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Comparing antigenaemia- and microfilaraemia as criteria for stopping decisions in lymphatic filariasis elimination programmes in Africa
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Stolk, Wilma A., Coffeng, Luc E., Bolay, Fatorma K., Eneanya, Obiora A., Fischer, Peter U., Hollingsworth, T. Déirdre, Koudou, Benjamin G., Méité, Aboulaye, Michael, Edwin, Prada, Joaquin M., Caja Rivera, Rocio M., Sharma, Swarnali, Touloupou, Panayiota, Weil, Gary J. and de Vlas, Sake J. (2022) Comparing antigenaemia- and microfilaraemia as criteria for stopping decisions in lymphatic filariasis elimination programmes in Africa. PLOS Neglected Tropical Diseases, 16 (12). e0010953. doi:10.1371/journal.pntd.0010953 ISSN 1935-2735.
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WRAP-Comparing-antigenaemia-and-microfilaraemia-as-criteria-for-stopping-decisions-in-lymphatic-filariasis-elimination-programmes-in-Africa-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (2026Kb) | Preview |
Official URL: https://doi.org/10.1371/journal.pntd.0010953
Abstract
Background:
Mass drug administration (MDA) is the main strategy towards lymphatic filariasis (LF) elimination. Progress is monitored by assessing microfilaraemia (Mf) or circulating filarial antigenaemia (CFA) prevalence, the latter being more practical for field surveys. The current criterion for stopping MDA requires <2% CFA prevalence in 6- to 7-year olds, but this criterion is not evidence-based. We used mathematical modelling to investigate the validity of different thresholds regarding testing method and age group for African MDA programmes using ivermectin plus albendazole.
Methodolgy/Principal findings:
We verified that our model captures observed patterns in Mf and CFA prevalence during annual MDA, assuming that CFA tests are positive if at least one adult worm is present. We then assessed how well elimination can be predicted from CFA prevalence in 6-7-year-old children or from Mf or CFA prevalence in the 5+ or 15+ population, and determined safe (>95% positive predictive value) thresholds for stopping MDA. The model captured trends in Mf and CFA prevalences reasonably well. Elimination cannot be predicted with sufficient certainty from CFA prevalence in 6-7-year olds. Resurgence may still occur if all children are antigen-negative, irrespective of the number tested. Mf-based criteria also show unfavourable results (PPV <95% or unpractically low threshold). CFA prevalences in the 5+ or 15+ population are the best predictors, and post-MDA threshold values for stopping MDA can be as high as 10% for 15+. These thresholds are robust for various alternative assumptions regarding baseline endemicity, biological parameters and sampling strategies.
Conclusions/Significance:
For African areas with moderate to high pre-treatment Mf prevalence that have had 6 or more rounds of annual ivermectin/albendazole MDA with adequate coverage, we recommend to adopt a CFA threshold prevalence of 10% in adults (15+) for stopping MDA. This could be combined with Mf testing of CFA positives to ensure absence of a significant Mf reservoir for transmission.
Item Type: | Journal Article | ||||||||||||
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Subjects: | Q Science > QP Physiology R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology |
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Divisions: | Faculty of Science, Engineering and Medicine > Science > Statistics | ||||||||||||
SWORD Depositor: | Library Publications Router | ||||||||||||
Library of Congress Subject Headings (LCSH): | Drugs -- Administration, Lymphatics -- Diseases -- Treatment, Filariasis -- Treatment | ||||||||||||
Journal or Publication Title: | PLOS Neglected Tropical Diseases | ||||||||||||
Publisher: | Public Library of Science | ||||||||||||
ISSN: | 1935-2735 | ||||||||||||
Official Date: | 12 December 2022 | ||||||||||||
Dates: |
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Volume: | 16 | ||||||||||||
Number: | 12 | ||||||||||||
Number of Pages: | 15 | ||||||||||||
Article Number: | e0010953 | ||||||||||||
DOI: | 10.1371/journal.pntd.0010953 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||
Date of first compliant deposit: | 30 January 2023 | ||||||||||||
Date of first compliant Open Access: | 30 January 2023 | ||||||||||||
RIOXX Funder/Project Grant: |
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