Lau Colleen L, Sheridan Sarah, Ryan Stephanie, Roineau Maureen, Andreosso Athena, Fuimaono Saipale, Tufa Joseph, Graves Patricia M
Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia.
Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia.
PLoS Negl Trop Dis. 2017 Sep 18;11(9):e0005914. doi: 10.1371/journal.pntd.0005914. eCollection 2017 Sep.
The Global Programme to Eliminate Lymphatic Filariasis (LF) aims to eliminate the disease as a public health problem by 2020 by conducting mass drug administration (MDA) and controlling morbidity. Once elimination targets have been reached, surveillance is critical for ensuring that programmatic gains are sustained, and challenges include timely identification of residual areas of transmission. WHO guidelines encourage cost-efficient surveillance, such as integration with other population-based surveys. In American Samoa, where LF is caused by Wuchereria bancrofti, and Aedes polynesiensis is the main vector, the LF elimination program has made significant progress. Seven rounds of MDA (albendazole and diethycarbamazine) were completed from 2000 to 2006, and Transmission Assessment Surveys were passed in 2010/2011 and 2015. However, a seroprevalence study using an adult serum bank collected in 2010 detected two potential residual foci of transmission, with Og4C3 antigen (Ag) prevalence of 30.8% and 15.6%. We conducted a follow up study in 2014 to verify if transmission was truly occurring by comparing seroprevalence between residents of suspected hotspots and residents of other villages. In adults from non-hotspot villages (N = 602), seroprevalence of Ag (ICT or Og4C3), Bm14 antibody (Ab) and Wb123 Ab were 1.2% (95% CI 0.6-2.6%), 9.6% (95% CI 7.5%-12.3%), and 10.5% (95% CI 7.6-14.3%), respectively. Comparatively, adult residents of Fagali'i (N = 38) had significantly higher seroprevalence of Ag (26.9%, 95% CI 17.3-39.4%), Bm14 Ab (43.4%, 95% CI 32.4-55.0%), and Wb123 Ab 55.2% (95% CI 39.6-69.8%). Adult residents of Ili'ili/Vaitogi/Futiga (N = 113) also had higher prevalence of Ag and Ab, but differences were not statistically significant. The presence of transmission was demonstrated by 1.1% Ag prevalence (95% CI 0.2% to 3.1%) in 283 children aged 7-13 years who lived in one of the suspected hotspots; and microfilaraemia in four individuals, all of whom lived in the suspected hotspots, including a 9 year old child. Our results provide field evidence that integrating LF surveillance with other surveys is effective and feasible for identifying potential hotspots, and conducting surveillance at worksites provides an efficient method of sampling large populations of adults.
全球消除淋巴丝虫病规划（LF）旨在通过开展大规模药物 administration（MDA）和控制发病率，到2020年将该疾病作为公共卫生问题予以消除。一旦达到消除目标，监测对于确保项目成果得以维持至关重要，而挑战包括及时识别残留的传播区域。世界卫生组织的指南鼓励采用具有成本效益的监测方法，例如与其他基于人群的调查相结合。在美属萨摩亚，淋巴丝虫病由班氏吴策线虫引起，波利尼西亚伊蚊是主要传播媒介，淋巴丝虫病消除规划已取得重大进展。2000年至2006年完成了七轮MDA（阿苯达唑和乙胺嗪），并于2010/2011年和2015年通过了传播评估调查。然而，一项使用2010年收集的成人血清库进行的血清阳性率研究检测到两个潜在的残留传播疫点，Og4C3抗原（Ag）阳性率分别为30.8%和15.6%。我们在2014年开展了一项后续研究，通过比较疑似热点地区居民和其他村庄居民的血清阳性率，以核实是否真的存在传播。在非热点村庄的成年人（N = 602）中，Ag（免疫层析法或Og4C3）、Bm14抗体（Ab）和Wb123 Ab的血清阳性率分别为1.2%（95%置信区间0.6 - 2.6%）、9.6%（95%置信区间7.5% - 12.3%）和10.5%（95%置信区间7.6 - 14.3%）。相比之下，法加利伊（Fagali'i）的成年居民（N = 38）的Ag血清阳性率（26.9%，95%置信区间17.3 - 39.4%）、Bm14 Ab（43.4%，95%置信区间32.4 - 55.0%）和Wb123 Ab（55.2%，95%置信区间39.6 - 69.8%）显著更高。伊利伊利/瓦伊托吉/富蒂加（Ili'ili/Vaitogi/Futiga）的成年居民（N = 113）的Ag和Ab阳性率也较高，但差异无统计学意义。在居住在其中一个疑似热点地区的283名7至13岁儿童中，Ag阳性率为1.1%（95%置信区间0.2%至3.1%），证明存在传播；在所有居住在疑似热点地区的四个人中检测到微丝蚴血症，其中包括一名9岁儿童。我们的结果提供了现场证据，表明将淋巴丝虫病监测与其他调查相结合对于识别潜在热点地区是有效且可行的，并且在工作场所进行监测提供了一种对大量成年人群进行抽样的有效方法。
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