title: The burden of parasitic zoonoses in Nepal: a systematic review.
abstract: BACKGROUND
  Parasitic zoonoses (PZs) pose a significant but often neglected threat to public health, especially in developing countries. In order to obtain a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year (DALY). However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of under-recognition and under-funding.
  
  
  METHODS
  We examined the burden of PZs in Nepal through a systematic review of online and offline data sources. PZs were classified qualitatively according to endemicity, and where possible a quantitative burden assessment was conducted in terms of the annual number of incident cases, deaths and DALYs.
  
  
  RESULTS
  Between 2000 and 2012, the highest annual burden was imposed by neurocysticercosis and congenital toxoplasmosis (14,268 DALYs [95% Credibility Interval (CrI): 5450-27,694] and 9255 DALYs [95% CrI: 6135-13,292], respectively), followed by cystic echinococcosis (251 DALYs [95% CrI: 105-458]). Nepal is probably endemic for trichinellosis, toxocarosis, diphyllobothriosis, foodborne trematodosis, taeniosis, and zoonotic intestinal helminthic and protozoal infections, but insufficient data were available to quantify their health impact. Sporadic cases of alveolar echinococcosis, angiostrongylosis, capillariosis, dirofilariosis, gnathostomosis, sparganosis and cutaneous leishmaniosis may occur.
  
  
  CONCLUSIONS
  In settings with limited surveillance capacity, it is possible to quantify the health impact of PZs and other neglected diseases, thereby interrupting the vicious circle of neglect. In Nepal, we found that several PZs are endemic and are imposing a significant burden to public health, higher than that of malaria, and comparable to that of HIV/AIDS. However, several critical data gaps remain. Enhanced surveillance for the endemic PZs identified in this study would enable additional burden estimates, and a more complete picture of the impact of these diseases.
authors.affiliation: Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium ; Institute of Health and Society (IRSS), Faculty of Public Health, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Brecht
authors.initials: B
authors.lastname: Devleesschauwer
authors.affiliation: National Zoonoses and Food Hygiene Research Center, Kathmandu, Nepal.
authors.forename: Anita
authors.initials: A
authors.lastname: Ale
authors.affiliation: Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Torgerson
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Praet
authors.affiliation: Institute of Health and Society (IRSS), Faculty of Public Health, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Charline
authors.initials: C
authors.lastname: Maertens de Noordhout
authors.affiliation: Everest International Clinic and Research Center, Kathmandu, Nepal.
authors.forename: Basu Dev
authors.initials: BD
authors.lastname: Pandey
authors.affiliation: Clinical Research Unit, Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal.
authors.forename: Sher Bahadur
authors.initials: SB
authors.lastname: Pun
authors.affiliation: Institute of Environmental Science and Research, Christchurch, New Zealand.
authors.forename: Rob
authors.initials: R
authors.lastname: Lake
authors.affiliation: Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
authors.forename: Jozef
authors.initials: J
authors.lastname: Vercruysse
authors.affiliation: National Zoonoses and Food Hygiene Research Center, Kathmandu, Nepal.
authors.forename: Durga Datt
authors.initials: DD
authors.lastname: Joshi
authors.affiliation: Centre for Zoonoses and Environmental Microbiology, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands ; Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
authors.forename: Arie H
authors.initials: AH
authors.lastname: Havelaar
authors.affiliation: Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Duchateau
authors.affiliation: Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium ; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Dorny
authors.affiliation: Institute of Health and Society (IRSS), Faculty of Public Health, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Niko
authors.initials: N
authors.lastname: Speybroeck
mesh_terms: D000818:Animals; D019353:Endemic Diseases; D006801:Humans; D009390:Nepal / Q000453:epidemiology; D010272:Parasitic Diseases / Q000453:epidemiology*; D015995:Prevalence; D015047:Zoonoses / Q000453:epidemiology*