotic transmission and anthelmintic resistance markers in samples collected during the field survey. Objective 3 will develop mathematical models to quantify the contribution of zoonotic transmission and environmental reservoirs to human infection risk and predict the effects of intervention strategies. Epidemiological and genetic data gathered under Objectives 1 and 2 will be used for model parameterisation. Objective 4 will formulate policy recommendations based on model outcomes and an evaluation of the socio-economic and health impacts of intestinal helminth infections in the Philippines. This will involve quantitative risks assessment, impact quantification and economic valuation of impacts. Overall the project will shed new light on the epidemiology of intestinal helminths in the Philippines and quantify the contribution of zoonotic transmission to human infection. Project findings will lead to increased effectiveness and sustainability of intestinal helminth control in the Philippines and worldwide, and ultimately to health improvements in endemic areas.

Planned Impact

There will be a number of beneficiaries of this project:

Staff working on the project:
Project staff will have the opportunity to develop a range of scientific skills including epidemiological surveys, parasitological diagnosis, molecular diagnostics, genomics, bioinformatics, mathematical modelling, economic analysis. There will be significant strengthening of capacity in molecular biology at the Institute of Biological Sciences through establishment of a dedicated laboratory and provision of training in molecular biology and bioinformatics. In addition, staff will gain experience in logistics, project management, writing research publications and presenting research findings. There will be opportunities for student exchange between Philippines and the UK, and undergraduate and graduate students in the UK and Philippines will have their research projects affiliated with the project thereby introducing them first-hand to studies aimed at improving the welfare of humans and animals.

Public health officers and local health units:
During the course of the project, training and capacity development in control of intestinal helminths will be provided for public health officers and local health units. This will ultimately lead to improved control of intestinal helminths at a local level.

World Health Organization (WHO) and the Department of Health (DOH), Republic of the Philippines:
Through highlighting and recording the potential for zoonotic transmission and forecasting effective and cost-efficient management strategies, our findings will inform WHO and the DOH in development of national policies on control of intestinal helminths in the Philippines and, over the longer-term, in other countries. Possible changes to treatment and control policy could include improved hygiene and sanitation, improvements in livestock management practices and deworming of livestock and companion animals in endemic communities. This could ultimately lead to a reduction in the impact of intestinal helminthiasis worldwide.

People and animals in intestinal helminth-endemic communities in the Philippines/worldwide:
Study participants (humans and animals) will be examined for intestinal helminth infections and referred for treatment where appropriate. Information, engagement and feedback meetings will be held in the study communities to communicate the nature and purpose of the project, ongoing progress and research findings and to receive input and feedback from the communities. This will increase awareness of intestinal helminths, and provide a better road-to-health for such activated communities. Information, Education and Communication (IEC) materials will be developed based on feedback from local communities. More effective control of intestinal helminths will bring longer term benefits to their own future health and socio-economic status and that of others living in endemic communities.

ODA COMPLIANCE
Intestinal helminths are classified as neglected tropical diseases (NTDs), described as "poverty-promoting" due to their significant impacts on health, child development and agricultural productivity. Thus control of NTDs can improve economic development and welfare in endemic areas. In the Philippines >30 million children are infected with intestinal helminths. Through advances in understanding of intestinal parasite transmission dynamics and infection reservoirs and their socio-economic impacts, this project will provide a crucial evidence base for implementation of effective and sustainable parasite control. This will lead to improvements in human health and socio-economic development, particularly in poor and marginalized communities. At least half of the project will take place in the Philippines led by Filipino researchers. The project will involve a significant capacity-building component including training in cutting-edge laboratory and computational techniques.
 
Description An early impact of the award is raised awareness of intestinal helminths among health workers, local government units and communities in the Philippines where field work is being conducted. This addresses Sustainable Development Goal 3 "Good health and well-being". Gender equality Study participants are recruited on a household basis, with households in study communities selected at random and all household members between 10 and 60 years of age invited to take part in the study. This provides the opportunity for people of different genders to participate in the study, which is borne out by the gender balance in study participants to date.
First Year Of Impact 2019
Sector Healthcare
Impact Types Societal

 
Description UKRI COVID-19 Grant Extension Allocation (CoA)
Amount £57,768 (GBP)
Organisation United Kingdom Research and Innovation 
Sector Public
Country United Kingdom
Start 02/2021 
End 09/2021
 
Title ZooTRIP dataset 
Description A dataset including information on intestinal helminths circulating in humans, animals and the environment in the Philippines with associated socio-economic, knowledge, attitudes and practice data. 
Type Of Material Database/Collection of data 
Year Produced 2020 
Provided To Others? No  
Impact Dataset is currently being analysed so there are no impacts yet. The dataset is being used by researchers in the Philippines and the UK and the impacts will be relevant to populations in the Philippines and elsewhere in southeast Asia. 
 
Description ZooTRIP collaboration 
Organisation University of Philippines Manila
Country Philippines 
Sector Academic/University 
PI Contribution Study design. Development and optimisation of research protocols. Development of training material including video tutorials. Epidemiological analysis and mathematical modelling. Molecular diagnosis, parasite genotyping and parasite genomics.
Collaborator Contribution Study design. Fieldwork - sample and data collection. Epidemiological analysis. Molecular diagnosis & parasite genotyping.
Impact ZooTRIP. Zoonotic transmission of intestinal parasites: Implications for control and elimination - poster at BSP Autumn Symposium. ZooTRIP team members from UK and Philippines contributed to work included in poster and are included as authors. Talk at Pint of Science Guildford. Based on collaborative work carried out in the ZooTRIP project. ZooTRIP dataset. Data collected in the Philippines by members of the ZooTRIP research team in the Philippines. The results of the analysis will be of benefit to the Philippines and other countries in southeast Asia. Presentation at ASTMH Annual Meeting 2019. Dr Paller from University of Philippines Los Banos (PI of ZooTRIP in Philippines) was invited to present to present at this high profile international conference. Invitation to Dr Betson present at EMOP2021 (delayed from 2020 due to COVID-19). Review article/book chapter: Advances in Parasitology: "Zoonotic transmission of intestinal helminths in southeast Asia: Implications for control and elimination". ZooTRIP team members from UK and Philippines contributed to this review and are included as authors. The review is relevant to the Philippines and to other countries in southeast Asia. Four presentations at JITMM (Joint International Tropical Medicine Meeting) Virtual 2020 by researchers from UPLB and UPM. Collaboration is multidisciplinary. Disciplines involved: Parasitology including molecular diagnostics Medicine Veterinary Medicine Epidemiology and mathematical modelling Genomics Economics and social science
Start Year 2018
 
Description ZooTRIP collaboration 
Organisation University of the Philippines Los Baños
Country Philippines 
Sector Academic/University 
PI Contribution Study design. Development and optimisation of research protocols. Development of training material including video tutorials. Epidemiological analysis and mathematical modelling. Molecular diagnosis, parasite genotyping and parasite genomics.
Collaborator Contribution Study design. Fieldwork - sample and data collection. Epidemiological analysis. Molecular diagnosis & parasite genotyping.
Impact ZooTRIP. Zoonotic transmission of intestinal parasites: Implications for control and elimination - poster at BSP Autumn Symposium. ZooTRIP team members from UK and Philippines contributed to work included in poster and are included as authors. Talk at Pint of Science Guildford. Based on collaborative work carried out in the ZooTRIP project. ZooTRIP dataset. Data collected in the Philippines by members of the ZooTRIP research team in the Philippines. The results of the analysis will be of benefit to the Philippines and other countries in southeast Asia. Presentation at ASTMH Annual Meeting 2019. Dr Paller from University of Philippines Los Banos (PI of ZooTRIP in Philippines) was invited to present to present at this high profile international conference. Invitation to Dr Betson present at EMOP2021 (delayed from 2020 due to COVID-19). Review article/book chapter: Advances in Parasitology: "Zoonotic transmission of intestinal helminths in southeast Asia: Implications for control and elimination". ZooTRIP team members from UK and Philippines contributed to this review and are included as authors. The review is relevant to the Philippines and to other countries in southeast Asia. Four presentations at JITMM (Joint International Tropical Medicine Meeting) Virtual 2020 by researchers from UPLB and UPM. Collaboration is multidisciplinary. Disciplines involved: Parasitology including molecular diagnostics Medicine Veterinary Medicine Epidemiology and mathematical modelling Genomics Economics and social science
Start Year 2018
 
Description Diagnosis of helminth parasites from companion and livestock animals for non-veterinarians, UPLB, Laguna, Philippines 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact The aim of this workshop was to provide training in diagnosis of helminth parasites in companion animals and livestock for graduate students and researchers at UPLB and other state universities in the Philippines.
Year(s) Of Engagement Activity 2019
 
Description Diagnosis, Prevention, and Control of STH, Schistosomisis, Foodborne helminthiasis, and other intestinal parasitic infections, Region 13, Philippines 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact The purpose of the workshop was to provide training for DOH-Region 13 Medical Technologists and Barangay (Village) Healthworkers in diagnosis, prevention and control of helminth infections.
Year(s) Of Engagement Activity 2019
 
Description Pint of Science Guildford 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact The Pint of Science is a global event which takes place in May each year and provide an opportunity for researchers at local universities to share their research with the general public through evening talks in pubs and cafes. Martha Betson presented at the Pint of Science event in Guildford together with colleagues from the School of Veterinary Medicine, University of Surrey and included an introduction to intestinal worms and the ZooTRIP project in her presentation.
Year(s) Of Engagement Activity 2019
URL https://pintofscience.co.uk/
 
Description Socio-economic analysis for epidemiological studies, UPLB, Laguna, Philippines 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact The aim of this workshop was to provide training for graduate students and researchers from UPLB and other state universities in the Philippines on socio-economic analysis for epidemiological studies.
Year(s) Of Engagement Activity 2020
 
Description Training-workshop on Quantitative and Spatial Parasitology: Applications in Epidemiology and Ecology, UPLB, Laguna, Philippines 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact Training workshop for graduate students in the Philippines on application of quantitative and spatial epidemiology approaches to parasitology.
Year(s) Of Engagement Activity 2019
 
Description ZOOTRIP Pre-coordination meeting and workshop, Region 12, Philippines 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact This workshop involved representatives from the Dept of Health (DOH) Region 12, Dept of Education R12, Bureau of Animal Industry, Dept of Agriculture, Local Government Units (LGU), Local NTD coordinators and Xavier University. The aim of the workshop was to provide information about the ZooTRIP project and coordinate relevant stakeholders for fieldwork. Unfortunately due to the COVID pandemic, planned fieldwork did not take place.
Year(s) Of Engagement Activity 2019
 
Description ZooTRIP Pre-Coordination Meeting and Workshop, Region 13, Philippines 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact This meeting included representatives from the Dept of Health (DOH) Region 13, Dept of Education -R13, Bureau of Animal Industry, Dept of Agriculture, Local Government units (LGU), Local NTD coordinators, Caraga Sate University. The aim of the meeting was to provide information about the ZooTRIP project and to coordinate all relevant stakeholders for implementation of fieldwork in Region 13, Philippines.
Year(s) Of Engagement Activity 2019
 
Description ZooTRIP Symposium, UPLB, Laguna, Philippines 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Purpose was to introduce the ZooTRIP project to relevant stakeholders and practitioners including eterinarians, academics, students, State universities, public health officials, researchers within the Philippines.
Year(s) Of Engagement Activity 2019