Island-Wide Surveillance of Gastrointestinal Protozoan Infection on Fiji by Expanding Lymphatic Filariasis Transmission Assessment Surveys as an Access Platform.

Sung Hye Kim,Jaco J Verweij,Sung-Tae Hong,Nemani Talemaitoga,Min-Ho Choi,John H Lowry,Meleresita Rainima-Qaniuci,J Russell Stothard,Mike Kama,Louise Kelly-Hope,Eric Rafai,Milika Rinamalo

doi:10.4269/ajtmh.17-0559

Abstract

.As part of lymphatic filariasis (LF) transmission assessment surveys (TAS) on Fiji, an island-wide assessment of gastrointestinal protozoan infection was performed by inspection of a concomitant stool sample collection to investigate the distribution of parasitic protozoa. All grade 1 and 2 students of 69 schools on the two main islands were targeted in two phases (one in the Western Division and the other in the Central and Northern Divisions, except Taveuni sub-Division of Northern), where fecal samples of 1,800 students were available for coproscopy using formalin-ether-acetate concentration. The overall prevalence of Giardia infection was 1.6%, having 2.2% in Western and 0.8% in Central/Northern Divisions (P = 0.094). The school-level prevalence of giardiasis ranged from 0% to 15.4%, and hotspot analysis using the Getis-Ord Gi* method detected spatial heterogeneity of giardiasis prevalence in schools around Lautoka (Z-score = 3.36, P value < 0.05), an area affected by Cyclone Kofi in February 2014. Any protozoan infection prevalence was 4.9% in Western and 4.4% in Central/Northern Divisions (P = 0.825). Real-time polymerase chain reaction analysis to confirm the findings from a parasitological examination of a 10% stool archive in 95% ethanol from Western Division revealed an elevated prevalence of giardiasis up to 22.4%, the presence of Entamoeba histolytica, and the absence of Cryptosporidium parvum. Obtaining stool samples alongside LF TAS is a convenient access platform for cosurveillance of gastrointestinal protozoan infection and has pinpointed hitherto unknown hotspots of giardiasis in urban city centers of Fiji. This calls for greater attention to apply tailored water, sanitation and hygiene measures for the control of these parasites.

Highlights

Oceania is a region of tropical and subtropical islands in the Pacific Ocean where one-quarter of the population is living in poverty, which places them at an increased risk of several neglected tropical diseases.[1]
All grade 1 and 2 students of 69 schools on the two main islands were targeted in two phases, where fecal samples of 1,800 students were available for coproscopy using formalin-etheracetate concentration
Real-time polymerase chain reaction analysis to confirm the findings from a parasitological examination of a 10% stool archive in 95% ethanol from Western Division revealed an elevated prevalence of giardiasis up to 22.4%, the presence of Entamoeba histolytica, and the absence of Cryptosporidium parvum

Summary

Introduction

Oceania is a region of tropical and subtropical islands in the Pacific Ocean where one-quarter of the population is living in poverty, which places them at an increased risk of several neglected tropical diseases.[1]. Fiji is an island country with the fourth largest population in the Pacific, where up to 835,000 Fijians reside mostly on two main islands out of 100 consistently inhabited.[12] Throughout the country, there has been a long history of efforts made against LF and STH,[2] but the occurrence of gastrointestinal protozoan infection is only scantily documented and not received sufficient attention, despite inadequate sanitation and safe water coverage at the national level.[13] The infection may be persistent and as a major public health problem in this part of the world, especially in rural areas,[14] where water and sanitary conditions are worse. Previous surveillance efforts have attempted to determine the burden of the gastrointestinal protozoan infection in a few pockets of the country[15,16] but has likely underestimated its true prevalence, as solely

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