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Abstract
Since the launch of the Global Programme to Eliminate Lymphatic Filariasis, more than 70% of the endemic countries have implemented mass drug administration (MDA) to interrupt disease transmission. The monitoring of filarial infection in sentinel populations, particularly schoolchildren, is recommended to assess the impact of MDA. A key issue is choosing the appropriate tools for these initial assessments (to define the best intervention) and for monitoring transmission. This study compared the pre-MDA performance of five diagnostic methods, namely, thick film test, Knott's technique, filtration, Og4C3-ELISA, and the AD12-ICT card test, in schoolchildren from Brazil. Venous and capillary blood samples were collected between 11 pm and 1 am. The microfilarial loads were analyzed with a negative binomial regression, and the prevalence and associated 95% confidence intervals were estimated for all methods. The accuracies of the AD12-ICT card and Og4C3-ELISA tests were assessed against the combination of parasitological test results. A total of 805 schoolchildren were examined. The overall and stratified prevalence by age group and gender detected by Og4C3-ELISA and AD12-ICT were markedly higher than the prevalence estimated by the parasitological methods. The sensitivity of the AD12-ICT card and Og4C3-ELISA tests was approximately 100%, and the positive likelihood ratios were above 6. The specificity of the Og4C3-ELISA was higher than that of the AD12-ICT at different prevalence levels. The ICT card test should be the recommended tool for monitoring school-age populations living in areas with ongoing or completed MDA.
Highlights
Since the launch of the Global Programme to Eliminate Lymphatic Filariasis, more than 70% of the endemic countries have implemented mass drug administration (MDA) to interrupt disease transmission
Consent for taking venous blood samples was obtained from only 554 participants, all of whom were examined by Knott's concentration method, 546 by the filtration technique, and 545 by the Og4C3-ELISA test
This study assessed the accuracy of tests in detecting bancroftian filariasis in a large and representative sample of schoolchildren from an endemic area in northeastern Brazil before the initiation of MDA
Summary
Since the launch of the Global Programme to Eliminate Lymphatic Filariasis, more than 70% of the endemic countries have implemented mass drug administration (MDA) to interrupt disease transmission. The monitoring of filarial infection in sentinel populations, schoolchildren, is recommended to assess the impact of MDA. The accuracies of the AD12-ICT card and Og4C3-ELISA tests were assessed against the combination of parasitological test results. Conclusions: The ICT card test should be the recommended tool for monitoring school-age populations living in areas with ongoing or completed MDA. Of the 73 endemic countries, 56 have implemented mass drug administration (MDA) programs to interrupt disease transmission. A number of diagnostic tools designed to assess filarial infection are standardized and currently recommended by the WHO1 These tools include both parasitological methods for detecting microfilaremia and tests for detecting
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