Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Infection and Immunity, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Adv Parasitol. 2014;84:151-208. doi: 10.1016/B978-0-12-800099-1.00003-X.
As malaria declines in parts of Africa and elsewhere, and as more countries move towards elimination, it is necessary to robustly evaluate the effect of interventions and control programmes on malaria transmission. To help guide the appropriate design of trials to evaluate transmission-reducing interventions, we review 11 metrics of malaria transmission, discussing their accuracy, precision, collection methods and costs and presenting an overall critique. We also review the nonlinear scaling relationships between five metrics of malaria transmission: the entomological inoculation rate, force of infection, sporozoite rate, parasite rate and the basic reproductive number, R0. Our chapter highlights that while the entomological inoculation rate is widely considered the gold standard metric of malaria transmission and may be necessary for measuring changes in transmission in highly endemic areas, it has limited precision and accuracy and more standardised methods for its collection are required. In areas of low transmission, parasite rate, seroconversion rates and molecular metrics including MOI and mFOI may be most appropriate. When assessing a specific intervention, the most relevant effects will be detected by examining the metrics most directly affected by that intervention. Future work should aim to better quantify the precision and accuracy of malaria metrics and to improve methods for their collection.
随着疟疾在非洲和其他地区的发病率下降,以及越来越多的国家朝着消除疟疾的目标迈进,有必要对干预措施和控制规划对疟疾传播的影响进行有力评估。为了帮助指导评估减少疟疾传播干预措施的试验的适当设计,我们回顾了 11 种疟疾传播指标,讨论了它们的准确性、精度、采集方法和成本,并提出了总体评价。我们还回顾了疟疾传播的五个指标之间的非线性比例关系:昆虫接种率、感染率、子孢子率、寄生虫率和基本繁殖数 R0。我们的章节强调,尽管昆虫接种率被广泛认为是疟疾传播的黄金标准指标,并且可能对于衡量高度流行地区的传播变化是必要的,但它的精度和准确性有限,需要更标准化的采集方法。在低传播地区,寄生虫率、血清转化率以及包括 MOI 和 mFOI 在内的分子指标可能是最合适的。在评估特定干预措施时,通过检查最直接受该干预措施影响的指标,可以检测到最相关的效果。未来的工作应旨在更好地量化疟疾指标的精度和准确性,并改进其采集方法。