Towards soil-transmitted helminths transmission interruption:The impact of diagnostic tools on infection prediction in a low intensity setting in Southern Mozambique

Grau-Pujol, Berta and Martí-Soler, Helena and Escola, Valdemiro and Demontis, Maria and Jamine, Jose Carlos and Gandasegui, Javier and Muchisse, Osvaldo and Cambra-Pelleja, Maria and Cossa, Anelsio and Martinez-Valladares, Maria and Sacoor, Charfudin and Van Lieshout, Lisette and Cano, Jorge and Giorgi, Emanuele and Munoz, Jose (2021) Towards soil-transmitted helminths transmission interruption:The impact of diagnostic tools on infection prediction in a low intensity setting in Southern Mozambique. PLoS Neglected Tropical Diseases, 15 (10). ISSN 1935-2727

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Abstract

World Health Organization goals against soil-transmitted helminthiases (STH) are pointing towards seeking their elimination as a public health problem: reducing to less than 2% the proportion of moderate and heavy infections. Some regions are reaching WHO goals, but transmission could rebound if strategies are discontinued without an epidemiological evaluation. For that, sensitive diagnostic methods to detect low intensity infections and localization of ongoing transmission are crucial. In this work, we estimated and compared the STH infection as obtained by different diagnostic methods in a low intensity setting. We conducted a cross-sectional study enrolling 792 participants from a district in Mozambique. Two stool samples from two consecutive days were collected from each participant. Samples were analysed by Telemann, Kato-Katz and qPCR for STH detection. We evaluated diagnostic sensitivity using a composite reference standard. By geostatistical methods, we estimated neighbourhood prevalence of at least one STH infection for each diagnostic method. We used environmental, demographical and socioeconomical indicators to account for any existing spatial heterogeneity in infection. qPCR was the most sensitive technique compared to composite reference standard: 92% (CI: 83%– 97%) for A. lumbricoides, 95% (CI: 88%– 98%) for T. trichiura and 95% (CI: 91%– 97%) for hookworm. qPCR also estimated the highest neighbourhood prevalences for at least one STH infection in a low intensity setting. While 10% of the neighbourhoods showed a prevalence above 20% when estimating with single Kato-Katz from one stool and Telemann from one stool, 86% of the neighbourhoods had a prevalence above 20% when estimating with qPCR. In low intensity settings, STH estimated prevalence of infection may be underestimated if based on Kato-Katz. qPCR diagnosis outperformed the microscopy methods. Thus, implementation of qPCR based predictive maps at STH control and elimination programmes would disclose hidden transmission and facilitate targeted interventions for transmission interruption.

Item Type:
Journal Article
Journal or Publication Title:
PLoS Neglected Tropical Diseases
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/3000
Subjects:
ID Code:
161515
Deposited By:
Deposited On:
26 Oct 2021 13:00
Refereed?:
Yes
Published?:
Published
Last Modified:
19 Nov 2021 12:05