Detecting Malaria Hotspots: A Comparison of Rapid Diagnostic Test, Microscopy, and Polymerase Chain Reaction
Detecting Malaria Hotspots: A Comparison of Rapid Diagnostic Test, Microscopy, and Polymerase Chain Reaction
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DOI：
10.1093/infdis/jix321
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发表时间：
2017-11-01
影响因子：
6.4
通讯作者：
Bejon, Philip
中科院分区：
文献类型：
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作者：
Mogeni, Polycarp;Williams, Thomas N.;Bejon, Philip
背景疟疾控制战略需要对传播的地理热点作出反应。热点的检测取决于所使用的诊断工具的灵敏度。我们在肯尼亚基利菲县的3个地点进行了横断面调查，这些地点具有不同的传播强度。采用快速诊断试验（RDT）、显微镜和聚合酶链反应（PCR）检测无症状寄生虫血症，并采用空间扫描技术检测热点。在3个研究中心对8581名研究参与者进行了调查。有统计学意义的疟疾热点RDT，显微镜和PCR的所有网站，除了显微镜在1个低传播的网站。在中等环境下，PCR热点的合并数据分析与显微镜热点重叠，但在2个较低的传输环境下则不重叠。然而，在按年份分析数据时注意到重叠程度的变化。RDT热点预测PCR/显微镜在中度设置，但不是在2个低传输设置。我们通过PCR和显微镜观察到热点的长期稳定性，但不是RDT。一旦感染流行率福尔斯下降，疟疾控制项目可以考虑PCR检测来指导无症状疟疾热点检测。
Background. Malaria control strategies need to respond to geographical hotspots of transmission. Detection of hotspots depends on the sensitivity of the diagnostic tool used.Methods. We conducted cross-sectional surveys in 3 sites within Kilifi County, Kenya, that had variable transmission intensities. Rapid diagnostic test (RDT), microscopy, and polymerase chain reaction (PCR) were used to detect asymptomatic parasitemia, and hotspots were detected using the spatial scan statistic.Results. Eight thousand five hundred eighty-one study participants were surveyed in 3 sites. There were statistically significant malaria hotspots by RDT, microscopy, and PCR for all sites except by microscopy in 1 low transmission site. Pooled data analysis of hotspots by PCR overlapped with hotspots by microscopy at a moderate setting but not at 2 lower transmission settings. However, variations in degree of overlap were noted when data were analyzed by year. Hotspots by RDT were predictive of PCR/microscopy at the moderate setting, but not at the 2 low transmission settings. We observed long-term stability of hotspots by PCR and microscopy but not RDT.Conclusion. Malaria control programs may consider PCR testing to guide asymptomatic malaria hotspot detection once the prevalence of infection falls.