Identification of Hot Spots of Malaria Transmission for Targeted Malaria Control
Identification of Hot Spots of Malaria Transmission for Targeted Malaria Control
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DOI：
10.1086/652456
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发表时间：
2010-06-01
影响因子：
6.4
通讯作者：
Gosling, Roly
中科院分区：
文献类型：
--
作者：
Bousema, Teun;Drakeley, Chris;Gosling, Roly
背景人群中疟疾风险的变化是一种经常描述但知之甚少的现象。这种异质性为有针对性的干预措施创造了机会，但前提是疟疾传播的热点可以很容易地确定。我们确定了坦桑尼亚东北部一个地区疟疾传播的空间模式，使用的疟疾发病率数据来自一项涉及婴儿和家庭层面蚊子采样数据的队列研究。结果恶性疟原虫抗体阳性率为100%。发现了五组疟疾发病率较高的病例，并将其解释为传播热点。这些热点部分重叠的集群较高的蚊子暴露，但不能令人满意的预测基于环境因素的概率模型。小规模的疟疾暴露的地方变化检测寄生虫患病率和SCR估计的样本的医疗保健设施的与会者。SCR估计值与当地疟疾发病率密切相关，并预测疟疾传播热点，敏感性为95%，特异性为85%。血清学标志物能够在微观流行病学一级检测疟疾传播的空间变异，它们有可能成为疟疾防治工作空间目标确定的有效方法。
Background. Variation in the risk of malaria within populations is a frequently described but poorly understood phenomenon. This heterogeneity creates opportunities for targeted interventions but only if hot spots of malaria transmission can be easily identified.Methods. We determined spatial patterns in malaria transmission in a district in northeastern Tanzania, using malaria incidence data from a cohort study involving infants and household-level mosquito sampling data. The parasite prevalence rates and age-specific seroconversion rates (SCRs) of antibodies against Plasmodium falciparum antigens were determined in samples obtained from people attending health care facilities.Results. Five clusters of higher malaria incidence were detected and interpreted as hot spots of transmission. These hot spots partially overlapped with clusters of higher mosquito exposure but could not be satisfactorily predicted by a probability model based on environmental factors. Small-scale local variation in malaria exposure was detected by parasite prevalence rates and SCR estimates for samples of health care facility attendees. SCR estimates were strongly associated with local malaria incidence rates and predicted hot spots of malaria transmission with 95% sensitivity and 85% specificity.Conclusions. Serological markers were able to detect spatial variation in malaria transmission at the micro-epidemiological level, and they have the potential to form an effective method for spatial targeting of malaria control efforts.