A systematic review on malaria sero-epidemiology studies in the Brazilian Amazon: insights into immunological markers for exposure and protection.
A systematic review on malaria sero-epidemiology studies in the Brazilian Amazon: insights into immunological markers for exposure and protection.
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DOI：
10.1186/s12936-017-1762-7
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发表时间：
2017-03-07
期刊：
影响因子：
3
通讯作者：
Braga ÉM
中科院分区：
文献类型：
--
作者：
Folegatti PM;Siqueira AM;Monteiro WM;Lacerda MV;Drakeley CJ;Braga ÉM
巴西在降低疟疾发病率和死亡率方面取得了相当大的成功，导致人们讨论了走向消灭疟疾的可能性。然而，除了报告和统计临床病例之外，消除还需要使用有效的工具和策略来测量传播动态并检测传染源，作为监测和评估的主要指标。由于抗疟疾抗体的获得和维持取决于寄生虫的暴露，血清阳性率可用作评估疟疾流行的可靠工具和以快速和具有成本效益的方式监测传播的辅助措施。本系统综述综合了巴西亚马逊流域疟疾血清阳性率的现有文献。考虑了不同的研究设计（横断面调查和纵向研究），报告了明确定义的巴西人群的血清学结果。对Medline（通过PubMed）、EMBASE和LILACS数据库进行筛选，并根据既定的选择标准纳入文章。由两位作者进行数据提取，并采用修改后的关键评价工具来评估有关定义的感兴趣变量的横断面研究的质量和完整性。从确定的220个单一记录中，23个研究被纳入本系统评价中进行定性综合。5项研究报告了恶性疟原虫的血清学结果，14篇论文评估了间日疟原虫，4篇文章报告了两种疟原虫的结果。观察到评价的疟疾抗原之间存在相当大的异质性，包括子孢子和血液阶段抗原。最近的大多数研究分析了针对间日疟原虫抗原的IgG应答，反映了过去几十年巴西的物种分布模式。大部分发表的论文是横断面调查（73.9%），只有6项队列研究被纳入本综述。三项研究指出，抗恶性疟原虫和间日疟原虫环子孢子蛋白的抗体与疟疾暴露之间存在关联。此外，13项横断面研究中有5项证明了间日疟原虫裂殖子表面蛋白1（PvMSP 119）保守的19 kDa C-末端区域的IgG抗体与疟疾暴露之间的正相关性。本系统评价确定了巴西疟疾传播可变和不稳定地区恶性疟原虫和间日疟原虫暴露的潜在生物标志物。然而，这项研究强调了进一步研究标准化的必要性，以提供一个理想的监测工具来评估巴西疟疾传播的趋势和疟疾干预方案的有效性。此外，本研究中开发和使用的基于分数的加权工具仍需进一步验证。
Considerable success in reducing malaria incidence and mortality has been achieved in Brazil, leading to discussions over the possibility of moving towards elimination. However, more than reporting and counting clinical cases, elimination will require the use of efficient tools and strategies for measuring transmission dynamics and detecting the infectious reservoir as the primary indicators of interest for surveillance and evaluation. Because acquisition and maintenance of anti-malarial antibodies depend on parasite exposure, seroprevalence rates could be used as a reliable tool for assessing malaria endemicity and an adjunct measure for monitoring transmission in a rapid and cost-effective manner. This systematic review synthesizes the existing literature on seroprevalence of malaria in the Brazilian Amazon Basin. Different study designs (cross-sectional surveys and longitudinal studies) with reported serological results in well-defined Brazilian populations were considered. Medline (via PubMed), EMBASE and LILACS databases were screened and the articles were included per established selection criteria. Data extraction was performed by two authors and a modified critical appraisal tool was applied to assess the quality and completeness of cross-sectional studies regarding defined variables of interest. From 220 single records identified, 23 studies were included in this systematic review for the qualitative synthesis. Five studies reported serology results on Plasmodium falciparum, 14 papers assessed Plasmodium vivax and four articles reported results on both Plasmodium species. Considerable heterogeneity among the evaluated malarial antigens, including sporozoite and blood stage antigens, was observed. The majority of recent studies analysed IgG responses against P. vivax antigens reflecting the species distribution pattern in Brazil over the last decades. Most of the published papers were cross-sectional surveys (73.9%) and only six cohort studies were included in this review. Three studies pointed to an association between antibodies against circumsporozoite protein of both P. falciparum and P. vivax and malaria exposure. Furthermore, five out 13 cross-sectional studies evidenced a positive association between IgG antibodies to the conserved 19-kDa C-terminal region of the merozoite surface protein 1 of P. vivax (PvMSP119) and malaria exposure. This systematic review identifies potential biomarkers of P. falciparum and P. vivax exposure in areas with variable and unstable malaria transmission in Brazil. However, this study highlights the need for standardization of further studies to provide an ideal monitoring tool to evaluate trends in malaria transmission and the effectiveness of malaria intervention programmes in Brazil. Moreover, the score-based weighted tool developed and used in this study still requires further validation.