Estimating the duration of Plasmodium falciparum infection from trials of indoor residual spraying
Estimating the duration of Plasmodium falciparum infection from trials of indoor residual spraying
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DOI：
10.4269/ajtmh.2004.70.625
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发表时间：
2004-06-01
影响因子：
3.3
通讯作者：
Smith, T
中科院分区：
文献类型：
--
作者：
Sama, W;Killeen, G;Smith, T
我们回顾了使用简单的数学模型来估计传播中断后恶性疟原虫感染的持续时间。然后，我们拟合一个指数衰减模型，重复横断面调查数据收集的三个历史性试验的室内滞留喷洒疟疾：一个从两个相邻的地区在坦桑尼亚-肯尼亚（帕雷塔维塔）在1954年进行，其他在西巴布亚（1953年），和加尔基项目在北方尼日利亚（1972-1973年）。对这些数据集的横断面分析得出，帕雷塔维塔的感染持续时间总体估计为602天（95%置信区间[CI] = 581-625），西巴布亚为734天（95% CI = 645-849），加尔基为1,329天（95% CI = 1193 - 1499）。这些估计数远高于最广泛引用的未经治疗的恶性疟原虫感染持续时间的数字。尽管这些数字可能被夸大了，因为尽管进行了密集的病媒控制，但仍发生了一些再感染，但在所有这些项目结束时，流行率仍在下降。Garki数据的纵向生存分析给出了更短的持续时间估计（186天，95%CI = 181-191），但通过显微镜检测寄生虫的不完善的影响严重偏倚这些估计。不同年龄组的感染持续时间估计数差异很大，但没有普遍的年龄趋势。疟疾流行与感染持续时间之间也没有明确的关系。需要对从具有寄生虫分型的相同个体连续采样进行分析，以获得流行区感染持续时间的更可靠估计。可能需要几年的时间来评价干预措施对疟疾流行的长期影响。
We reviewed the use of simple mathematical models to estimate the duration of Plasmodium falciparum infection after transmission has been interrupted. We then fit an exponential decay model to repeated cross-sectional survey data collected from three historical trials of indoor residual spraying against malaria: one from two contiguous districts in Tanzania-Kenya (Pare Taveta) carried out in 1954, the others in West Papua (1953), and the Garki project in northern Nigeria (1972-1973). A cross-sectional analysis of these datasets gave overall estimates of 602 days (95% confidence interval [CI] = 581-625) for the infection duration in Pare Taveta, 734 days (95% CI = 645-849) in West Papua, and 1,329 days (95% CI = 1,193-1,499) for Garki. These estimates are much greater than the most widely quoted figures for the duration of untreated P. falciparum infections. Although these may be exaggerated because some reinfections occurred despite intensive vector control, prevalence was still decreasing when all these projects ended. Longitudinal survival analysis of the Garki data gave much shorter estimates of duration (186 days, 95% CI = 181-191), but effects of imperfect detection of parasites by microscopy severely bias these estimates. Estimates of infection duration for different age groups showed considerable variation but no general age trend. There was also no clear relationship between malaria endemicity and infection duration. Analyses of successive sampling from the same individuals with parasite typing are needed to obtain more reliable estimates of infection duration in endemic areas. Periods of several years may be required to evaluate long-term effects of interventions on malaria prevalence.