Mogeni Polycarp, Williams Thomas N, Omedo Irene, Kimani Domtila, Ngoi Joyce M, Mwacharo Jedida, Morter Richard, Nyundo Christopher, Wambua Juliana, Nyangweso George, Kapulu Melissa, Fegan Gregory, Bejon Philip
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Faculty of Medicine, Imperial College London.
J Infect Dis. 2017 Nov 27;216(9):1091-1098. doi: 10.1093/infdis/jix321.
Malaria control strategies need to respond to geographical hotspots of transmission. Detection of hotspots depends on the sensitivity of the diagnostic tool used.
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.
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.
Malaria control programs may consider PCR testing to guide asymptomatic malaria hotspot detection once the prevalence of infection falls.
疟疾控制策略需要应对传播的地理热点地区。热点地区的检测取决于所使用诊断工具的敏感性。
我们在肯尼亚基利菲县的3个传播强度不同的地点进行了横断面调查。使用快速诊断检测（RDT）、显微镜检查和聚合酶链反应（PCR）检测无症状寄生虫血症，并使用空间扫描统计方法检测热点地区。
在3个地点对8581名研究参与者进行了调查。除了1个低传播地点的显微镜检查外，所有地点通过RDT、显微镜检查和PCR均发现了具有统计学意义的疟疾热点地区。PCR对热点地区的汇总数据分析在中等传播水平下与显微镜检查的热点地区重叠，但在2个较低传播水平下不重叠。然而，按年份分析数据时，发现重叠程度存在差异。在中等传播水平下，RDT检测到的热点地区可预测PCR/显微镜检查结果，但在2个低传播水平下则不然。我们观察到PCR和显微镜检查发现的热点地区具有长期稳定性，但RDT检测的热点地区不具有长期稳定性。
一旦感染率下降，疟疾控制项目可考虑采用PCR检测来指导无症状疟疾热点地区的检测。
