Surveillance for malaria elimination in Swaziland: a national cross-sectional study using pooled PCR and serology.
Surveillance for malaria elimination in Swaziland: a national cross-sectional study using pooled PCR and serology.
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DOI：
10.1371/journal.pone.0029550
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Greenhouse B
中科院分区：
文献类型：
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作者：
Hsiang MS;Hwang J;Kunene S;Drakeley C;Kandula D;Novotny J;Parizo J;Jensen T;Tong M;Kemere J;Dlamini S;Moonen B;Angov E;Dutta S;Ockenhouse C;Dorsey G;Greenhouse B
为了指导斯威士兰和其他国家消除疟疾的努力，准确评估传播情况至关重要。混合PCR有可能有效地提高检测感染的灵敏度;血清学可以澄清暴露的时间和空间趋势。采用分层两阶段聚类，横断面设计，从斯威士兰疟疾流行区招募受试者。采集血液进行快速诊断试验（RDT）、合并PCR和ELISA检测恶性疟原虫表面抗原抗体。在4330名受试者中，有3人是RDT阳性，但PCR结果为假阳性。合并PCR导致在RDT阴性参与者中鉴定出一种恶性疟原虫和一种三日疟原虫感染。感染恶性疟原虫的参与者报告最近去过莫桑比克。与对数千个样本进行单独测试相比，PCR合并将劳动力和消耗品成本降低了95.5%。血清阳性与年龄≥20岁（11.7% vs 1.9%，P<0.001）、最近去过莫桑比克（OR 4.4 [95%CI 1.0-19.0]）和居住在斯威士兰东南部（RR 3.78，P<0.001）相关。斯威士兰的疟疾感染率和近期接触率极低，表明消除疟疾是可行的。今后的努力应解决输入性疟疾问题，并针对剩余的传播疫源地。聚合酶链反应和酶联免疫吸附试验是指导消除工作的有价值的监测工具。
To guide malaria elimination efforts in Swaziland and other countries, accurate assessments of transmission are critical. Pooled-PCR has potential to efficiently improve sensitivity to detect infections; serology may clarify temporal and spatial trends in exposure. Using a stratified two-stage cluster, cross-sectional design, subjects were recruited from the malaria endemic region of Swaziland. Blood was collected for rapid diagnostic testing (RDT), pooled PCR, and ELISA detecting antibodies to Plasmodium falciparum surface antigens. Of 4330 participants tested, three were RDT-positive yet false positives by PCR. Pooled PCR led to the identification of one P. falciparum and one P. malariae infection among RDT-negative participants. The P. falciparum-infected participant reported recent travel to Mozambique. Compared to performing individual testing on thousands of samples, PCR pooling reduced labor and consumable costs by 95.5%. Seropositivity was associated with age ≥20 years (11·7% vs 1·9%, P<0.001), recent travel to Mozambique (OR 4.4 [95% CI 1.0–19.0]) and residence in southeast Swaziland (RR 3.78, P<0.001). The prevalence of malaria infection and recent exposure in Swaziland are extremely low, suggesting elimination is feasible. Future efforts should address imported malaria and target remaining foci of transmission. Pooled PCR and ELISA are valuable surveillance tools for guiding elimination efforts.