Cloots Kristien, Singh Om Prakash, Singh Abhishek Kumar, Rai Tulika Kumari, Tiwari Vishwa Deepak, Neyaz Aziza, Pandey Sundaram, Scholar Vivek Kumar, Malaviya Paritosh, Hasker Epco, Sundar Shyam
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Biochemistry, Institute of Sciences, Banaras Hindu University, Varanasi, India.
Int J Infect Dis. 2024 Oct;147:107153. doi: 10.1016/j.ijid.2024.107153. Epub 2024 Jun 25.
Monitoring of Leishmania transmission is considered a strategic priority for sustaining elimination of visceral leishmaniasis as a public health problem in the Indian subcontinent. The objective of this study was to evaluate whether serological surveys can distinguish between communities with and without Leishmania transmission, and to assess which serological marker performs best.
Seven villages were selected from Bihar and Uttar Pradesh state, India, and categorized as either currently endemic (CE), previously endemic (PE) or nonendemic (NE). Blood samples were analyzed with the rK39 RDT, direct agglutination test (DAT), and rK39 ELISA.
Contrary to the rK39 RDT and DAT, the rK39 ELISA showed a significant difference between all three categories of endemicity, with a seroprevalence of 5.21% in CE villages, 1.55% in PE villages, and 0.13% in NE villages. Even when only looking at the seroprevalence among children aged <10 years, the rK39 ELISA was still able to differentiate between villages with and without ongoing transmission.
Our findings suggest the rK39 ELISA to be the most promising marker for monitoring of Leishmania transmission. Further validation is required, and practical, context-adapted recommendations need to be formulated in order to guide policymakers toward meaningful and sustainable surveillance strategies in the post-elimination phase.
监测利什曼原虫传播被视为印度次大陆将内脏利什曼病作为公共卫生问题持续消除的战略重点。本研究的目的是评估血清学调查能否区分存在和不存在利什曼原虫传播的社区，并评估哪种血清学标志物表现最佳。
从印度比哈尔邦和北方邦选取了7个村庄，并将其分类为当前流行区（CE）、既往流行区（PE）或非流行区（NE）。采用rK39快速诊断试验（RDT）、直接凝集试验（DAT）和rK39酶联免疫吸附测定（ELISA）对血样进行分析。
与rK39 RDT和DAT相反，rK39 ELISA在所有三类流行程度之间均显示出显著差异，CE村庄的血清阳性率为5.21%，PE村庄为1.55%，NE村庄为0.13%。即使仅观察<10岁儿童的血清阳性率，rK39 ELISA仍能够区分有和没有持续传播的村庄。
我们的研究结果表明，rK39 ELISA是监测利什曼原虫传播最有前景的标志物。需要进一步验证，并制定切实可行、因地制宜的建议，以指导政策制定者在消除后阶段制定有意义且可持续的监测策略。
