BackgroundNorthern Vietnam is an endemic region for fish-borne zoonotic trematodes (FZT), including liver and intestinal flukes. Humans acquire the FZT infection by eating raw or inadequately cooked fish. The production of FZT-free fish in aquaculture is a key component in establishing a sustainable program to prevent and control the FZT transmission to humans. Interventions in aquaculture should be based on knowledge of the main risk factors associated with FZT transmission.Methodology/Principal FindingsA longitudinal study was carried out from June 2006 to May 2007 in Nam Dinh province, Red River Delta to investigate the development and risk factors of FZT infections in freshwater cultured fish. A total of 3820 fish were sampled six times at two-month intervals from 96 fish farms. Logistic analysis with repeated measurements was used to evaluate potential risk factors based on information collected through questionnaire interviews with 61 fish farm owners. The results showed that the FZT infections significantly increased from first sampling in June to July 2006 (65%) to sixth sampling in April to May, 2007 (76%). The liver fluke, Clonorchis sinensis and different zoonotic intestinal flukes including Haplochis pumilio, H. taichui, H. yokogawai, Centrocestus formosanus and Procerovum varium were found in sampled fish. Duration of fish cultured (sampling times), mebendazole drug self-medication of household members, presence of snails in the pond, and feeding fish with green vegetation collected outside fish farms all had a significant effect on the development of FZT prevalence in the fish.Conclusions/SignificanceThe FZT prevalence in fish increased by 11 percentage points during a one-year culture period and the risk factors for the development of infection were identified. Results also highlight that the young fish are already highly infected when stocked into the grow-out systems. This knowledge should be incorporated into control programs of FZT transmission in integrated small-scale aquaculture nursery and grow-out systems in Vietnam.
Raw fish consumption in restaurants, for example, Sashimi style, is popular worldwide. In Vietnam, raw fish dishes are also traditionally prepared and consumed in private households. However, the habits of eating raw or otherwise inadequately cooked fish can be associated with risks of acquiring fishborne zoonotic trematode (FZT) infection. The present study was done in a fish-farming community in Nam Dinh, Vietnam, to obtain information about habits of eating raw fish dishes and risks for human FZT infection. Discussions were held in different groups divided by gender and age on raw-fish-eating behavior. A total of 180 household members were interviewed and their stool samples analyzed to identify risk factors of FZT infection. There was awareness about the risk of liver fluke infections from eating raw fish. However, many older people accepted these risks and continued eating raw fish, as they know effective drug treatment is available. Raw fish dishes are consumed at social gatherings from shared plates and dipping sauces using the same chop sticks. This is likely to pose risks of crosscontamination with FZT metacercariae to different food items as indicated by the finding that 25.8% of household members that stated not to have eaten raw fish were infected. In total, 32.2% fish farm household members were infected with FZT. The odds of FZT infection was 2.3 times higher (p = 0.013) for those eating raw fish than for those who did not eat raw fish. Among the people eating raw fish, those eating raw fish in restaurants had 3.6 times higher odds of FZT infection (p = 0.009) than people eating raw fish at home. A successful program to control FZT must be based on in-depth knowledge on the social and anthropological determinants of people's raw-fish-eating behavior and hygiene practices as well as production of FZT-free fish for human consumption.
Nam Dinh province in Red River Delta, Vietnam, is an endemic area for the human liver fluke Clonorchis sinensis, but little is known about its occurrence in the fish intermediate host in this region. A cross-sectional study was carried out to identify fish-borne zoonotic trematodes (FZT) species diversity and to estimate the prevalence and infection densities of FZT in three major types of fish: cultured species and self-recruiting species from family ponds and wild-caught species from irrigation canals in Nam Dinh province. A total of 714 wild-caught fish from canals and 829 fish from family ponds were examined for FZT infection. Only a single fish from a pond was infected with Cl. sinensis. The intestinal fluke Haplorchis pumilio was very common and found in more than 50% of fish irrespective of origin. Four other intestinal FZT species were found at low prevalence (<4.0%) except Procerovum varium, which was found in 14.4% of wild-caught fish. There was no significant difference (p > 0.05) in FZT prevalence in cultured fish (64.3%) compared with wild-caught fish (68.9%), nor between cultured fish species (65.1%) and self-recruiting species obtained from ponds (58.1%). The prevalence of FZT in silver carp (Hypophthalmichthys molitrix) (82.7%), grass carp (Ctenopharyngodon idellus) (76.9%), and mrigal (Cirrhinus mrigala) (63.8%) was significantly higher than that in rohu (Labeo rohita) (49.1%) (p < 0.001). The density of FZT metacercariae in fish from canals (0.56 metacercariae/g) was significantly higher (p < 0.001) than that in fish from ponds (0.03 metacercariae/g). The frequent occurrence of intestinal flukes in all fish types indicates that wild-caught and cultured fish are equally at risk of infection with FZT, particularly in species commonly used in Nam Dinh to prepare raw fish dishes. These results underscore the need for greater awareness of the risk from raw fish dishes among public health agencies and consumers.
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