More Poop, More Precision: Improving Epidemiologic Surveillance of Soil-Transmitted Helminths with Multiple Fecal Sampling using the Kato-Katz Technique
More Poop, More Precision: Improving Epidemiologic Surveillance of Soil-Transmitted Helminths with Multiple Fecal Sampling using the Kato-Katz Technique
复制标题
更多粪便，更精确：利用 Kato-Katz 技术进行多次粪便采样，改善土源性蠕虫的流行病学监测
DOI：
10.4269/ajtmh.16-0728
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Zang, Wei
中科院分区：
文献类型：
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作者：
Liu, Chengfang;Lu, Louise;Zang, Wei
土壤传播的蠕虫或寄生肠蠕虫是世界上最普遍和地理分布最广的寄生虫感染之一。蠕虫感染的准确诊断和量化对于提供信息和评估驱虫干预措施至关重要。Kato-Katz厚涂片技术是定量评估蠕虫感染率和感染强度的最广泛的实验室方法，经常与其他方法进行比较。然而，只有少数小规模研究考虑了提高其诊断灵敏度的方法。本研究在中国农村地区的4，985名学龄儿童中进行，蠕虫感染中度流行，检查Kato-Katz技术诊断灵敏度的影响，当连续几天收集两份粪便样本进行检查并与单一样本进行比较时。第二个目的是通过计算获得额外粪便样本的边际成本估计来考虑成本效益。我们的研究结果表明，分析额外的粪便样本导致蛔虫，鞭虫和钩虫患病率分别增加了23%，26%和100%。我们研究人群采集第二份粪便样本的成本约为每份粪便样本4.60美元。总的来说，研究结果表明，在粪便样本收集方面多投资31%可以防止低估约21%的患病率，从而提高Kato-Katz方法的诊断灵敏度。特别是在土壤传播蠕虫感染强度较低和公共卫生资源有限的地区，使用多种粪便样本进行更准确的流行病学监测将为感染控制和预防决策提供重要信息。
Soil-transmitted helminths, or parasitic intestinal worms, are among the most prevalent and geographically widespread parasitic infections in the world. Accurate diagnosis and quantification of helminth infection are critical for informing and assessing deworming interventions. The Kato-Katz thick smear technique, the most widely used laboratory method to quantitatively assess infection prevalence and infection intensity of helminths, has often been compared with other methods. Only a few small-scale studies, however, have considered ways to improve its diagnostic sensitivity. This study, conducted among 4,985 school-age children in an area of rural China with moderate prevalence of helminth infection, examines the effect on diagnostic sensitivity of the Kato-Katz technique when two fecal samples collected over consecutive days are examined and compared with a single sample. A secondary aim was to consider cost-effectiveness by calculating an estimate of the marginal costs of obtaining an additional fecal sample. Our findings show that analysis of an additional fecal sample led to increases of 23%, 26%, and 100% for Ascaris lumbricoides, Trichuris trichiura, and hookworm prevalence, respectively. The cost of collecting a second fecal sample for our study population was approximately USD4.60 per fecal sample. Overall, the findings suggest that investing 31% more capital in fecal sample collection prevents an underestimation of prevalence by about 21%, and hence improves the diagnostic sensitivity of the Kato-Katz method. Especially in areas with light-intensity infections of soil-transmitted helminths and limited public health resources, more accurate epidemiological surveillance using multiple fecal samples will critically inform decisions regarding infection control and prevention.