Towards soil-transmitted helminths transmission interruption: The impact of diagnostic tools on infection prediction in a low intensity setting in Southern Mozambique.
Towards soil-transmitted helminths transmission interruption: The impact of diagnostic tools on infection prediction in a low intensity setting in Southern Mozambique.
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DOI：
10.1371/journal.pntd.0009803
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发表时间：
2021-10
影响因子：
3.8
通讯作者：
Muñoz J
中科院分区：
文献类型：
--
作者：
Grau-Pujol B;Martí-Soler H;Escola V;Demontis M;Jamine JC;Gandasegui J;Muchisse O;Cambra-Pellejà M;Cossa A;Martinez-Valladares M;Sacoor C;Van Lieshout L;Cano J;Giorgi E;Muñoz J
世界卫生组织针对土壤传播蠕虫硫酶(STH)的目标是将其作为一个公共卫生问题寻求消除：将中度和重度感染的比例降低到2%以下。一些地区正在实现世卫组织的目标，但如果在没有流行病学评估的情况下停止战略，传播可能会反弹。为此，检测低强度感染的敏感诊断方法和正在进行的传播的定位至关重要。在这项工作中，我们估计和比较了在低强度环境下通过不同诊断方法获得的STH感染。我们进行了一项横断面研究，从莫桑比克的一个地区招募了792名参与者。每名参与者连续两天采集两份粪便样本。标本用Telemann、Kato-Katz和qPCR进行STH检测。我们使用复合参考标准评估诊断敏感性。通过地统计学方法，我们估计了每种诊断方法至少有一种STH感染的社区流行率。我们使用环境、人口学和社会经济指标来解释任何现有的感染空间异质性。与复合参考标准相比，定量聚合酶链式反应是最敏感的方法：蛔虫92%(CI：83%~97%)，鞭虫95%(CI：88%~98%)，钩虫95%(CI：91%~97%)。定量聚合酶链式反应还估计了在低强度环境下至少一种性传播疾病感染的最高社区流行率。当用单一的Kato-Katz和Telemann分别从一个凳子和一个凳子估计时，10%的社区的患病率超过20%，而当用qPCR估计时，86%的社区的患病率超过20%。在低强度环境下，如果基于加藤-卡茨，STH估计的感染流行率可能被低估。定量聚合酶链式反应诊断优于镜检方法。因此，在性传播疾病控制和消除方案中实施基于定量聚合酶链式反应的预测地图将揭示隐藏的传播，并促进对传播中断的有针对性的干预。土壤传播蠕虫(STH)是存在于超过10亿人中的寄生蠕虫。人类通过排泄物将STH卵释放到环境中，然后它们会被鸡蛋摄取或幼虫皮肤渗透感染。感染中的卵子数量越多(高强度感染)，发病率越高。为此，世界卫生组织(WHO)的目标是到2030年在96%的流行国家将中等和高强度感染减少到2%以下，以消除STH作为一个健康问题。STH感染的主要控制策略是对高危人群进行大规模药物管理，以及改善水、卫生和个人卫生。如今，一些地区正在实现世卫组织的目标。因此，需要工具来确认是否可以停止控制策略。在这项研究中，我们选择了莫桑比克南部的一个低强度地区，在那里我们评估了当感染强度低时，不同的诊断技术如何检测STH。此外，我们还根据评估的不同诊断为STH估计的感染流行率创建了地区地图，以确定正在进行的传播的位置。定量聚合酶链式反应是最敏感的方法。因此，基于广泛使用的加藤-卡茨的地图可能低估了性病的流行程度，并丢失了隐藏的传播。
World Health Organization goals against soil-transmitted helminthiases (STH) are pointing towards seeking their elimination as a public health problem: reducing to less than 2% the proportion of moderate and heavy infections. Some regions are reaching WHO goals, but transmission could rebound if strategies are discontinued without an epidemiological evaluation. For that, sensitive diagnostic methods to detect low intensity infections and localization of ongoing transmission are crucial. In this work, we estimated and compared the STH infection as obtained by different diagnostic methods in a low intensity setting. We conducted a cross-sectional study enrolling 792 participants from a district in Mozambique. Two stool samples from two consecutive days were collected from each participant. Samples were analysed by Telemann, Kato-Katz and qPCR for STH detection. We evaluated diagnostic sensitivity using a composite reference standard. By geostatistical methods, we estimated neighbourhood prevalence of at least one STH infection for each diagnostic method. We used environmental, demographical and socioeconomical indicators to account for any existing spatial heterogeneity in infection. qPCR was the most sensitive technique compared to composite reference standard: 92% (CI: 83%– 97%) for A. lumbricoides, 95% (CI: 88%– 98%) for T. trichiura and 95% (CI: 91%– 97%) for hookworm. qPCR also estimated the highest neighbourhood prevalences for at least one STH infection in a low intensity setting. While 10% of the neighbourhoods showed a prevalence above 20% when estimating with single Kato-Katz from one stool and Telemann from one stool, 86% of the neighbourhoods had a prevalence above 20% when estimating with qPCR. In low intensity settings, STH estimated prevalence of infection may be underestimated if based on Kato-Katz. qPCR diagnosis outperformed the microscopy methods. Thus, implementation of qPCR based predictive maps at STH control and elimination programmes would disclose hidden transmission and facilitate targeted interventions for transmission interruption. Soil-transmitted helminths (STH) are parasitic worms present in over 1 billion people. Humans release STH eggs to the environment through faeces, and they become infected by egg ingestion or larvae skin penetration. The higher the number of eggs in an infection (high intensity infection) the higher the morbidity severity. For that, the World Health Organization (WHO) aims to eliminate STH as a health problem by reducing moderate and high intensity infections below 2% in 96% of endemic countries by 2030. STH infections main control strategies are mass drug administration to people at risk, and water, sanitation, and hygiene improvements. Nowadays, some regions are reaching WHO goals. Thus, tools to confirm if control strategies could be halted are needed. In this study, we selected a low intensity district in Southern Mozambique where we evaluated how different diagnostic techniques detect STH when intensity of infection is low. In addition, we also created district maps for STH estimated infection prevalence based on the different diagnostics assessed in order to identify the location of ongoing transmission. qPCR showed to be the most sensitive technique. Hence, maps based on the widely used Kato-Katz could underestimate the STH prevalence and lose hidden transmission.
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DOI：
10.1016/j.trstmh.2006.04.008
发表时间：
2007-02-01
影响因子：
2.2
作者：
Dacombe, R. J.;Crampin, A. C.;Fine, P. E. M.
通讯作者：
Fine, P. E. M.
影响因子：
3.8
作者：
Meurs L;Polderman AM;Vinkeles Melchers NV;Brienen EA;Verweij JJ;Groosjohan B;Mendes F;Mechendura M;Hepp DH;Langenberg MC;Edelenbosch R;Polman K;van Lieshout L
通讯作者：
van Lieshout L
影响因子：
1
作者：
Ayele, Dawit;Zewotir, Temesgen;Mwambi, Henry
通讯作者：
Mwambi, Henry
全球流行病学，生态学和控制土壤传播的蠕虫感染。
影响因子：
--
作者：
Brooker, S.;Clements, A. C. A.;Bundy, D. A. P.
通讯作者：
Bundy, D. A. P.
影响因子：
3.9
作者：
Ásbjörnsdóttir KH;Means AR;Werkman M;Walson JL
通讯作者：
Walson JL