Impact of Changes in Detection Effort on Control of Visceral Leishmaniasis in the Indian Subcontinent
Impact of Changes in Detection Effort on Control of Visceral Leishmaniasis in the Indian Subcontinent
复制标题
DOI：
10.1093/infdis/jiz644
复制
发表时间：
2019-06-15
影响因子：
6.4
通讯作者：
Medley, Graham F.
中科院分区：
文献类型：
--
作者：
Coffeng, Luc E.;Le Rutte, Epke A.;Medley, Graham F.
背景。在印度次大陆，内脏利什曼病的控制依赖于及时发现和治疗有症状的病例。检测努力影响观察到的VL发生率以及它反映潜在真实发生率的程度。由于控制目标是根据观察到的病例确定的，因此迫切需要了解检测延迟和改进检测的人口覆盖率的变化如何影响VI，控制。使用VL传播和控制的数学模型，我们预测减少检测延迟和/或增加检测计划的人口覆盖率对观察到的和真实的VL发病率和死亡率的影响。通过提高覆盖率或减少发现延迟来改进病例发现，可导致观察到的VL发病率在下降之前开始上升。放松改进的检测可能导致VI发病率的明显暂时（1年）降低，但伴随有感染水平恢复的高风险。发现病例的症状持续时间与发现努力有明确的关联。VL发病率本身并不是病例检测程序性能的可靠指标。在检测到的病例中，症状的持续时间可以作为病例检测程序性能的额外标志。
Background. Control of visceral leishmaniasis (VL) on the Indian subcontinent relies on prompt detection and treatment of symptomatic cases. Detection efforts influence the observed VL incidence and how well it reflects the underlying true incidence. As control targets are defined in terms of observed cases, there is an urgent need to understand how changes in detection delay and population coverage of improved detection affect VI, control.Methods. Using a mathematical model for transmission and control of VL, we predict the impact of reduced detection delays and/or increased population coverage of the detection programs on observed and true VL incidence and mortality.Results. Improved case detection, either by higher coverage or reduced detection delay, causes an initial rise in observed VL incidence before a reduction. Relaxation of improved detection may lead to an apparent temporary (1 year) reduction in VI, incidence, but comes with a high risk of resurging infection levels. Duration of symptoms in detected cases shows an unequivocal association with detection effort.Conclusions. VL incidence on its own is not a reliable indicator of the performance of case detection programs. Duration of symptoms in detected cases can be used as an additional marker of the performance of case detection programs.