Do hotspots fuel malaria transmission: a village-scale spatio-temporal analysis of a 2-year cohort study in The Gambia
Do hotspots fuel malaria transmission: a village-scale spatio-temporal analysis of a 2-year cohort study in The Gambia
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DOI：
10.1186/s12916-018-1141-4
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发表时间：
2018-09-14
期刊：
影响因子：
9.3
通讯作者：
D'Alessandro, Umberto
中科院分区：
文献类型：
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作者：
Stresman, Gillian H.;Mwesigwa, Julia;D'Alessandro, Umberto
背景：尽管热点地区助长疟疾传播在生物学上是合理的，但支持这一概念的证据却很复杂。如果传播以一致的方式从高负担家庭传播到低负担家庭，那么这可能对控制和消除计划的制定产生重要影响。方法：对冈比亚纵向队列的数据进行了分析。从 6 月（旱季）到 2013 年 12 月（雨季）、2014 年 4 月（旱季中期）每月对居住在全国 12 个村庄的所有同意的个体进行采样，从 2014 年 6 月到 12 月每月对居住在该国 12 个村庄的所有个人进行采样。驻扎在每个村庄的一名研究护士记录了两次访问期间被动检测到的疟疾发作情况。通过聚合酶链反应确定恶性疟原虫感染情况，并使用地统计模型进行分析。结果：在抽样月份中，家庭水平观察到的每人月发病率范围为 0 至 0.50 例感染（四分位数范围 = 0.02-0.10），所有研究村庄都存在高负担家庭。无论传播强度如何，证据表明每月时间尺度上存在时空模式。家庭内传播是解释观察到的感染异质性的最合理的假设。结论：村内疟疾传播模式集中在一小部分高负担家庭中，但无论是否流行，模式都是随机的。我们的研究结果支持传播发生在家庭和村庄规模的概念，但不支持在这种情况下使用有针对性的方法来阻止感染从村庄内的高负担地区向低负担地区的传播。
Background: Despite the biological plausibility of hotspots fueling malaria transmission, the evidence to support this concept has been mixed. If transmission spreads from high burden to low burden households in a consistent manner, then this could have important implications for control and elimination program development.Methods: Data from a longitudinal cohort in The Gambia was analyzed. All consenting individuals residing in 12 villages across the country were sampled monthly from June (dry season) to December 2013 (wet season), in April 2014 (mid dry season), and monthly from June to December 2014. A study nurse stationed within each village recorded passively detected malaria episodes between visits. Plasmodium falciparum infections were determined by polymerase chain reaction and analyzed using a geostatistical model.Results: Household-level observed monthly incidence ranged from 0 to 0.50 infection per person (interquartile range = 0.02-0.10) across the sampling months, and high burden households exist across all study villages. There was limited evidence of a spatio-temporal pattern at the monthly timescale irrespective of transmission intensity. Within-household transmission was the most plausible hypothesis examined to explain the observed heterogeneity in infections.Conclusions: Within-village malaria transmission patterns are concentrated in a small proportion of high burden households, but patterns are stochastic regardless of endemicity. Our findings support the notion of transmission occurring at the household and village scales but not the use of a targeted approach to interrupt spreading of infections from high to low burden areas within villages in this setting.