Abstract
Antifilarial antibody testing has been established as a sensitive and specific method of diagnosing lymphatic filariasis. However, the development of serological responses to specific filarial antigens and their relationship to acquisition of infection is poorly understood. In order to evaluate whether the development of antigen specific antifilarial antibodies precedes microfilaremia and antigenemia, we compared the antibody responses of serum samples collected between 1990 and 1999 from a cohort of 142 Haitian children followed longitudinally. Antigen status was determined using the Og4C3 ELISA and the presence of microfilaremia was detected using microscopy. Antibody responses to Wb123, a Wuchereria bancrofti L3 antigen, were measured using a Luciferase Immunoprecipitation System (LIPS) assay. Antibody responses to Bm14 and Bm33, Brugia malayi antigens and to a major surface protein (WSP) from Wolbachia were analyzed using a multiplex bead assay. Over follow-up, 80 (56%) of the children became antigen-positive and 30 (21%) developed microfilaremia. Detectable antibody responses to Bm14, Bm33, Wb123, and WSP developed in 95%, 100%, 92%, and 29% of children, respectively. With the exception of WSP, the development of antibody responses generally preceded detection of filarial antigen. Our results show that antifilarial antibody responses can serve as an important epidemiological indicator in a sentinel population of young children and thus, may be valuable as tool for surveillance in the context of lymphatic filariasis elimination programs.
Highlights
Lymphatic filariasis (LF) is a significant cause of global morbidity and is responsible for causing lymphedema, elephantiasis, and hydrocele
The World Health Organization estimates that there are 120 million people living in 72 countries that are infected with the filarial parasite which causes LF and 1.34 billion people worldwide who live in filariasis-endemic areas and are at risk of developing the infection [7,8]
We used samples collected over time from 142 Haitian children living in an area of intense transmission of LF to determine when they first developed antibody responses to defined filarial antigens compared to when they became infected
Summary
Lymphatic filariasis (LF) is a significant cause of global morbidity and is responsible for causing lymphedema, elephantiasis, and hydrocele. More important from the public health perspective, there is evidence that early disease in children is reversible following treatment [5]. These observations reinforce the argument for using community-based treatment strategies for the control and elimination of LF as such efforts will prevent the development of morbidity in children residing in LF-endemic areas as well as in future generations [6]. Mass drug administration (MDA) programs have been developed in more than 50 countries and more than ten countries have stopped MDA in all or part of the country after carrying out 5 or more rounds of annual MDA [8] These successes in the efforts to eliminate LF have highlighted the need for more sensitive, standardized tools to help programs define MDA endpoints and to conduct surveillance [9,10]. WHO guidelines are based on the monitoring of antigenemia in children; since antibody responses generally develop before patent infection, their detection in a serum-based assay could be used to provide an early measure of filarial exposure and ongoing transmission [10,11]
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