孟加拉国用于淋巴丝虫病终期监测的传播评估调查（TAS）显著扩大并取得成功：向2020年消除目标又迈进了一步。
The significant scale up and success of Transmission Assessment Surveys 'TAS' for endgame surveillance of lymphatic filariasis in Bangladesh: One step closer to the elimination goal of 2020.
作者信息
Shamsuzzaman A K M, Haq Rouseli, Karim Mohammad J, Azad Motasim B, Mahmood A S M Sultan, Khair Abul, Rahman Muhammad Mujibur, Hafiz Israt, Ramaiah K D, Mackenzie Charles D, Mableson Hayley E, Kelly-Hope Louise A
机构信息
Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh.
Consultant on Lymphatic Filariasis, Tagore Nagar, Pondicherry, India.
出版信息
PLoS Negl Trop Dis. 2017 Jan 31;11(1):e0005340. doi: 10.1371/journal.pntd.0005340. eCollection 2017 Jan.
BACKGROUND
Bangladesh had one of the highest burdens of lymphatic filariasis (LF) at the start of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) with an estimated 70 million people at risk of infection across 34 districts. In total 19 districts required mass drug administration (MDA) to interrupt transmission, and 15 districts were considered low endemic. Since 2001, the National LF Programme has implemented MDA, reduced prevalence, and been able to scale up the WHO standard Transmission Assessment Survey (TAS) across all endemic districts as part of its endgame surveillance strategy. This paper presents TAS results, highlighting the momentous geographical reduction in risk of LF and its contribution to the global elimination target of 2020.
METHODOLOGY/PRINCIPAL FINDINGS: The TAS assessed primary school children for the presence of LF antigenaemia in each district (known as an evaluation unit-EU), using a defined critical cut-off threshold (or 'pass') that indicates interruption of transmission. Since 2011, a total of 59 TAS have been conducted in 26 EUs across the 19 endemic MDA districts (99,148 students tested from 1,801 schools), and 22 TAS in the 15 low endemic non-MDA districts (36,932 students tested from 663 schools). All endemic MDA districts passed TAS, except in Rangpur which required two further rounds of MDA. In total 112 students (male n = 59; female n = 53), predominately from the northern region of the country were found to be antigenaemia positive, indicating a recent or current infection. However, the distribution was geographically sparse, with only two small focal areas showing potential evidence of persistent transmission.
CONCLUSIONS/SIGNIFICANCE: This is the largest scale up of TAS surveillance activities reported in any of the 73 LF endemic countries in the world. Bangladesh is now considered to have very low or no risk of LF infection after 15 years of programmatic activities, and is on track to meet elimination targets. However, it will be essential that the LF Programme continues to develop and maintain a comprehensive surveillance strategy that is integrated into the health infrastructure and ongoing programmes to ensure cost-effectiveness and sustainability.
背景
在全球消除淋巴丝虫病规划（GPELF）启动时，孟加拉国是淋巴丝虫病（LF）负担最重的国家之一，估计有7000万人在34个地区面临感染风险。总共有19个地区需要进行大规模药物治疗（MDA）以阻断传播，15个地区被视为低度流行区。自2001年以来，国家淋巴丝虫病规划实施了大规模药物治疗，降低了患病率，并能够在所有流行地区扩大世卫组织标准的传播评估调查（TAS），作为其终期监测战略的一部分。本文介绍了TAS结果，突出了淋巴丝虫病风险在地理上的显著降低及其对2020年全球消除目标的贡献。
方法/主要发现：TAS在每个地区（称为评估单位-EU）对小学生进行淋巴丝虫病抗原血症检测，使用定义的临界阈值（或“通过”）来表明传播阻断情况。自2011年以来，在19个流行的MDA地区的26个评估单位共进行了59次TAS（对来自1801所学校的99148名学生进行了检测），在15个低度流行的非MDA地区进行了22次TAS（对来自663所学校的36932名学生进行了检测）。除朗布尔地区需要再进行两轮MDA外，所有流行的MDA地区TAS均通过。总共发现112名学生（男性n = 59；女性n = 53）抗原血症呈阳性，主要来自该国北部地区，表明近期或当前感染。然而，这种分布在地理上很稀疏，只有两个小的重点区域显示出持续传播的潜在证据。
结论/意义：这是世界上73个淋巴丝虫病流行国家中报告的最大规模的TAS监测活动。经过15年的规划活动，孟加拉国现在被认为淋巴丝虫病感染风险非常低或不存在，并且有望实现消除目标。然而，淋巴丝虫病规划必须继续制定和维持一项全面的监测战略，该战略要融入卫生基础设施和正在进行的项目中，以确保成本效益和可持续性。
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