Optimising passive surveillance of a neglected tropical disease in the era of elimination: A modelling study.
Optimising passive surveillance of a neglected tropical disease in the era of elimination: A modelling study.
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在消除时代优化被忽视的热带病的被动监测：一项建模研究。
DOI：
10.1371/journal.pntd.0008599
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发表时间：
2021-03
影响因子：
3.8
通讯作者：
Stanton MC
中科院分区：
文献类型：
--
作者：
Longbottom J;Wamboga C;Bessell PR;Torr SJ;Stanton MC
监测是消除传染病和避免疾病（重新）流行的全球方案的重要组成部分。随着病例数量的减少，治疗和控制的费用减少，但即使在“最后一个”病例之后，监测费用仍然很高。减少监测可能会有遗漏持续或（重新）出现疾病病灶的风险。在这里，我们使用基于模拟的方法来确定所需的被动监测站点的最小数量，以确保最大限度地覆盖一个传染病的风险人群（PAR）。在这项研究中，我们以乌干达西北部的冈比亚人非洲锥虫病（g-HAT）为例，这是一种被忽视的热带疾病（NTD），已降至历史低水平（全球<1000例/年）。为了量化诊断设施的旅行时间，监测覆盖率的代理，我们制作了一个高空间分辨率的阻力面，并进行了成本-距离分析。我们模拟了不同数量（1-170）和位置（170，000个总位置组合）的诊断设施的PAR旅行时间，根据国内目标，量化了设施1小时和5小时旅行内的PAR百分比。我们的模拟表明，诊断中心减少70%（51/170）仍然超过了覆盖率的最低目标，即使是偏远地区的人口，超过95%的总PAR约300万人生活在诊断中心≤ 1小时，我们展示了一种方法，以最佳的位置，这些设施，通知最小的影响缩减。我们的研究结果强调，在乌干达西北部的g-HAT的监测可以缩减，而不会大幅减少PAR的覆盖范围。所描述的方法可以有助于成本效益和均衡的战略监测NTD和其他传染病接近消除或（重新）出现。疾病监测系统是公共卫生实践的一个重要组成部分，通常被认为是防止疾病（重新）出现的流行病的第一线。对监测系统的定期评价确保这些系统继续以最高效率运作;调查低发病率疾病的系统，如在消除环境中的疾病，应予以简化，以减轻报告负担。缺乏关于如何在消除环境中优化疾病监测的指导可能会导致费用增加和/或疾病报告不足。在这里，我们提出了一个框架方法，以系统地确定最佳的数量和监测点的位置接近消除传染病的监测。通过利用估计的地理可达性，通过建设一个阻力面和模拟方法，我们确定，冈比亚人非洲锥虫在乌干达西北部的业务诊断设施的数量可以减少70%，在现有的覆盖范围减少最少，并确定所需的设施，以满足覆盖目标的最低数量。我们的分析可用于告知消除环境中疾病监测点的数量和位置。随着病例减少和主动监测成本效益降低，被动监测变得越来越重要;鉴于设施能力和地理分布，评估如何最好地利用这种被动监测能力的方法与诊断复杂的几种NTD有关。这不仅是一个复杂的研究领域的疾病接近消除，一个精心设计的监测系统是必不可少的检测新出现的疾病，这项工作是热门的气候，新出现的病原体变得越来越普遍。
Surveillance is an essential component of global programs to eliminate infectious diseases and avert epidemics of (re-)emerging diseases. As the numbers of cases decline, costs of treatment and control diminish but those for surveillance remain high even after the ‘last’ case. Reducing surveillance may risk missing persistent or (re-)emerging foci of disease. Here, we use a simulation-based approach to determine the minimal number of passive surveillance sites required to ensure maximum coverage of a population at-risk (PAR) of an infectious disease. For this study, we use Gambian human African trypanosomiasis (g-HAT) in north-western Uganda, a neglected tropical disease (NTD) which has been reduced to historically low levels (<1000 cases/year globally), as an example. To quantify travel time to diagnostic facilities, a proxy for surveillance coverage, we produced a high spatial-resolution resistance surface and performed cost-distance analyses. We simulated travel time for the PAR with different numbers (1–170) and locations (170,000 total placement combinations) of diagnostic facilities, quantifying the percentage of the PAR within 1h and 5h travel of the facilities, as per in-country targets. Our simulations indicate that a 70% reduction (51/170) in diagnostic centres still exceeded minimal targets of coverage even for remote populations, with >95% of a total PAR of ~3million individuals living ≤1h from a diagnostic centre, and we demonstrate an approach to best place these facilities, informing a minimal impact scale back. Our results highlight that surveillance of g-HAT in north-western Uganda can be scaled back without substantially reducing coverage of the PAR. The methodology described can contribute to cost-effective and equable strategies for the surveillance of NTDs and other infectious diseases approaching elimination or (re-)emergence. Disease surveillance systems are an essential component of public health practice and are often considered the first line in averting epidemics for (re-)emerging diseases. Regular evaluation of surveillance systems ensures that they remain operating at maximum efficiency; systems that survey diseases of low incidence, such as those within elimination settings, should be simplified to reduce the reporting burden. A lack of guidance on how to optimise disease surveillance in an elimination setting may result in added expense, and/or the underreporting of disease. Here, we propose a framework methodology to determine systematically the optimal number and placement of surveillance sites for the surveillance of infectious diseases approaching elimination. By utilising estimates of geographic accessibility, through the construction of a resistance surface and a simulation approach, we identify that the number of operational diagnostic facilities for Gambian human African trypanosomiasis in north-western Uganda can be reduced by 70% with a minimal reduction in existing coverage, and identify the minimum number of facilities required to meet coverage targets. Our analysis can be used to inform the number and positioning of surveillance sites for diseases within an elimination setting. Passive surveillance becomes increasingly important as cases decline and active surveillance becomes less cost-effective; methods to evaluate how best to engage this passive surveillance capacity given facility capacity and geographic distribution are pertinent for several NTDs where diagnosis is complex. Not only is this a complicated research area for diseases approaching elimination, a well-designed surveillance system is essential for the detection of emerging diseases, with this work being topical in a climate where emerging pathogens are becoming more commonplace.
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影响因子：
3.7
作者：
Bessell PR;Lumbala C;Lutumba P;Baloji S;Biéler S;Ndung'u JM
通讯作者：
Ndung'u JM
影响因子：
8.1
作者：
Iyer HS;Flanigan J;Wolf NG;Schroeder LF;Horton S;Castro MC;Rebbeck TR
通讯作者：
Rebbeck TR
影响因子：
4.8
作者：
Bakeera, Solome K.;Wamala, Sarah P.;Pariyo, George W.
通讯作者：
Pariyo, George W.
影响因子：
4.9
作者：
Houben, Rein M. G. J.;Van Boeckel, Thomas P.;Crampin, Amelia C.
通讯作者：
Crampin, Amelia C.
影响因子：
3.8
作者：
Buescher, Philippe;Ngoyi, Dieudonne Mumba;Bieler, Sylvain
通讯作者：
Bieler, Sylvain