Serology reveals heterogeneity of Plasmodium falciparum transmission in northeastern South Africa: implications for malaria elimination.
Serology reveals heterogeneity of Plasmodium falciparum transmission in northeastern South Africa: implications for malaria elimination.
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血清学揭示了南非东北部恶性疟原虫传播的异质性：消除疟疾的影响。
DOI：
10.1186/s12936-017-1701-7
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发表时间：
2017-01-26
期刊：
影响因子：
3
通讯作者：
Kleinschmidt I
中科院分区：
文献类型：
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作者：
Biggs J;Raman J;Cook J;Hlongwana K;Drakeley C;Morris N;Serocharan I;Agubuzo E;Kruger P;Mabuza A;Zitha A;Machaba E;Coetzee M;Kleinschmidt I
人们普遍承认，如果南非要实现消灭疟疾的目标，就需要修改现有的控制干预措施。在已发现病例的地区使用室内滞留喷洒是南非东北部目前正在研究的一项战略。这项血清阳性率基线研究是在一项有针对性的室内滞留喷雾杀虫剂试验中进行的，目的是深入了解南非的疟疾传播动态，并评价血清流行病学做法是否有可能例行纳入消除方案。滤纸血点，人口和家庭调查数据收集从2710个随机选择的家庭在56个研究病房位于巴-Phalaborwa和Bushbuckridge市。血点检测恶性疟原虫顶端膜抗原-1和裂殖子表面蛋白-119血液阶段抗原，使用酶联免疫吸附试验。使用反向催化模型分析血清阳性率数据，以确定疟疾血清转换率。地理空间聚类分析用于调查传播异质性，而随机效应逻辑回归确定与疟疾暴露相关的风险因素。整个研究中心的总体SCR为0.012（95% CI 0.008-0.017）/年。对比SCR，对应于整个研究中心的不同地理区域，范围为每年<0.001（95% CI <0.001-0.005）至0.022（95% CI 0.008-0.062），显示出显著的传播异质性。家庭血清阳性率和年龄校正抗体反应的地理空间聚类分析发现恶性疟原虫暴露的空间聚类具有统计学显著性（p < 0.05）。在抽样人群中，正规中等教育与较低的疟疾暴露相关（AOR 0.72，95%CI 0.56-0.95，p = 0.018）。虽然两个研究地点的疟疾传播强度和暴露程度都很低，但疟疾传播强度高度异质，并与该地区的社会经济地位低有关。研究结果表明，重点针对干预措施有可能是一个适当的战略部署在南非。此外，将血清流行病学做法例行纳入消灭疟疾方案，可能有助于监测南非和其他努力消灭疟疾的国家的疟疾传播强度。本文的在线版本（doi：10.1186/s12936-017-1701-7）包含补充材料，可供授权用户使用。
It is widely acknowledged that modifications to existing control interventions are required if South Africa is to achieve malaria elimination. Targeting indoor residual spraying (IRS) to areas where cases have been detected is one strategy currently under investigation in northeastern South Africa. This seroprevalence baseline study, nested within a targeted IRS trial, was undertaken to provide insights into malaria transmission dynamics in South Africa and evaluate whether sero-epidemiological practices have the potential to be routinely incorporated into elimination programmes. Filter-paper blood spots, demographic and household survey data were collected from 2710 randomly selected households in 56 study wards located in the municipalities of Ba-Phalaborwa and Bushbuckridge. Blood spots were assayed for Plasmodium falciparum apical membrane antigen-1 and merozoite surface protein-119 blood-stage antigens using an enzyme linked immunosorbent assay. Seroprevalence data were analysed using a reverse catalytic model to determine malaria seroconversion rates (SCR). Geospatial cluster analysis was used to investigate transmission heterogeneity while random effects logistic regression identified risk factors associated with malaria exposure. The overall SCR across the entire study site was 0.012 (95% CI 0.008–0.017) per year. Contrasting SCRs, corresponding to distinct geographical regions across the study site, ranging from <0.001 (95% CI <0.001–0.005) to 0.022 (95% CI 0.008–0.062) per annum revealed prominent transmission heterogeneity. Geospatial cluster analysis of household seroprevalence and age-adjusted antibody responses detected statistically significant (p < 0.05) spatial clusters of P. falciparum exposure. Formal secondary education was associated with lower malaria exposure in the sampled population (AOR 0.72, 95% CI 0.56–0.95, p = 0.018). Although overall transmission intensity and exposure to malaria was low across both study sites, malaria transmission intensity was highly heterogeneous and associated with low socio-economic status in the region. Findings suggest focal targeting of interventions has the potential to be an appropriate strategy to deploy in South Africa. Furthermore, routinely incorporating sero-epidemiological practices into elimination programmes may prove useful in monitoring malaria transmission intensity in South Africa, and other countries striving for malaria elimination. The online version of this article (doi:10.1186/s12936-017-1701-7) contains supplementary material, which is available to authorized users.