Mass screening and treatment on the basis of results of a Plasmodium falciparum-specific rapid diagnostic test did not reduce malaria incidence in Zanzibar.
- Cook J Department of Microbiology and Tumor and Cell Biology.
- Xu W Department of Microbiology and Tumor and Cell Biology.
- Msellem M Zanzibar Malaria Elimination Programme, Ministry of Health.
- Vonk M Department of Microbiology and Tumor and Cell Biology.
- Bergström B Department of Microbiology and Tumor and Cell Biology.
- Gosling R Global Health Group, University of California-San Francisco.
- Al-Mafazy AW Zanzibar Malaria Elimination Programme, Ministry of Health.
- McElroy P US President's Malaria Initiative and Centers for Disease Control and Prevention Tanzania Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
- Molteni F Swiss Tropical and Public Health Institute University of Basel, Switzerland.
- Abass AK Zanzibar Malaria Elimination Programme, Ministry of Health.
- Garimo I RTI International, Dar es Salaam, Tanzania.
- Ramsan M RTI International, Dar es Salaam, Tanzania.
- Ali A Zanzibar Malaria Elimination Programme, Ministry of Health.
- Mårtensson A Department of Microbiology and Tumor and Cell Biology Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm Centre for Clinical Research Sörmland, Uppsala University, Sweden.
- Björkman A Department of Microbiology and Tumor and Cell Biology.
- 2014-11-28
Published in:
- The Journal of infectious diseases. - 2015
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium vivax
Zanzibar
diagnostic tests
malaria elimination
mass screening and treatment
molecular methods
subpatent
Adolescent
Adult
Aged
Aged, 80 and over
Antimalarials
Child
Child, Preschool
Female
Humans
Incidence
Infant
Malaria, Falciparum
Male
Mass Screening
Middle Aged
Plasmodium falciparum
Polymerase Chain Reaction
Seasons
Sensitivity and Specificity
Tanzania
Young Adult
English
BACKGROUND
Seasonal increases in malaria continue in hot spots in Zanzibar. Mass screening and treatment (MSAT) may help reduce the reservoir of infection; however, it is unclear whether rapid diagnostic tests (RDTs) detect a sufficient proportion of low-density infections to influence subsequent transmission.
METHODS
Two rounds of MSAT using Plasmodium falciparum-specific RDT were conducted in 5 hot spots (population, 12 000) in Zanzibar in 2012. In parallel, blood samples were collected on filter paper for polymerase chain reaction (PCR) analyses. Data on confirmed malarial parasite infections from health facilities in intervention and hot spot control areas were monitored as proxy for malaria transmission.
RESULTS
Approximately 64% of the population (7859) were screened at least once. P. falciparum prevalence, as measured by RDT, was 0.2% (95% confidence interval [CI], .1%-.3%) in both rounds, compared with PCR measured prevalences (for all species) of 2.5% (95% CI, 2.1%-2.9%) and 3.8% (95% CI, 3.2%-4.4%) in rounds 1 and 2, respectively. Two fifths (40%) of infections detected by PCR included non-falciparum species. Treatment of RDT-positive individuals (4% of the PCR-detected parasite carriers) did not reduce subsequent malaria incidence, compared with control areas.
CONCLUSIONS
Highly sensitive point-of-care diagnostic tools for detection of all human malaria species are needed to make MSAT an effective strategy in settings where malaria elimination programs are in the pre-elimination phase.
Seasonal increases in malaria continue in hot spots in Zanzibar. Mass screening and treatment (MSAT) may help reduce the reservoir of infection; however, it is unclear whether rapid diagnostic tests (RDTs) detect a sufficient proportion of low-density infections to influence subsequent transmission.
METHODS
Two rounds of MSAT using Plasmodium falciparum-specific RDT were conducted in 5 hot spots (population, 12 000) in Zanzibar in 2012. In parallel, blood samples were collected on filter paper for polymerase chain reaction (PCR) analyses. Data on confirmed malarial parasite infections from health facilities in intervention and hot spot control areas were monitored as proxy for malaria transmission.
RESULTS
Approximately 64% of the population (7859) were screened at least once. P. falciparum prevalence, as measured by RDT, was 0.2% (95% confidence interval [CI], .1%-.3%) in both rounds, compared with PCR measured prevalences (for all species) of 2.5% (95% CI, 2.1%-2.9%) and 3.8% (95% CI, 3.2%-4.4%) in rounds 1 and 2, respectively. Two fifths (40%) of infections detected by PCR included non-falciparum species. Treatment of RDT-positive individuals (4% of the PCR-detected parasite carriers) did not reduce subsequent malaria incidence, compared with control areas.
CONCLUSIONS
Highly sensitive point-of-care diagnostic tools for detection of all human malaria species are needed to make MSAT an effective strategy in settings where malaria elimination programs are in the pre-elimination phase.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1093/infdis/jiu655
- PMID 25429102
- Persistent URL
- https://sonar.ch/global/documents/232072
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