Björkman Anders, Cook Jackie, Sturrock Hugh, Msellem Mwinyi, Ali Abdullah, Xu Weiping, Molteni Fabrizio, Gosling Roly, Drakeley Chris, Mårtensson Andreas
Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health.
Clin Infect Dis. 2017 May 1;64(9):1236-1243. doi: 10.1093/cid/cix136.
Optimal use of mass/targeted screen-and-treat or mass or focal drug administration as malaria elimination strategies remains unclear. We therefore studied spatial distribution of Plasmodium falciparum infections to compare simulated effects of these strategies on reducing the parasite reservoir in a pre-elimination setting.
P. falciparum rapid diagnostic tests (RDTs) and molecular (polymerase chain reaction [PCR]) and serological (enzyme-linked immunosorbent assay) analyses were performed on finger-prick blood samples from a population-based survey in 3 adjacent communities.
Among 5278 persons screened, 13 (0.2%) were positive by RDT and 123 (2.3%) by PCR. PCR-positive individuals were scattered over the study area, but logistic regression analysis suggested a propensity of these infections to cluster around RDT-positive individuals. The odds ratios for being PCR positive was 7.4 (95% confidence interval, 2.8-19.9) for those living in the household of an RDT-positive individual and 1.64 (1.0-2.8; P = .06) for those living within <300 m, compared with >1000 m. Treating everyone within households of RDT-positive individuals (1% population) would target 13% of those who are PCR positive. Treating all living within a radius of <300 or <1000 m (14% or 58% population) would target 30% or 66% of infections, respectively. Among 4431 serologically screened individuals, 26% were seropositive. Treating everyone within seropositive households (63% population) would target 77% of PCR-positive individuals.
Presumptive malaria treatment seemed justified within RDT-positive households and potentially worth considering within, for example, a radius of <300 m. Serology was not discriminative enough in identifying ongoing infections for improving focal interventions in this setting but may rather be useful to detect larger transmission foci.
作为疟疾消除策略，大规模/针对性筛查与治疗或大规模或局部药物给药的最佳使用仍不明确。因此，我们研究了恶性疟原虫感染的空间分布，以比较这些策略在消除前环境中对减少寄生虫储存库的模拟效果。
对来自3个相邻社区的基于人群的调查中的手指刺血样本进行了恶性疟原虫快速诊断试验（RDT）、分子（聚合酶链反应[PCR]）和血清学（酶联免疫吸附测定）分析。
在5278名接受筛查的人中，13人（0.2%）RDT呈阳性，123人（2.3%）PCR呈阳性。PCR阳性个体分散在研究区域，但逻辑回归分析表明这些感染倾向于聚集在RDT阳性个体周围。与居住在距离>1000米处的人相比，居住在RDT阳性个体家庭中的人PCR呈阳性的优势比为7.4（95%置信区间，2.8 - 19.9），居住在<300米内的人PCR呈阳性的优势比为1.64（1.0 - 2.8；P = 0.06）。对RDT阳性个体家庭中的所有人（占人口的1%）进行治疗，将针对13%的PCR阳性者。对居住在<300米或<1000米半径内的所有人（分别占人口的14%或58%）进行治疗，将分别针对30%或66%的感染者。在4431名接受血清学筛查的个体中，26%呈血清阳性。对血清阳性家庭中的所有人（占人口的63%）进行治疗，将针对77%的PCR阳性个体。
在RDT阳性家庭中进行推定疟疾治疗似乎是合理的，在例如<300米半径内可能值得考虑。在这种情况下，血清学在识别正在进行的感染以改善局部干预方面的区分度不够，但可能有助于检测更大的传播病灶。
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