Reconciling Egg- and Antigen-Based Estimates of Schistosoma mansoni Clearance and Reinfection: A Modeling Study.
Reconciling Egg- and Antigen-Based Estimates of Schistosoma mansoni Clearance and Reinfection: A Modeling Study.
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曼氏血吸虫清除和再感染的基于虫卵和抗原的评估：一项建模研究。
DOI：
10.1093/cid/ciab679
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发表时间：
2022-05-03
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影响因子：
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尽管经过数十年的干预，仍有 2.4 亿人患有血吸虫病。无法直接观察感染情况，并且基于鸡蛋的 Kato-Katz 厚涂片缺乏敏感性，影响了治疗效果和再感染率估计。护理点循环阴极抗原（此处称为 POC-CCA+）测试被提倡作为 Kato-Katz 方法的改进，但改进的估计受到痕量结果解释的模糊性的限制。我们收集了 210 名学龄儿童的重复 Kato-Katz 鸡蛋计数，并根据制造商的指南（此处称为 POC-CCA+）和外部开发的 G 分数对 POC-CCA 测试进行评分。我们使用用 Kato-Katz 参数化的隐马尔可夫模型；加藤-卡茨和 POC-CCA+； Kato-Katz 和 G-Scores，通过对这些诊断进行比以前更正式的统计协调，推断六个月内四个时间点的潜在清除和再感染概率。我们的方法需要关于迹线解释的最小但稳健的假设。与 Kato-Katz 模型相比，基于抗原的模型估计所有时间点的感染率较高，对应于较低的清除率和较高的再感染估计。具体而言，治疗前患病率估计为 85%（Kato-Katz；95% CI：79%–92%）、99%（POC-CCA+；97%–100%）和 98%（G-Score；95%–100%）。治疗后，估计有 93%（Kato-Katz；88%–96%）、72%（POC-CCA+；64%–79%）和 65%（G-Score；57%–73%）的感染者清除了感染。在清除感染的人中，估计有 35%（Kato-Katz；27%–42%）、51%（POC-CCA+；41%–62%）和 44%（G-Score；33%–55%）在 9 周内再次感染。治疗效果比仅基于 Kato-Katz 的估计所显示的持续时间更短，清除率较低，并且快速再感染。治疗后 3 周，捕获长期清除动态。治疗后 9 周，再次感染被捕获，但未能将清除失败与快速再感染区分开来。因此，需要频繁采样来了解这些重要的流行病学动态。在高流行地区，血吸虫病治疗的影响是短暂的，因为治疗的效果远低于世界卫生组织推荐的加藤-卡茨方法所显示的效果，而且再感染的发生速度比当前监测时间框架检测到的要快。
Despite decades of interventions, 240 million people have schistosomiasis. Infections cannot be directly observed, and egg-based Kato-Katz thick smears lack sensitivity, affected treatment efficacy and reinfection rate estimates. The point-of-care circulating cathodic antigen (referred to from here as POC-CCA+) test is advocated as an improvement on the Kato-Katz method, but improved estimates are limited by ambiguities in the interpretation of trace results. We collected repeated Kato-Katz egg counts from 210 school-aged children and scored POC-CCA tests according to the manufacturer’s guidelines (referred to from here as POC-CCA+) and the externally developed G score. We used hidden Markov models parameterized with Kato-Katz; Kato-Katz and POC-CCA+; and Kato-Katz and G-Scores, inferring latent clearance and reinfection probabilities at four timepoints over six-months through a more formal statistical reconciliation of these diagnostics than previously conducted. Our approach required minimal but robust assumptions regarding trace interpretations. Antigen-based models estimated higher infection prevalence across all timepoints compared with the Kato-Katz model, corresponding to lower clearance and higher reinfection estimates. Specifically, pre-treatment prevalence estimates were 85% (Kato-Katz; 95% CI: 79%–92%), 99% (POC-CCA+; 97%–100%) and 98% (G-Score; 95%–100%). Post-treatment, 93% (Kato-Katz; 88%–96%), 72% (POC-CCA+; 64%–79%) and 65% (G-Score; 57%–73%) of those infected were estimated to clear infection. Of those who cleared infection, 35% (Kato-Katz; 27%–42%), 51% (POC-CCA+; 41%–62%) and 44% (G-Score; 33%–55%) were estimated to have been reinfected by 9-weeks. Treatment impact was shorter-lived than Kato-Katz–based estimates alone suggested, with lower clearance and rapid reinfection. At 3 weeks after treatment, longer-term clearance dynamics are captured. At 9 weeks after treatment, reinfection was captured, but failed clearance could not be distinguished from rapid reinfection. Therefore, frequent sampling is required to understand these important epidemiological dynamics. The impact of treatment for schistosomiasis in high-endemicity settings is short-lived because treatment is far less efficacious than the World Health Organization–recommended Kato-Katz method would suggest, and reinfection occurs more rapidly than is detected by current surveillance time frames.
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5.8
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