{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:40:46Z","timestamp":1790617246210,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009909","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000}}],"reference-count":103,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T00:00:00Z","timestamp":1635811200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"BECAL Paraguay https:\/\/www.becal.gov.py\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Underestimation of zoonoses is exacerbated in low and middle-income countries due mainly to inequalities with serious consequences in healthcare. This is difficult to gauge and reduce the impact of those diseases. Our study focuses on Paraguay, where the livestock industry is one of the major components of the country\u2019s economy. Therefore, the rationale of this study was to develop a case study in Paraguay to estimate the dual impact of zoonotic diseases on both the human health and animal health sector and thus determine the societal burden of such diseases.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principal findings<\/jats:title>\n<jats:p>We conducted a systemic review (including a meta-analysis) to assess the burden of zoonoses in Paraguay, including official reports and grey literature of disease incidence and prevalence. We estimated the Disability Adjusted Life Years (DALYs) and Zoonosis Disability Adjusted Life Years (zDALYs) to measure the difference between the current health status and the desired health situation of animals and the Paraguayan population based on 50 zoonotic diseases suggested by the WHO (World Health Organization), OIE (World Organization for Animal Health) and the National Health in Paraguay. The total DALYs represent 19,384 (95% CI: from 15,805 to 29,733), and zDALYs, 62,178 (95% CI: from 48,696 to 77,188). According to the results, the priority pathogens for DALYs are <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic>, <jats:italic>Trypanosoma cruzi<\/jats:italic>, <jats:italic>Leishmania spp<\/jats:italic>, and <jats:italic>Toxoplasma gondii<\/jats:italic>. When we include the additional animal health burden, the most important pathogens are <jats:italic>Brucella spp<\/jats:italic>, <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic>, <jats:italic>Trypanosoma cruzi<\/jats:italic>, and <jats:italic>Fasciola hepatica<\/jats:italic> for zDALYs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusion\/Significance<\/jats:title>\n<jats:p>This is the first study to integrate DALYs and zDALYs with important clues related to the health status of Paraguay. Through DALYs and zDALYs, our perspective becomes more complete because we consider not only human health but also animal health. This is important for setting priorities in disease control, especially in a society where livestock contribute significantly to the economy and to human well-being.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0009909","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T19:32:03Z","timestamp":1635881523000},"page":"e0009909","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["The burden of zoonoses in Paraguay: A systematic review"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5057-8458","authenticated-orcid":true,"given":"Liz Paola","family":"Noguera Zayas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6732-3870","authenticated-orcid":true,"given":"Simon","family":"R\u00fcegg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4277-9983","authenticated-orcid":true,"given":"Paul","family":"Torgerson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,11,2]]},"reference":[{"key":"pntd.0009909.ref001","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1098\/rstb.2001.0888","article-title":"Risk factors for human disease emergence.","volume":"356","author":"LH Taylor","year":"2001","journal-title":"Philos Trans R Soc B Biol Sci"},{"key":"pntd.0009909.ref002","first-page":"238","article-title":"Impact of anthropogenic environmental alterations on vector-borne diseases.","author":"N. 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Available: http:\/\/ghdx.healthdata.org\/"},{"key":"pntd.0009909.ref007","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.onehlt.2017.11.003","article-title":"zDALY: An adjusted indicator to estimate the burden of zoonotic diseases.","volume":"5","author":"PR Torgerson","year":"2018","journal-title":"One Heal"},{"key":"pntd.0009909.ref008","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.","author":"D Moher","year":"2009","journal-title":"PLoS Medicine."},{"key":"pntd.0009909.ref009","unstructured":"Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement | The EQUATOR Network. [cited 28 Jun 2020]. 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Available: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0140673617321529"},{"key":"pntd.0009909.ref016","unstructured":"Global Burden of Disease (GBD) | Institute for Health Metrics and Evaluation. [cited 14 Aug 2020]. Available: http:\/\/www.healthdata.org\/gbd"},{"key":"pntd.0009909.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0142498","article-title":"Methodological framework for World Health Organization estimates of the global burden of foodborne disease.","volume":"10","author":"B Devleesschauwer","year":"2015","journal-title":"PLoS One."},{"key":"pntd.0009909.ref018","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1093\/ije\/dyr152","article-title":"Epidemiological methods in diarrhoea studies-An update.","volume":"40","author":"WP Schmidt","year":"2011","journal-title":"Int J Epidemiol"},{"key":"pntd.0009909.ref019","unstructured":"UN-Water GLAAS 2017: Financing universal water, sanitation and hygiene under the Sustainable Development Goals | UN-Water. [cited 18 Aug 2020]. 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Available: https:\/\/www.paho.org\/par\/index.php?option=com_content&view=article&id=2062:paraguay-recibio-la-certificacion-pais-libre-de-la-transmision-vectorial-domiciliaria-de-chagas&Itemid=258"},{"key":"pntd.0009909.ref026","unstructured":"Institutos y Programas\u2014Ministerio de Salud P\u00fablica y Bienestar Social. [cited 3 Aug 2020]. Available: https:\/\/www.mspbs.gov.py\/institutos-programas.html"},{"key":"pntd.0009909.ref027","unstructured":"Tasa de alfabetizaci\u00f3n, total de adultos (% de personas de 15 a\u00f1os o m\u00e1s) | Data. [cited 1 Jul 2020]. Available: https:\/\/datos.bancomundial.org\/indicador\/SE.ADT.LITR.ZS?name_desc=false"},{"key":"pntd.0009909.ref028","unstructured":"Arbo L de, C\u00e9spedes L, Paraguay PM-\u2026 del, 2019 U. Conocimiento, pr\u00e1cticas de prevenci\u00f3n y bioseguridad sobre Brucelosis en trabajadores de hatos lecheros de Caaguaz\u00fa-Paraguay. revistas.ins.gov.py. 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Available: http:\/\/scielo.iics.una.py\/scielo.php?pid=S2312-38932019000100146&script=sci_arttext"},{"key":"pntd.0009909.ref036","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/CRD.0b013e31823efde2","article-title":"Chagas heart disease: Report on recent developments.","author":"FS MacHado","year":"2012","journal-title":"Cardiology in Review"},{"key":"pntd.0009909.ref037","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ijcard.2016.12.169","article-title":"Manifestations of Lyme carditis.","author":"T Kosti\u0107","year":"2017","journal-title":"International Journal of Cardiology."},{"key":"pntd.0009909.ref038","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.rvsc.2019.01.022","article-title":"Current status and management of canine leishmaniasis in Latin America","author":"M Marcondes","year":"2019","journal-title":"Research in Veterinary Science"},{"key":"pntd.0009909.ref039","unstructured":"Fraenkel S, Tintel M, Salvioni O, Centuri\u00f3n N, Arze P. Avalia\u00e7\u00e3o da efic\u00e1cia do diagnotico sorol\u00f3gico por ELISA para leishmaniose em c\u00e3es do Paraguai. adaltech.com.br. [cited 3 Oct 2019]. Available: http:\/\/www.adaltech.com.br\/anais\/medtrop2018\/resumos\/PDF-eposter-trab-aceito-2595-1.pdf"},{"key":"pntd.0009909.ref040","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1136\/bmj.38917.503056.7C","article-title":"A meta-analysis of the diagnostic performance of the direct agglutination test and rK39 dipstick for visceral leishmaniasis","volume":"333","author":"F Chappuis","year":"2006","journal-title":"Br Med J"},{"key":"pntd.0009909.ref041","unstructured":"GBD Results Tool | GHDx. [cited 28 Jun 2020]. Available: http:\/\/ghdx.healthdata.org\/gbd-results-tool"},{"key":"pntd.0009909.ref042","first-page":"205","article-title":"Seroprevalencia de la infecci\u00f3n por Trypanosoma cruzi en Canis familiaris del estado Sucre, Venezuela.","volume":"33","author":"C Rubio","year":"2013","journal-title":"Biom\u00e9dica"},{"key":"pntd.0009909.ref043","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1590\/0037-8682-0088-2017","article-title":"Natural infection by trypanosoma cruzi in triatomines and seropositivity for chagas disease of dogs in rural areas of Rio Grande do Norte, Brazil.","volume":"51","author":"YBN Freitas","year":"2018","journal-title":"Rev Soc Bras Med Trop"},{"key":"pntd.0009909.ref044","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1186\/s40249-017-0333-z","article-title":"Seropositivity for Trypanosoma cruzi in domestic dogs from Sonora, Mexico.","volume":"6","author":"M Arce-Fonseca","year":"2017","journal-title":"Infect Dis Poverty"},{"key":"pntd.0009909.ref045","doi-asserted-by":"crossref","first-page":"235","DOI":"10.4269\/ajtmh.2003.68.235","article-title":"Association and epidemiologic features of Trypanosoma cruzi and human T cell lymphotropic a virus type II in inhabitants of the Paraguayan Gran Chaco","volume":"68","author":"JF Ferrer","year":"2003","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0009909.ref046","first-page":"216","article-title":"Prevalence of Trypanosoma cruzi infection in dogs and small mammals in Nuevo Le\u00f3n, Mexico.","volume":"49","author":"L Galaviz-Silva","year":"2017","journal-title":"Rev Argent Microbiol"},{"key":"pntd.0009909.ref047","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1186\/s13071-015-1100-2","article-title":"Eco-epidemiological study of an endemic Chagas disease region in northern Colombia reveals the importance of Triatoma maculata (Hemiptera: Reduviidae), dogs and Didelphis marsupialis in Trypanosoma cruzi maintenance.","volume":"8","author":"O Cantillo-Barraza","year":"2015","journal-title":"Parasites and Vectors"},{"key":"pntd.0009909.ref048","doi-asserted-by":"crossref","first-page":"66","DOI":"10.5216\/rpt.v45i1.40274","article-title":"PRESENCIA DE INFECCI\u00d3N POR Trypanosoma cruzi Y Toxoplasma gondii EN PERROS DOM\u00c9STICOS DE LOCALIDADES RURALES EN EL NOROESTE ARGENTINO.","volume":"45","author":"J Alejandro Binda","year":"2016","journal-title":"Rev Patol Trop."},{"key":"pntd.0009909.ref049","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S1473-3099(18)30362-1","article-title":"Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016","volume":"18","author":"C Troeger","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"pntd.0009909.ref050","unstructured":"Orrego M, Huber C, Ortiz F, Paraguay M\u00c1-\u2026 publica del, 2019 undefined. Prevalencia de pat\u00f3genos causantes de enfermedad diarreica aguda en el \u00e1rea Metropolitana de Asunci\u00f3n y Central. revistas.ins.gov.py. [cited 6 Apr 2020]. Available: http:\/\/revistas.ins.gov.py\/index.php\/rspp\/article\/download\/542\/448"},{"key":"pntd.0009909.ref051","doi-asserted-by":"crossref","first-page":"649","DOI":"10.4067\/S0716-10182015000700006","article-title":"Enteroparasitosis en ni\u00f1os bajo 5 a\u00f1os de edad, ind\u00edgenas y no ind\u00edgenas, de comunidades rurales del Paraguay.","volume":"32","author":"G Echag\u00fce","year":"2015","journal-title":"Rev Chil infectolog\u00eda."},{"key":"pntd.0009909.ref052","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1016\/S0140-6736(18)32335-3","article-title":"Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017.","volume":"392","author":"HH Kyu","year":"2018","journal-title":"Lancet"},{"key":"pntd.0009909.ref053","unstructured":"Chena L, Nara E, AC-del I, 2016 undefined. Coinfecci\u00f3n Leishmania infantum, VIH e Histoplasma capsulatum: manifestaciones dermatol\u00f3gicas. revistascientificas.una.py. [cited 21 Oct 2019]. Available: http:\/\/revistascientificas.una.py\/index.php\/RIIC\/article\/view\/1115"},{"key":"pntd.0009909.ref054","first-page":"1","article-title":"Epidemiolog\u00eda de VIH\/SIDA en el Hospital Nacional de Itaugu\u00e1.","author":"R Leguizam\u00f3n","year":"2012","journal-title":"Paraguay Epidemiology of HIV\/AIDS at the National Hospital Itaugu\u00e1. Paraguay"},{"key":"pntd.0009909.ref055","first-page":"32","article-title":"Patolog\u00edas asociadas en pacientes con VIH TT\u2014Associated pathologies in HIV patients.","volume":"5","author":"L. Vera","year":"2013","journal-title":"Rev Nac"},{"key":"pntd.0009909.ref056","unstructured":"\u2026 KY-L-\u2026 de SM, 2019 undefined. Cobertura de vacunaci\u00f3n de BCG en Sudam\u00e9rica, 2010\u20132017: Distribuci\u00f3n geogr\u00e1fica y su v\u00ednculo con la incidencia y mortalidad de tuberculosis. ojs.revistamaternofetal.com. [cited 3 Apr 2020]. Available: http:\/\/ojs.revistamaternofetal.com\/index.php\/RISMF\/article\/view\/156"},{"key":"pntd.0009909.ref057","doi-asserted-by":"crossref","first-page":"34","DOI":"10.18004\/rspp.2018.diciembre.34-39","article-title":"Intensified surveillance of public health events in communities displaced by floods in Paraguay, 2015\u20132016.","volume":"8","author":"ME Pedrozo","year":"2018","journal-title":"Rev salud publica del Paraguay."},{"key":"pntd.0009909.ref058","doi-asserted-by":"crossref","first-page":"39","DOI":"10.18004\/ped.2016.abril.39-44","article-title":"Skin Diseases in children living in shelters in flooded areas.","volume":"43","author":"T Moreno","year":"2016","journal-title":"Pediatr\u00eda (Asunci\u00f3n)."},{"key":"pntd.0009909.ref059","unstructured":"Cabello A, Cabral M, MS-del I, 2010 undefined. Dengue y leptospirosis compartiendo el mismo nicho ecol\u00f3gico en la localidad ribere\u00f1a de Carmen del Paran\u00e1 (Itap\u00faa). revistascientificas.una.py. [cited 20 Sep 2019]. Available: http:\/\/revistascientificas.una.py\/index.php\/RIIC\/article\/view\/244"},{"key":"pntd.0009909.ref060","doi-asserted-by":"crossref","first-page":"274","DOI":"10.4269\/ajtmh.1997.57.274","article-title":"An outbreak of hantavirus pulmonary syndrome in western Paraguay","volume":"57","author":"RJ Williams","year":"1997","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0009909.ref061","unstructured":"PAHO W. Hantavirus. [cited 13 Jul 2020]. Available: https:\/\/www.paho.org\/English\/GOV\/CE\/doc287.pdf"},{"key":"pntd.0009909.ref062","doi-asserted-by":"crossref","unstructured":"Chu Y, Owen R, LG-TA journal of, 2003 undefined. The complex ecology of hantavirus in Paraguay. ASTMH. [cited 25 Sep 2019]. Available: https:\/\/www.ajtmh.org\/content\/journals\/10.4269\/ajtmh.2003.69.263","DOI":"10.4269\/ajtmh.2003.69.263"},{"key":"pntd.0009909.ref063","first-page":"14","article-title":"Estudio de la infecci\u00f3n natural por Fasciola hepatica en Lymnaea spp. en el distrito de Yabebyry, departamento de Misiones-Paraguay.","volume":"04","author":"T Gimenez","year":"2014","journal-title":"Compend ciencias Vet."},{"key":"pntd.0009909.ref064","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1111\/j.1466-822X.2006.00244.x","article-title":"Land cover associated with hantavirus presence in Paraguay.","volume":"15","author":"DG Goodin","year":"2006","journal-title":"Glob Ecol Biogeogr"},{"key":"pntd.0009909.ref065","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ttbdis.2013.08.004","article-title":"Rickettsial infections in ticks from wild birds in Paraguay.","volume":"5","author":"M Ogrzewalska","year":"2014","journal-title":"Ticks Tick Borne Dis"},{"key":"pntd.0009909.ref066","doi-asserted-by":"crossref","first-page":"e0201307","DOI":"10.1371\/journal.pone.0201307","article-title":"Habitat, species richness and hantaviruses of sigmodontine rodents within the Interior Atlantic Forest, Paraguay.","volume":"13","author":"G Eastwood","year":"2018","journal-title":"PLoS One"},{"key":"pntd.0009909.ref067","doi-asserted-by":"crossref","first-page":"721","DOI":"10.15560\/14.5.721","article-title":"New and noteworthy records of rodents (Mammalia, Rodentia, Cricetidae and Echimyidae) from Paraguay.","volume":"14","author":"RD Owen","year":"2018","journal-title":"Check List."},{"key":"pntd.0009909.ref068","first-page":"35","article-title":"Esporotricosis trasmitida por gato dom\u00e9stico. Reporte de un caso familiar.","volume":"9","author":"GC Samudio Dom\u00ednguez","year":"2017","journal-title":"Rev Nac."},{"key":"pntd.0009909.ref069","first-page":"34","article-title":"Meningitis criptoc\u00f3ccica: Cryptococcal meningitis","volume":"5","author":"A. 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Estudio de Fiebre Amarilla en primates en \u00e1reas de brote de los departamentos de San Pedro y Central del Paraguay Study of Yellow Fever in primates in. researchgate.net. [cited 9 Oct 2019]. Available: https:\/\/www.researchgate.net\/profile\/Gloria_Echaguee_De_Mendez\/publication\/277030533_Study_of_Yellow_Fever_in_primates_in_outbreaks_areas_of_the_departments_of_San_Pedro_and_Central_in_Paraguay\/links\/560bd72d08ae6de32e9b25eb.pdf"},{"key":"pntd.0009909.ref087","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s13071-020-3966-x","article-title":"Yellow fever epizootics in non-human primates, Southeast and Northeast Brazil (2017 and 2018).","volume":"13","author":"Horta MA Mares-Guia MAMDM","year":"2020","journal-title":"Parasites and Vectors."},{"key":"pntd.0009909.ref088","unstructured":"Epidemiological Update Yellow Fever Situation summary in the Americas. 2019. 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