The McFarlane Burnet Institute of Medical Research and Public Health, Melbourne, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
Elife. 2021 Dec 23;10:e73080. doi: 10.7554/eLife.73080.
Entomological surveillance for malaria is inherently resource-intensive and produces crude population-level measures of vector exposure which are insensitive in low-transmission settings. Antibodies against salivary proteins measured at the individual level may serve as proxy biomarkers for vector exposure and malaria transmission, but their relationship is yet to be quantified.
A systematic review of studies measuring antibodies against salivary antigens (PROSPERO: CRD42020185449). Multilevel modelling (to account for multiple study-specific observations [level 1], nested within study [level 2], and study nested within country [level 3]) estimated associations between seroprevalence with human biting rate (HBR) and malaria transmission measures.
From 3981 studies identified in literature searches, 42 studies across 16 countries were included contributing 393 study-specific observations of anti- salivary antibodies determined in 42,764 samples. A positive association between HBR (log transformed) and seroprevalence was found; overall a twofold (100% relative) increase in HBR was associated with a 23% increase in odds of seropositivity (OR: 1.23, 95% CI: 1.10-1.37; p<0.001). The association between HBR and salivary antibodies was strongest with concordant, rather than discordant, species. Seroprevalence was also significantly positively associated with established epidemiological measures of malaria transmission: entomological inoculation rate, spp. prevalence, and malarial endemicity class.
salivary antibody biomarkers can serve as a proxy measure for HBR and malaria transmission, and could monitor malaria receptivity of a population to sustain malaria transmission. Validation of species-specific biomarkers is important given the global heterogeneity in the distribution of species. Salivary biomarkers have the potential to transform surveillance by replacing impractical, inaccurate entomological investigations, especially in areas progressing towards malaria elimination.
Australian National Health and Medical Research Council, Wellcome Trust.
昆虫学监测疟疾需要大量资源，并且只能提供人群层面的媒介暴露程度的粗略测量，在低传播环境中不敏感。个体水平检测的唾液蛋白抗体可能成为媒介暴露和疟疾传播的替代生物标志物，但它们之间的关系尚未量化。
系统综述了测量抗唾液抗原抗体的研究（PROSPERO：CRD42020185449）。多水平模型（考虑到多个研究特定观察值[一级]、嵌套在研究内[二级]以及嵌套在国家内的研究[三级]）估计了血清阳性率与人类叮咬率（HBR）和疟疾传播措施之间的关联。
从文献检索中确定了 3981 项研究，纳入了来自 16 个国家的 42 项研究，共提供了 393 项特定于研究的观察结果，涉及 42764 个样本中抗唾液抗体的测定。发现 HBR（对数转换）与血清阳性率之间存在正相关；总体而言，HBR 增加一倍（100%相对）与血清阳性的几率增加 23%相关（OR：1.23，95%CI：1.10-1.37；p<0.001）。HBR 和唾液抗体之间的关联在一致性而非不一致性物种上最强。血清阳性率也与疟疾传播的既定流行病学指标呈显著正相关：昆虫接种率、 spp. 患病率和疟疾流行程度等级。
唾液抗体生物标志物可以作为 HBR 和疟疾传播的替代指标，并且可以监测人群对疟疾传播的接受程度。鉴于物种分布的全球异质性，验证物种特异性生物标志物非常重要。唾液生物标志物有可能通过取代不切实际、不准确的昆虫学调查来改变监测，特别是在向疟疾消除迈进的地区。
澳大利亚国家健康与医学研究理事会、惠康信托基金会。
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