Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Macha Research Trust, Choma District, Zambia.
Am J Trop Med Hyg. 2018 May;98(5):1382-1388. doi: 10.4269/ajtmh.17-0865. Epub 2018 Mar 15.
To improve malaria surveillance and achieve elimination, the Zambian National Malaria Elimination Program implemented a reactive test-and-treat program in Southern Province in 2013 in which individuals with rapid diagnostic test (RDT)-confirmed malaria are followed-up at their home within 1 week of diagnosis. Individuals present at the index case household and those residing within 140 m of the index case are tested with an RDT and treated with artemether-lumefantrine if positive. This study evaluated the efficiency of this reactive test-and-treat strategy by characterizing infected individuals missed by the RDT and the current screening radius. The radius was expanded to 250 m, and a quantitative polymerase chain reaction (qPCR) test was performed on dried blood spot specimens. From January 2015 through March 2016, 145 index cases were identified at health centers and health posts. A total of 3,333 individuals residing in 525 households were screened. Excluding index cases, the parasite prevalence was 1.1% by RDT (33 positives of 3,016 participants) and 2.4% by qPCR (73 positives of 3,016 participants). Of the qPCR-positive cases, 62% of 73 individuals tested negative by RDT. Approximately half of the infected individuals resided within the index case household (58% of RDT-positive individuals and 48% of qPCR-positive individuals). The low sensitivity of the RDT and the high proportion of secondary cases within the index case household decreased the efficiency of this reactive test-and-treat strategy. Reactive focal drug administration in index case households would be a more efficient approach to treating infected individuals associated with a symptomatic case.
为了改善疟疾监测并实现消除疟疾目标，赞比亚国家消除疟疾规划于 2013 年在南部省实施了一项反应性检测和治疗方案，该方案要求在确诊后的 1 周内对快速诊断检测（RDT）确诊的疟疾病例进行家庭随访。对在首发病例家庭中出现的病例以及居住在首发病例半径 140 米范围内的病例进行 RDT 检测，如果呈阳性则给予青蒿素-哌喹治疗。本研究通过描述 RDT 漏检的感染个体特征和当前的筛查半径，评估了该反应性检测和治疗策略的效率。将筛查半径扩大到 250 米，并对干血斑标本进行定量聚合酶链反应（qPCR）检测。2015 年 1 月至 2016 年 3 月，在卫生中心和卫生所共发现 145 例首发病例。对居住在 525 户家庭中的共 3333 人进行了筛查。除首发病例外，RDT 检测的寄生虫感染率为 1.1%（3016 名参与者中 33 例阳性），qPCR 检测的寄生虫感染率为 2.4%（3016 名参与者中 73 例阳性）。在 qPCR 阳性病例中，62%的 RDT 阴性病例呈阳性。约一半的感染个体居住在首发病例家庭中（RDT 阳性个体的 58%和 qPCR 阳性个体的 48%）。RDT 的敏感性较低，以及首发病例家庭中二级病例的比例较高，降低了这种反应性检测和治疗策略的效率。在首发病例家庭中进行反应性局部药物治疗可能是一种更有效的方法，用于治疗与症状性病例相关的感染个体。
