1
|
Stelzle D, Makasi CE, Schmidt V, Van Damme I, Trevisan C, Ruether C, Fleury A, Noh J, Handali S, Dorny P, Magnussen P, Zulu G, Mwape KE, Bottieau E, Gabriël S, Ngowi BJ, Winkler AS. Evaluation of a point-of-care test for the diagnosis of Taenia solium neurocysticercosis in rural southern Tanzania: a diagnostic accuracy study. Lancet Infect Dis 2024; 24:98-106. [PMID: 37660709 DOI: 10.1016/s1473-3099(23)00378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Neurocysticercosis is a common cause of epilepsy in Taenia solium-endemic areas in sub-Saharan Africa but is often undiagnosed because of an absence of affordable diagnostic tools. This study evaluated the diagnostic accuracy of a T solium cysticercosis antibody-detecting lateral-flow point-of-care assay (TS POC test) for the neuroimaging-based diagnosis of neurocysticercosis. METHODS Patients with epileptic seizures or severe progressive headache were recruited consecutively from three hospitals in southern Tanzania. All patients were tested with the TS POC test. All patients positive for cysticercosis on the TS POC test and every tenth patient who was negative for cysticercosis received a brain CT examination and underwent reference testing for T solium cysticercosis (ie, rT24H-EITB, LLGP-EITB, and antigen ELISA). The primary outcome of the study was the sensitivity of the TS POC test for the diagnosis of neurocysticercosis. FINDINGS Of the 601 recruited participants, 102 (17%) tested positive for cysticercosis with the TS POC test. Overall, 48 (62%) of the 77 patients positive for cysticercosis and five (17%) of the 29 patients negative for cysticercosis on the TS POC test had CT-confirmed neurocysticercosis. The TS POC test yielded a sensitivity of 49% (uncertainty interval [UI] 41-58) for neurocysticercosis. Sensitivity was similar to that of the rT24H-EITB (44%, UI 37-51) and the antigen ELISA (50%, 43-56). For the subset of neurocysticercosis cases with at least one active (ie, vesicular) lesion, sensitivity was above 98% for the TS POC test, the rT24H-ETIB, and the antigen ELISA. INTERPRETATION The TS POC test showed promising results for the diagnosis of neurocysticercosis in patients with vesicular lesions, which need to be confirmed in a larger study. This test could be considered to support policies on screening patients with suspected neurocysticercosis in clinical settings, which would allow appropriate referral for neuroimaging and early treatment. FUNDING German Federal Ministry of Education and Research and the European & Developing Countries Clinical Trials Partnership. TRANSLATION For the Swahili translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Dominik Stelzle
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Munich, Germany.
| | - Charles E Makasi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania; Kilimanjaro Christian Medical University, College of Tumaini University, Moshi, Tanzania
| | - Veronika Schmidt
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Inge Van Damme
- Department of Translational Physiology, Infectiology, and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Chiara Trevisan
- Department of Translational Physiology, Infectiology, and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Charlotte Ruether
- Department of Neuroradiology, RoMed Clinic Rosenheim, Rosenheim, Germany
| | - Agnès Fleury
- Department of Genomic Medicine and Environmental Toxicology, Instituto de Investigaciones Biomédicas - UNAM, Ciudad de México, Mexico; Neurocysticercosis Clinic, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - John Noh
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sukwan Handali
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Pascal Magnussen
- Department of Microbiology and Immunology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Kabemba E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sarah Gabriël
- Department of Translational Physiology, Infectiology, and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Bernard J Ngowi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania; Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
2
|
Zulu G, Sikasunge CS, Welte TM, Simuunza MC, Stelzle D, Schmidt V, Hachangu A, Mutale W, Masuku M, Chembensofu M, da Costa CP, Mwape KE, Winkler AS, Phiri IK. Epidemiology of intestinal helminthiasis with an emphasis on taeniasis in Chipata district of the Eastern province of Zambia. PLoS Negl Trop Dis 2023; 17:e0011561. [PMID: 37983246 PMCID: PMC10695371 DOI: 10.1371/journal.pntd.0011561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/04/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Intestinal helminth infections are among the most common infections worldwide and have a negative impact on the health, education, nutrition and economic development of affected populations. This study aimed to estimate the prevalence of intestinal helminthiasis, including T. solium taeniasis, using a large-scale community-based study in Chiparamba area of Chipata District in the Eastern province of Zambia. METHODS/PRINCIPAL FINDINGS A cross-sectional study was conducted between June 2019 and December 2022 in a rural community of 25 randomly selected villages known to be at risk for T. solium infection. Stool samples were examined for intestinal helminths using the formol-ether concentration technique and further tested for taeniasis by copro antigen-ELISA (copro Ag-ELISA). Descriptive statistical analyses were conducted, and associations between the disease prevalence of active infections and individual- and village-level variables were determined using the chi-square or Fisher's exact test. Predictors of an individual being positive for either taeniasis or other soil-transmitted helminths were determined using binary logistic regression. A total of 2762 stool samples were examined. One hundred ninety-five (7.1%) tested positive for at least one helminthic parasite on microscopy, with hookworm being the most frequent 84 (3.0%), followed by S. mansoni, 66 (2.4%). For taeniasis, 11 (0.4%) participants were positive for Taenia spp. microscopically, while 241 (8.7%) tested positive via copro Ag-ELISA. On bivariate analysis, male sex was significantly associated with the prevalence of intestinal parasites (p = 0.012) but not with that of taeniasis based on copro Ag-ELISA results. Village level differences were significant for infection with intestinal helminths as well as for taeniasis positivity on copro Ag-ELISA (p <0.001). CONCLUSION Intestinal helminths, including T. solium taeniasis, are prevalent in Chiparamba area of Chipata district in the eastern province of Zambia, supporting the clear need for further targeted public health interventions for surveillance and control.
Collapse
Affiliation(s)
- Gideon Zulu
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Chummy S. Sikasunge
- Department of Para-clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Tamara M. Welte
- Department of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Epilepsy Centre, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Martin C. Simuunza
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Dominik Stelzle
- Department of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Veronika Schmidt
- Department of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Alex Hachangu
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Wilbroad Mutale
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Maxwell Masuku
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Mwelwa Chembensofu
- Department of Para-clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Clarissa Prazeres da Costa
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich site, Munich, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Kabemba E. Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Andrea S. Winkler
- Department of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Isaac K. Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| |
Collapse
|
3
|
Zulu G, Mwape KE, Welte TM, Simuunza MC, Hachangu A, Mutale W, Chembensofu M, Sikasunge CS, Phiri IK, Winkler AS. Community knowledge, attitudes and practices related to Taenia solium taeniosis and cysticercosis in Zambia. PLoS Negl Trop Dis 2023; 17:e0011375. [PMID: 37561784 PMCID: PMC10443877 DOI: 10.1371/journal.pntd.0011375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/22/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Several studies on Taenia solium taeniosis / cysticercosis (TSTC) have been conducted in Zambia. However, none has assessed community knowledge, attitudes and practices related to TSTC and epilepsy. METHODS A community-based cross-sectional study was conducted between November and December 2022. The design consisted of a questionnaire-based survey conducted in each of the 25 purposely selected villages in Chiparamba Rural Health Centre (RHC) catchment area in Chipata district of the Eastern Province. RESULTS A total of 588 participants comprising 259 (44%) males and 329 (56%) females with median age of 42 years (range 17 to 92 years) were interviewed. Awareness of the signs and symptoms of taeniosis and human cysticercosis (HCC), including transmission and prevention measures was very low. Whilst the majority had heard about epilepsy, they were not able to link HCC to epilepsy. Most participants were aware of cysticerci in pigs (PCC) including its predilection sites but were not aware of mode of transmission and prevention measures. The pork meat inspection by trained professionals was also not a common practice in the area. Risk perception of T. solium infections was thus very low. Overall knowledge, attitude and practice scores related to T. solium infections and to epilepsy were very low with median scores of 0.38 (IQR 0.25-0.54) for knowledge, 0.25 (0.25-0.50) for attitudes, and 0.31 (0.25-0.44) for practices. Males had better knowledge on TSTC (median = 0.42, p = 0.017, r = 0.098) and better practice scores (median = 0.38, p = < 0.001, r = 0.154) compared to females though the effect size was small. With regards to sanitation and hygiene washing with soap and water was reported by many but only few had a hand washing facility near their latrines. CONCLUSION The study shows overall poor knowledge, attitudes and practices related to TSTC among the community of Chiparamba RHC in Chipata district of the Eastern Province of Zambia. This poses a serious challenge for control and elimination of T. solium infections and thus efforts to improve knowledge, attitudes and practices should be made using a One Health approach for the control and elimination of TSTC. Educational programs about TSTC transmission, signs and symptoms, prevention, management and control need to be scaled up in the study area and Zambia as a whole.
Collapse
Affiliation(s)
- Gideon Zulu
- Ministry of Health, Government of the Republic of Zambia
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Kabemba E. Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Tamara M. Welte
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Munich, Germany
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Martin C. Simuunza
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Alex Hachangu
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Wilbroad Mutale
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mwelwa Chembensofu
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Chummy S. Sikasunge
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Isaac K. Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Andrea S. Winkler
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Zulu G, Stelzle D, Mwape KE, Welte TM, Strømme H, Mubanga C, Mutale W, Abraham A, Hachangu A, Schmidt V, Sikasunge CS, Phiri IK, Winkler AS. The epidemiology of human Taenia solium infections: A systematic review of the distribution in Eastern and Southern Africa. PLoS Negl Trop Dis 2023; 17:e0011042. [PMID: 37000841 PMCID: PMC10096517 DOI: 10.1371/journal.pntd.0011042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/12/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023] Open
Abstract
Background
Taenia solium is a tapeworm that causes taeniosis in humans and cysticercosis in humans and pigs. Within Eastern and Southern Africa (ESA), information on the presence of human taeniosis and cysticercosis seems scarce. This systematic review aimed to describe the current information available and gaps in the epidemiology of human T. solium infections in ESA.
Methods/Principle findings
Scientific literature published between 1st January 2000 and 20th June 2022 in international databases [MEDLINE (Ovid), Embase (Ovid), Global Health (Ovid), Scopus (Elsevier), African Index Medicus (via WHO Global Index Medicus), and Open Grey] was systematically reviewed for ESA. The study area included 27 countries that make up the ESA region. Information on either taeniosis, cysticercosis or NCC was available for 16 of 27 countries within the region and a total of 113 reports were retained for the review. Most case reports for cysticercosis and NCC were from South Africa, while Tanzania had the most aggregated cysticercosis reports. Eleven countries reported on NCC with seven countries reporting data on NCC and epilepsy. Unconfirmed human T. solium taeniosis cases were reported in nine countries while two countries (Madagascar and Zambia) reported confirmed T. solium cases. The cysticercosis seroprevalence ranged between 0.7–40.8% on antigen (Ag) ELISA and between 13.1–45.3% on antibody (Ab) ELISA. Based on immunoblot tests the Ab seroprevalence was between 1.7–39.3%, while the proportion of NCC-suggestive lesions on brain CT scans was between 1.0–76% depending on the study population. The human taeniosis prevalence based on microscopy ranged between 0.1–14.7%. Based on Copro Ag-ELISA studies conducted in Kenya, Rwanda, Tanzania, and Zambia, the highest prevalence of 19.7% was reported in Kenya.
Conclusions
Despite the public health and economic impact of T. solium in ESA, there are still large gaps in knowledge about the occurrence of the parasite, and the resulting One Health disease complex, and monitoring of T. solium taeniosis and cysticercosis is mostly not in place.
Collapse
|
5
|
Stelzle D, Makasi C, Schmidt V, Trevisan C, Van Damme I, Ruether C, Dorny P, Magnussen P, Zulu G, Mwape KE, Bottieau E, Prazeres da Costa C, Prodjinotho UF, Carabin H, Jackson E, Fleury A, Gabriël S, Ngowi BJ, Winkler AS. Efficacy and safety of antiparasitic therapy for neurocysticercosis in rural Tanzania: a prospective cohort study. Infection 2023:10.1007/s15010-023-02021-y. [PMID: 36961623 PMCID: PMC10037392 DOI: 10.1007/s15010-023-02021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Neurocysticercosis is common in regions endemic for Taenia solium. Active-stage neurocysticercosis can be treated with antiparasitic medication, but so far no study on efficacy and safety has been conducted in Africa. METHODS We conducted a prospective cohort study on treatment of neurocysticercosis in Tanzania between August 2018 and January 2022. Patients were initially treated with albendazole (15 mg/kg/d) for 10 days and followed up for 6 months. Additionally in July 2021, all participants who then still had cysts were offered a combination therapy consisting of albendazole (15 mg/kg/d) and praziquantel (50 mg/kg/d). Antiparasitic treatment was accompanied by corticosteroid medication and anti-seizure medication if the patient had experienced epileptic seizures before treatment. RESULTS Sixty-three patients were recruited for this study, of whom 17 had a complete follow-up after albendazole monotherapy. These patients had a total of 138 cysts at baseline, of which 58 (42%) had disappeared or calcified by the end of follow-up. The median cyst reduction was 40% (interquartile range 11-63%). Frequency of epileptic seizures reduced considerably (p < 0.001). Three patients had all active cysts resolved or calcified and of the remaining 14, eight received the combination therapy which resolved 63 of 66 cysts (95%). Adverse events were infrequent and mild to moderate during both treatment cycles. CONCLUSION Cyst resolution was unsatisfactory with albendazole monotherapy but was very high when it was followed by a combination of albendazole and praziquantel.
Collapse
Affiliation(s)
- D Stelzle
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.
- Department of Neurology, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.
| | - C Makasi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
| | - V Schmidt
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Department of Neurology, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - C Trevisan
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - I Van Damme
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- Service of Foodborne Pathogens, Sciensano, Brussels, Belgium
| | - C Ruether
- Department of Neuroradiology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - P Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - P Magnussen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G Zulu
- Ministry of Health, Lusaka, Zambia
| | - K E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - E Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - C Prazeres da Costa
- Institute for Medical Microbiology, Immunology and Hygiene, Center for Global Health, Technical University of Munich, Munich, Germany
- German Center for Infection and Research (DZIF), Munich, Germany
| | - U F Prodjinotho
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Center for Global Health, Technical University of Munich, Munich, Germany
| | - H Carabin
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'université de Montréal, Montréal, QC, H3N 1X9, Canada
- Centre de Recherche en Santé Publique (CReSP) de l'université de Montréal et du CIUSS du Centre Sud de Montréal, Montréal, QC, H3N 1X9, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
| | - E Jackson
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
- Centre de Recherche en Santé Publique (CReSP) de l'université de Montréal et du CIUSS du Centre Sud de Montréal, Montréal, QC, H3N 1X9, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
| | - A Fleury
- Instituto de Investigaciones Biomédicas-UNAM/Instituto Nacional de Neurología y Neurocirugía/Facultad de Medicina-UNAM, Ciudad de Mexico, Mexico
| | - S Gabriël
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - B J Ngowi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allies Sciences, Mbeya, Tanzania
| | - A S Winkler
- Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| |
Collapse
|
6
|
Sadlowski H, Schmidt V, Hiss J, Kuehn JA, Schneider CG, Zulu G, Hachangu A, Sikasunge CS, Mwape KE, Winkler AS, Schuelke M. Diagnosis of Taenia solium infections based on "mail order" RNA-sequencing of single tapeworm egg isolates from stool samples. PLoS Negl Trop Dis 2021; 15:e0009787. [PMID: 34890398 PMCID: PMC8694474 DOI: 10.1371/journal.pntd.0009787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/22/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Combined community health programs aiming at health education, preventive anti-parasitic chemotherapy, and vaccination of pigs have proven their potential to regionally reduce and even eliminate Taenia solium infections that are associated with a high risk of neurological disease through ingestion of T. solium eggs. Yet it remains challenging to target T. solium endemic regions precisely or to make exact diagnoses in individual patients. One major reason is that the widely available stool microscopy may identify Taenia ssp. eggs in stool samples as such, but fails to distinguish between invasive (T. solium) and less invasive Taenia (T. saginata, T. asiatica, and T. hydatigena) species. The identification of Taenia ssp. eggs in routine stool samples often prompts a time-consuming and frequently unsuccessful epidemiologic workup in remote villages far away from a diagnostic laboratory. Here we present "mail order" single egg RNA-sequencing, a new method allowing the identification of the exact Taenia ssp. based on a few eggs found in routine diagnostic stool samples. We provide first T. solium transcriptome data, which show extremely high mitochondrial DNA (mtDNA) transcript counts that can be used for subspecies classification. "Mail order" RNA-sequencing can be administered by health personnel equipped with basic laboratory tools such as a microscope, a Bunsen burner, and access to an international post office for shipment of samples to a next generation sequencing facility. Our suggested workflow combines traditional stool microscopy, RNA-extraction from single Taenia eggs with mitochondrial RNA-sequencing, followed by bioinformatic processing with a basic laptop computer. The workflow could help to better target preventive healthcare measures and improve diagnostic specificity in individual patients based on incidental findings of Taenia ssp. eggs in diagnostic laboratories with limited resources.
Collapse
Affiliation(s)
- Henrik Sadlowski
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Veronika Schmidt
- Department of Neurology, Centre for Global Health, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jonathan Hiss
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Johannes A. Kuehn
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Christian G. Schneider
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Gideon Zulu
- School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Alex Hachangu
- School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | | | - Kabemba E. Mwape
- School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Andrea S. Winkler
- Department of Neurology, Centre for Global Health, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Markus Schuelke
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuropediatrics, Berlin, Germany
- * E-mail:
| |
Collapse
|
7
|
Mubanga C, Trevisan C, Van Damme I, Schmidt V, Phiri IK, Zulu G, Noh J, Handali S, Mambo R, Chembensofu M, Masuku M, Reynders D, Jansen F, Bottieau E, Magnussen P, Winkler AS, Dorny P, Mwape KE, Gabriel S. Challenges Encountered When Evaluating an Antibody-Detecting Point-of-Care Test for Taeniosis in an Endemic Community in Zambia: A Prospective Diagnostic Accuracy Study. Diagnostics (Basel) 2021; 11:diagnostics11112039. [PMID: 34829386 PMCID: PMC8625551 DOI: 10.3390/diagnostics11112039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
Taenia solium taeniosis diagnosis is challenging because current tests perform sub-optimally and/or are expensive, require sophisticated equipment, infrastructure and trained manpower, and therefore are not community deployable. A recently-developed, multi-strip, T. solium point-of-care test (TS POC) for simultaneous detection of tapeworm (TS POC T) and cysticercus (TS POC CC) human antibodies was evaluated for diagnostic accuracy on consecutively recruited community participants in Sinda district, Zambia. All participants were tested using the TS POC test. All test-positives and 20% of the test-negative participants were invited to give a blood and stool sample for reference testing. Three different reference tests were used for taeniosis diagnosis: recombinant rES33 enzyme-linked immunoelectrotransfer blot (rES33 EITB), copro PCR and copro Ag ELISA. Bayesian analysis with probabilistic constraints was used to estimate sensitivity and specificity. In total, 1254 participants were tested with the TS POC test, of whom 13 tested positive using the TS POC T. Based on 161 participants with complete data, the estimated sensitivity and specificity for the TS POC T test were 38% (95% CI: 5–93%) and 99% (95% CI: 98–100%), respectively. The challenge of highly variable inter-assay performance is highlighted. We recommend either increasing the sensitivity or redesigning the test.
Collapse
Affiliation(s)
- Chishimba Mubanga
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia or (C.M.); (I.K.P.); (G.Z.); (R.M.); (M.C.); (M.M.); (K.E.M.)
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (C.T.); (I.V.D.)
| | - Chiara Trevisan
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (C.T.); (I.V.D.)
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (F.J.); (P.D.)
| | - Inge Van Damme
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (C.T.); (I.V.D.)
| | - Veronika Schmidt
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, 81675 Munich, Germany; (V.S.); (A.S.W.)
- Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Isaac K. Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia or (C.M.); (I.K.P.); (G.Z.); (R.M.); (M.C.); (M.M.); (K.E.M.)
| | - Gideon Zulu
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia or (C.M.); (I.K.P.); (G.Z.); (R.M.); (M.C.); (M.M.); (K.E.M.)
- Eastern Provincial Health Office, Ministry of Health, Chipata 510023, Zambia
| | - John Noh
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (J.N.); (S.H.)
| | - Sukwan Handali
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (J.N.); (S.H.)
| | - Richard Mambo
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia or (C.M.); (I.K.P.); (G.Z.); (R.M.); (M.C.); (M.M.); (K.E.M.)
- Eastern Provincial Health Office, Ministry of Health, Chipata 510023, Zambia
| | - Mwelwa Chembensofu
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia or (C.M.); (I.K.P.); (G.Z.); (R.M.); (M.C.); (M.M.); (K.E.M.)
| | - Maxwell Masuku
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia or (C.M.); (I.K.P.); (G.Z.); (R.M.); (M.C.); (M.M.); (K.E.M.)
| | - Dries Reynders
- Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Famke Jansen
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (F.J.); (P.D.)
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Andrea S. Winkler
- Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, 81675 Munich, Germany; (V.S.); (A.S.W.)
- Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (F.J.); (P.D.)
| | - Kabemba E. Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia or (C.M.); (I.K.P.); (G.Z.); (R.M.); (M.C.); (M.M.); (K.E.M.)
| | - Sarah Gabriel
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (C.T.); (I.V.D.)
- Correspondence:
| |
Collapse
|
8
|
Trevisan C, Damme IV, Ngowi B, Schmidt V, Stelzle D, Møller KS, Kabululu M, Makasi CE, Magnussen P, Bottieau E, Abatih E, Johansen MV, Ngowi H, Ndawi B, Mwape KE, Zulu G, Dorny P, Winkler AS, Gabriël S. Trial Design of a Prospective Multicenter Diagnostic Accuracy Study of a Point-of-Care Test for the Detection of Taenia solium Taeniosis and Neurocysticercosis in Hospital-Based Settings in Tanzania. Diagnostics (Basel) 2021; 11:diagnostics11091528. [PMID: 34573870 PMCID: PMC8470609 DOI: 10.3390/diagnostics11091528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/20/2022] Open
Abstract
Taenia solium diagnosis is challenging as trained personnel, good diagnostic tools, and infrastructure is lacking in resource-poor areas. This paper aims to describe the study trial design adopted to evaluate a newly developed rapid point-of-care test that simultaneously detects taeniosis and neurocysticercosis (TS POC) in three district hospitals in Tanzania. The two-stage design included three types of patients: patients with specific neurological signs and symptoms (group 1); patients with complaints compatible with intestinal worm infections (group 2); patients with other symptom(s) (group 3). For group 1, all patients were tested using the TS POC test (stage 1), after which all positive, and a subset of negative, patients were selected for laboratory reference tests, clinical examination, and a brain computed tomography (CT) scan (stage 2). For groups 2 and 3, a similar design was adopted, but clinical examination and a brain CT scan (stage 2) were only performed in patients who were TS POC test-positive for cysticercosis. Due to the lack of a gold standard, a Bayesian approach was used to determine test accuracy for taeniosis and cysticercosis. For neurocysticercosis, a composite case definition was used as the reference standard. If successful, this study will help the future developments (commercialization and implementation) of the rapid test and improve patient management and disease prevention.
Collapse
Affiliation(s)
- Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium;
- Correspondence: (C.T.); (S.G.)
| | - Inge Van Damme
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium;
| | - Bernard Ngowi
- National Institute for Medical Research, Muhimbili Medical Research Centre Dar es Salaam, Dar es Salaam 11101, Tanzania; (B.N.); (C.E.M.)
- Department of Public Health, University of Dar es Salaam Tanzania, Dar es Salaam 65015, Tanzania
| | - Veronika Schmidt
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (V.S.); (D.S.); (A.S.W.)
- Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Dominik Stelzle
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (V.S.); (D.S.); (A.S.W.)
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany
| | - Karen Schou Møller
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark;
| | - Mwemezi Kabululu
- Tanzania Livestock Research Institute (TALIRI)-Uyole, Mbeya P.O. Box 6191, Tanzania;
| | - Charles E. Makasi
- National Institute for Medical Research, Muhimbili Medical Research Centre Dar es Salaam, Dar es Salaam 11101, Tanzania; (B.N.); (C.E.M.)
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
| | - Emmanuel Abatih
- Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, 9000 Ghent, Belgium;
| | | | - Helena Ngowi
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro P.O. Box 3021, Tanzania;
| | | | - Kabemba E. Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia; (K.E.M.); (G.Z.)
| | - Gideon Zulu
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia; (K.E.M.); (G.Z.)
- Eastern Provincial Health Office, Ministry of Health, Lusaka 30205, Zambia
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
| | - Andrea S. Winkler
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (V.S.); (D.S.); (A.S.W.)
- Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium;
- Correspondence: (C.T.); (S.G.)
| | | |
Collapse
|
9
|
Mubanga C, Mwape KE, Phiri IK, Trevisan C, Kabululu M, Zulu G, Van Damme I, Schmidt V, Dorny P, Gabriël S. Operational characteristics of an antibody detecting point of care test for Taenia solium infections in a community and hospital setting. BMC Infect Dis 2021; 21:607. [PMID: 34172004 PMCID: PMC8235832 DOI: 10.1186/s12879-021-06320-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/09/2021] [Indexed: 01/22/2023] Open
Abstract
Background Diagnostic test evaluation includes measures of performance and assessment of operational characteristics. The latter focuses on end-user understanding of instructions to perform the test, ease of use, test turnaround time and ease of result interpretation. This study aimed to assess user comprehension of training for and ease of use of a Taenia solium point of care test (TS POC) evaluated in a community and hospital setting in Zambia and Tanzania, respectively. Methods The TS POC is a three-step in-house-produced rapid diagnostic test (RDT) for the simultaneous detection of taeniosis (TST) and cysticercosis (TSCC) antibodies. Data collected by administering questionnaires to 29 end-users and from the main evaluation database was analyzed quantitatively. Results End-users (28/29, 97%) perceived that the training they received for performing the test was sufficient. They performed 4080 tests, of which 80 were invalid. The community-based study and TST tests had higher invalid rates. The overall result interpretation was within the acceptable range of RDTs with an overall disagreement between readers of 3.3%. The Kappa coefficient of agreement was 85 and 82% for TSCC and TST, respectively. There was more disagreement among readers in the community-based study. Conclusion End-users rated the TS POC kit moderate in terms of ease of use citing long test turnaround time and difficulties in using the blood transfer device. Overall, the operational performance of the TS POC kit and end-users was within the established acceptable performance range. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06320-3.
Collapse
Affiliation(s)
- Chishimba Mubanga
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia. .,Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Kabemba E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Isaac K Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mwemezi Kabululu
- Tanzania Livestock Research Institute (TALIRI) - Uyole, P. O. Box 6191, Mbeya, Tanzania
| | - Gideon Zulu
- Provincial Health Office, Ministry of Health, Chipata, Zambia
| | - Inge Van Damme
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Veronika Schmidt
- Department of Neurology, Centre for Global Health, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Virology, Parasitology, and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
10
|
Van Damme I, Trevisan C, Mwape KE, Schmidt V, Magnussen P, Zulu G, Mubanga C, Stelzle D, Bottieau E, Abatih E, Phiri IK, Johansen MV, Chabala C, Winkler AS, Dorny P, Gabriël S. Trial Design for a Diagnostic Accuracy Study of a Point-of-Care Test for the Detection of Taenia solium Taeniosis and (Neuro)Cysticercosis in Community Settings of Highly Endemic, Resource-Poor Areas in Zambia: Challenges and Rationale. Diagnostics (Basel) 2021; 11:diagnostics11071138. [PMID: 34206654 PMCID: PMC8306489 DOI: 10.3390/diagnostics11071138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 11/16/2022] Open
Abstract
Field-applicable, high-quality, and low-cost diagnostic tools are urgently needed for Taenia solium. The aim of this paper is to describe the design, challenges, and rationale for the design of a diagnostic accuracy study in low-resource community settings in Zambia. The trial was designed as a prospective study with a two-stage design to evaluate a new point-of-care test (TS POC) for the detection of taeniosis and (neuro)cysticercosis. Participants within randomly selected households were tested with the TS POC test (index test). Participants who tested TS POC positive for taeniosis and/or cysticercosis and a subset of the negatives were requested to give blood and stool samples for reference testing, and to undergo clinical examination and a cerebral CT scan. The difficulties of conducting a clinical trial in settings with limited research and neuroimaging infrastructure as well as peculiarities specifically related to the disease (low prevalence of taeniosis and the lack of a gold standard) were taken into consideration for the design of this study. The two-stage design increased the efficiency of the study by reducing the number of samples, clinical examinations, and CT scans. Simplified flows and sampling processes were preferred over complex follow-up and randomization systems, aiming to reduce bias and increase the generalizability of the study.
Collapse
Affiliation(s)
- Inge Van Damme
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (C.T.); (C.M.)
- Correspondence: (I.V.D.); (S.G.)
| | - Chiara Trevisan
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (C.T.); (C.M.)
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
| | - Kabemba E. Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia; (K.E.M.); (G.Z.); (I.K.P.)
| | - Veronika Schmidt
- Department of Neurology, Center for Global Health, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (V.S.); (D.S.); (A.S.W.)
- Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Gideon Zulu
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia; (K.E.M.); (G.Z.); (I.K.P.)
- Ministry of Health, Lusaka 10101, Zambia
| | - Chishimba Mubanga
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (C.T.); (C.M.)
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia; (K.E.M.); (G.Z.); (I.K.P.)
| | - Dominik Stelzle
- Department of Neurology, Center for Global Health, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (V.S.); (D.S.); (A.S.W.)
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
| | - Emmanuel Abatih
- Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Isaac K. Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia; (K.E.M.); (G.Z.); (I.K.P.)
| | | | - Chishala Chabala
- Paediatrics and Child Health, Children’s Hospital, University Teaching Hospitals, Lusaka 10101, Zambia;
- Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka 10101, Zambia
| | - Andrea S. Winkler
- Department of Neurology, Center for Global Health, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (V.S.); (D.S.); (A.S.W.)
- Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (C.T.); (C.M.)
- Correspondence: (I.V.D.); (S.G.)
| | | |
Collapse
|
11
|
Gabriël S, Mwape KE, Hobbs EC, Devleesschauwer B, Van Damme I, Zulu G, Mwelwa C, Mubanga C, Masuku M, Mambwe M, De Coster T, Phiri IK, Berkvens DL, Colston A, Bottieau E, Speybroeck N, Ketzis JK, Willingham AL, Trevisan C, Dorny P. Evidence for potential elimination of active Taenia solium transmission in Africa? N Engl J Med 2020; 383:396-397. [PMID: 32699455 PMCID: PMC7289521 DOI: 10.1056/nejmc1909955] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Emma C Hobbs
- Ross University School of Veterinary Medicine, Basseterre, St. Kitts
| | | | | | | | | | | | | | | | | | | | | | - Angie Colston
- Global Alliance for Livestock Veterinary Medicines, Nairobi, Kenya
| | | | | | - Jennifer K Ketzis
- Ross University School of Veterinary Medicine, Basseterre, St. Kitts
| | - A Lee Willingham
- Ross University School of Veterinary Medicine, Basseterre, St. Kitts
| | | | - Pierre Dorny
- Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
12
|
Hobbs EC, Mwape KE, Phiri AM, Mambwe M, Mambo R, Thys S, Zulu G, Chembensofu M, Trevisan C, Van Damme I, Phiri IK, Devleesschauwer B, Ketzis J, Dorny P, Willingham AL, Gabriël S. Perceptions and acceptability of piloted Taenia solium control and elimination interventions in two endemic communities in eastern Zambia. Transbound Emerg Dis 2020; 67 Suppl 2:69-81. [PMID: 31231968 PMCID: PMC7496623 DOI: 10.1111/tbed.13214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/23/2022]
Abstract
Infections with Taenia solium cause significant public health and economic losses worldwide. Despite effective control tools, long-term sustained control/elimination of the parasite has not been demonstrated to date. Success of intervention programs is dependent on their acceptability to local communities. Focus group discussions (FGDs) and questionnaires (QS) were conducted in two study communities in eastern Zambia to assess local perceptions and acceptance of two piloted intervention strategies: one targeting pigs only ('control' study arm), and one integrated human- and pig-based ('elimination') strategy. QS (n = 227) captured data regarding participation in project activities, knowledge and perceptions of T. solium and of the interventional drugs used in the study. FGDs (n = 18) discussed perceived advantages and disadvantages of the interventions and of the project's delivery and value. QS data revealed 67% of respondents participated in at least one educational activity, and 80% correctly identified at least one disease targeted by the education. All elimination study arm respondents (n = 113) had taken the human treatment, and 98% intended to do so next time. Most (70%) indicated willingness to pay for future treatments (median 0.20 USD per dose). Of pig-owning respondents, 11/12 (92%) had allowed their pigs to be treated/vaccinated and all intended to do so again next time. Four pig owners indicated willingness to pay 0.10-0.50 USD per dose of treatment or vaccine. FGD feedback revealed positive perceptions of interventions; people reported improved health in themselves and their pigs, and fewer cysticerci in pork. Latrine use, hand washing, meat inspection and proper cooking of pork had reportedly increased since the program's inception. Preliminary assessment indicates that the piloted intervention methods are generally acceptable to the communities. The reported willingness of many respondents to pay for the medications would contribute to the feasibility of long-term, government-led T. solium intervention programs in future.
Collapse
Affiliation(s)
- Emma Clare Hobbs
- One Health Center for Zoonoses and Tropical Veterinary MedicineRoss University School of Veterinary MedicineSaint KittsWest Indies
- Institute of Tropical MedicineAntwerpBelgium
- Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | | | - Andrew M. Phiri
- School of Veterinary MedicineUniversity of ZambiaLusakaZambia
| | - Moses Mambwe
- Ministry of HealthGovernment of the Republic of ZambiaLusakaZambia
| | - Richard Mambo
- Ministry of HealthGovernment of the Republic of ZambiaLusakaZambia
| | | | - Gideon Zulu
- Ministry of HealthGovernment of the Republic of ZambiaLusakaZambia
| | | | | | - Inge Van Damme
- Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | | | | | - Jennifer Ketzis
- One Health Center for Zoonoses and Tropical Veterinary MedicineRoss University School of Veterinary MedicineSaint KittsWest Indies
| | - Pierre Dorny
- Institute of Tropical MedicineAntwerpBelgium
- Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Arve Lee Willingham
- One Health Center for Zoonoses and Tropical Veterinary MedicineRoss University School of Veterinary MedicineSaint KittsWest Indies
| | - Sarah Gabriël
- Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| |
Collapse
|
13
|
Ferreras E, Matapo B, Chizema-Kawesha E, Chewe O, Mzyece H, Blake A, Moonde L, Zulu G, Poncin M, Sinyange N, Kasese-Chanda N, Phiri C, Malama K, Mukonka V, Cohuet S, Uzzeni F, Ciglenecki I, Danovaro-Holliday MC, Luquero FJ, Pezzoli L. Delayed second dose of oral cholera vaccine administered before high-risk period for cholera transmission: Cholera control strategy in Lusaka, 2016. PLoS One 2019; 14:e0219040. [PMID: 31469853 PMCID: PMC6716633 DOI: 10.1371/journal.pone.0219040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In April 2016, an emergency vaccination campaign using one dose of Oral Cholera Vaccine (OCV) was organized in response to a cholera outbreak that started in Lusaka in February 2016. In December 2016, a second round of vaccination was conducted, with the objective of increasing the duration of protection, before the high-risk period for cholera transmission. We assessed vaccination coverage for the first and second rounds of the OCV campaign. METHODS Vaccination coverage was estimated after each round from a sample selected from targeted-areas for vaccination using a cross-sectional survey in to establish the vaccination status of the individuals recruited. The study population included all individuals older than 12 months residing in the areas targeted for vaccination. We interviewed 505 randomly selected individuals after the first round and 442 after the second round. Vaccination status was ascertained either by vaccination card or verbal reporting. Households were selected using spatial random sampling. RESULTS The vaccination coverage with two doses was 58.1% (25/43; 95%CI: 42.1-72.9) in children 1-5 years old, 59.5% (69/116; 95%CI: 49.9-68.5) in children 5-15 years old and 19.9% (56/281; 95%CI: 15.4-25.1) in adults above 15 years old. The overall dropout rate was 10.9% (95%CI: 8.1-14.1). Overall, 69.9% (n = 309/442; 95%CI: 65.4-74.1) reported to have received at least one OCV dose. CONCLUSIONS The areas at highest risk of suffering cholera outbreaks were targeted for vaccination obtaining relatively high vaccine coverage after each round. However, the long delay between doses in areas subject to considerable population movement resulted in many individuals receiving only one OCV dose. Additional vaccination campaigns may be required to sustain protection over time in case of persistence of risk. Further evidence is needed to establish a maximum optimal interval time of a delayed second dose and variations in different settings.
Collapse
Affiliation(s)
- Eva Ferreras
- World Health Organization, Lusaka, Zambia
- Epicentre, Paris, France
| | | | | | - Orbrie Chewe
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Hannah Mzyece
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | - Marc Poncin
- Médecins Sans Frontières, Geneva, Switzerland
| | - Nyambe Sinyange
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | | | | | | | | | | | - Francisco J. Luquero
- Epicentre, Paris, France
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | |
Collapse
|
14
|
Mubanga C, Mwape KE, Phiri IK, Trevisan C, Zulu G, Chabala C, van Damme I, Schmidt V, Dorny P, Gabriël S. Progress on the development of rapid diagnostic tests for foodborne neglected zoonotic helminthiases: A systematic review. Acta Trop 2019; 194:135-147. [PMID: 30946810 DOI: 10.1016/j.actatropica.2019.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/15/2019] [Accepted: 03/31/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Foodborne Neglected Zoonotic Helminths (FNZH) are parasites of both economic and public health importance. They include Taenia solium, Echinococcus granulosus sensu lato, Echinococcus multilocularis and Foodborne trematodes (FBT). FNZH are earmarked for major interventions for control, elimination and eradication. This systematic review highlights the progress towards development of rapid tests for the diagnosis of FNZH since 2010 when they were listed as neglected tropical diseases. METHODOLOGY A systematic search was conducted in three databases, World of Science, Embase and PubMed using the same search phrase. The search produced 480 hits. Three studies from back referencing were included. Only 22 of these met the inclusion criteria. Data was extracted from these and presented qualitatively. RESULTS Twenty-five rapid diagnostic tests were found to have been developed since 2010, eight for diagnosis of T. solium infections, eight for echinococcosis and nine for FBT infections. The rapid tests for diagnosing T. solium infections included six antibody detecting and two antigen detecting tests. They constitute a combination among them, with some tests providing qualitative, others quantitative results. Similarly, seven out of the eight rapid tests developed for Echinococcus infections were antibody detecting tests save for one loop mediated isothermal amplification test. All of them were qualitative tests. For FBT infections, nine rapid tests were described; two antibody and one nucleic acid detecting test for diagnosis of Fascioliasis; three nucleic acid detecting tests for Opisthorchiasis; one antibody detecting test for Paragonimiasis; and for Clonorchiasis, one antibody and one nucleic acid detecting test. The FBT infection rapid tests were all qualitative in nature. Most of these tests have not undergone field evaluation in endemic areas where they will be used most. CONCLUSION This review describes the development and evaluation of rapid diagnostic tests, while highlighting the need for in depth validations of the tools to determine how well they can perform in endemic areas.
Collapse
Affiliation(s)
- Chishimba Mubanga
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia.
| | - Kabemba E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Isaac K Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gideon Zulu
- Provincial Medical Office, Ministry of Health, Kasama, Zambia
| | - Chishala Chabala
- Children's Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Inge van Damme
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Veronika Schmidt
- Centre for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany; Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
15
|
Hobbs EC, Mwape KE, Devleesschauwer B, Van Damme I, Krit M, Berkvens D, Zulu G, Mambwe M, Chembensofu M, Trevisan C, Baauw J, Phiri IK, Speybroeck N, Ketzis J, Dorny P, Willingham AL, Gabriël S. Effects of 'The Vicious Worm' educational tool on Taenia solium knowledge retention in Zambian primary school students after one year. PLoS Negl Trop Dis 2019; 13:e0007336. [PMID: 31107880 PMCID: PMC6544326 DOI: 10.1371/journal.pntd.0007336] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/31/2019] [Accepted: 03/27/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Taenia solium is a neglected zoonotic parasite endemic throughout many low-income countries worldwide, including Zambia, where it causes human and pig diseases with high health and socioeconomic burdens. Lack of knowledge is a recognized risk factor, and consequently targeted health educational programs can decrease parasite transmission and disease occurrence in endemic areas. Preliminary assessment of the computer-based education program 'The Vicious Worm' in rural areas of eastern Zambia indicated that it was effective at increasing knowledge of T. solium in primary school students. The aim of this study was to evaluate the impact of 'The Vicious Worm' on knowledge retention by re-assessing the same primary school students one year after the initial education workshops. METHODOLOGY/PRINCIPAL FINDINGS Follow-up questionnaires were administered in the original three primary schools in eastern Zambia in 2017, 12 months after the original workshops. In total, 86 pupils participated in the follow-up sessions, representing 87% of the initial workshop respondents. Knowledge of T. solium at 'follow-up' was significantly higher than at the initial 'pre' questionnaire administered during the Vicious Worm workshop that took place one year earlier. While some specifics of the parasite's life cycle were not completely understood, the key messages for disease prevention, such as the importance of hand washing and properly cooking pork, remained well understood by the students, even one year later. CONCLUSIONS/SIGNIFICANCE Results of this study indicate that 'The Vicious Worm' may be an effective tool for both short- and long-term T. solium education of rural primary school students in Zambia. Inclusion of educational workshops using 'The Vicious Worm' could be recommended for integrated cysticercosis control/elimination programs in sub-Saharan Africa, particularly if the content is simplified to focus on the key messages for prevention of disease transmission.
Collapse
Affiliation(s)
- Emma C. Hobbs
- Department of Biomedical Sciences, One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St Kitts, West Indies
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Kabemba Evans Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Brecht Devleesschauwer
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Inge Van Damme
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Meryam Krit
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dirk Berkvens
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gideon Zulu
- Department of Public Health, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - Moses Mambwe
- Department of Public Health, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - Mwelwa Chembensofu
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jacoba Baauw
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Isaac Khozozo Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Niko Speybroeck
- Institute for Health Research and Society, Université catholique de Louvain, Institute of Health and Society (IRSS), Brussels, Belgium
| | - Jennifer Ketzis
- Department of Biomedical Sciences, One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St Kitts, West Indies
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Arve Lee Willingham
- Department of Biomedical Sciences, One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St Kitts, West Indies
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
16
|
Mubanga C, Mwape K, Zulu G, Phiri I, Trevisan C, Dorny P, Gabriel S, Damme IV. OC 8432 EVALUATION OF AN ANTIBODY-DETECTING POINT-OF-CARE TEST FOR THE DIAGNOSIS OF TAENIA SOLIUM TAENIASIS AND NEUROCYSTICERCOSIS/CYSTICERCOSIS IN AN ENDEMIC AREA. BMJ Glob Health 2019. [DOI: 10.1136/bmjgh-2019-edc.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundTaenia solium taeniasis/(neuro)cysticercosis is a neglected parasitic zoonosis with significant economic and public health impacts. Neurocysticercosis is responsible for 30% cases of acquired epilepsy in endemic areas. Diagnosis and case management of neurocysticercosis/taeniasis in resource-limited endemic countries is challenging. Reliable, inexpensive and easy to use diagnostic tools with sufficient sensitivity and specificity are currently not available. A new point-of-care (POC) test based on recombinant rT24H and rES33 proteins developed by the Centre for Disease Control in Atlanta (US) which combines diagnosis of taeniasis and cysticercosis has been developed, however, its performance at community level is not known. The aim of this study is therefore, to evaluate the diagnostic performance of this test in a community setting.MethodsThe study site is Mtandaza community, Sinda district, Eastern Province of Zambia. The diagnostic accuracy is being evaluated for taeniasis and (neuro) cysticercosis in 1200 randomly selected participants in a community-based study. The performance characteristics (sensitivity and specificity) for neurocysticercosis will be computed by cross-tabulating of POC results with those of the ‘neurocysticercosis diagnosis’ while a Bayesian approach will be used for cysticercosis and taeniasis to compare the performance of the index test with reference tests (enzyme-linked immuno-electrotransfer blot (EITB), B158/B60 Ag-ELISA, Ab-ELISA, Copro-Ag ELISA, PCR).ResultsPreliminary results of 505 POC tests so far conducted show that 0.8% were positive for taeniasis, 9.1% for cysticercosis and, 4.6% were invalid or unclear. Except for Copro-Ag and B158/B60 Ag-ELISA for taeniasis and cysticercosis respectively, reference tests are yet to be conducted.ConclusionResults will show the diagnostic value of the POC test and its applicability for use at community level in endemic areas. If successful, implementation of the tool will enable early detection of taeniasis and suspected neurocysticercosis cases and lead to improved patient management and treatment outcomes.
Collapse
|
17
|
Hobbs EC, Mwape KE, Van Damme I, Berkvens D, Zulu G, Mambwe M, Chembensofu M, Phiri IK, Masuku M, Bottieau E, Devleesschauwer B, Speybroeck N, Colston A, Dorny P, Willingham AL, Gabriël S. Preliminary assessment of the computer-based Taenia solium educational program 'The Vicious Worm' on knowledge uptake in primary school students in rural areas in eastern Zambia. Trop Med Int Health 2018; 23:306-314. [PMID: 29314480 PMCID: PMC5888122 DOI: 10.1111/tmi.13029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The zoonotic helminth Taenia solium is endemic in Zambia, causing human (taeniasis and (neuro)cysticercosis) and pig (porcine cysticercosis) diseases with high health, social and economic burdens. We aimed to evaluate the impact of a health educational program intended to lead to powerful and cumulative improvements in knowledge, attitudes and practices that decrease parasite transmission and disease occurrence. METHODS Half-day health education workshops were conducted in three primary schools in the highly endemic Eastern Province of Zambia, using the computer-based T. solium educational program 'The Vicious Worm'. Questionnaires were administered before and after the educational component to determine the program's impact on knowledge uptake in primary school students. RESULTS In total, 99 students participated: 38 males and 61 females, with a median age of 14 years (range 10-18 years). Baseline general knowledge of T. solium, including awareness of the different human and pig disease states, and disease diagnosis, treatment and prevention, was quite high (average score 62%) and consistent across all three study areas. Participants' knowledge had significantly increased after the educational component, particularly regarding parasite transmission and disease prevention. CONCLUSION Preliminary assessment of 'The Vicious Worm' indicates it is an effective tool for the short-term T. solium education of primary school students in Zambia. Follow-up studies are planned to assess the longer term impact of the program on knowledge uptake in the study neighbourhoods. Inclusion of tailored 'The Vicious Worm' educational workshops should be considered in integrated cysticercosis control programs in endemic areas of sub-Saharan Africa.
Collapse
Affiliation(s)
- Emma C. Hobbs
- One Health Center for Zoonoses and Tropical Veterinary MedicineRoss University School of Veterinary MedicineBasseterreSt Kitts, West Indies
- Institute of Tropical MedicineAntwerpBelgium
- Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | | | - Inge Van Damme
- Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | | | - Gideon Zulu
- Ministry of HealthGovernment of the Republic of ZambiaLusakaZambia
| | - Moses Mambwe
- Ministry of HealthGovernment of the Republic of ZambiaLusakaZambia
| | | | | | - Maxwell Masuku
- School of Veterinary MedicineUniversity of ZambiaLusakaZambia
| | | | | | - Niko Speybroeck
- Institute of Health and SocietyUniversité Catholique de LouvainBrusselsBelgium
| | - Angela Colston
- Global Alliance for Livestock Veterinary Medicines (GALVmed)NairobiKenya
| | - Pierre Dorny
- Institute of Tropical MedicineAntwerpBelgium
- Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Arve Lee Willingham
- One Health Center for Zoonoses and Tropical Veterinary MedicineRoss University School of Veterinary MedicineBasseterreSt Kitts, West Indies
| | - Sarah Gabriël
- Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| |
Collapse
|
18
|
Ferreras E, Chizema-Kawesha E, Blake A, Chewe O, Mwaba J, Zulu G, Poncin M, Rakesh A, Page AL, Stoitsova S, Voute C, Uzzeni F, Robert H, Serafini M, Matapo B, Eiros JM, Quilici ML, Pezzoli L, Azman AS, Cohuet S, Ciglenecki I, Malama K, Luquero FJ. Single-Dose Cholera Vaccine in Response to an Outbreak in Zambia. N Engl J Med 2018; 378:577-579. [PMID: 29414267 DOI: 10.1056/nejmc1711583] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | - John Mwaba
- University Teaching Hospital, Lusaka, Zambia
| | | | - Marc Poncin
- Médecins sans Frontières, Geneva, Switzerland
| | | | | | - Savina Stoitsova
- European Program for Intervention Epidemiology Training, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | - Andrew S Azman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | | |
Collapse
|
19
|
Hobbs EC, Mwape KE, Devleesschauwer B, Gabriël S, Chembensofu M, Mambwe M, Phiri IK, Masuku M, Zulu G, Colston A, Willingham AL, Berkvens D, Dorny P, Bottieau E, Speybroeck N. Taenia solium from a community perspective: Preliminary costing data in the Katete and Sinda districts in Eastern Zambia. Vet Parasitol 2018; 251:63-67. [PMID: 29426478 DOI: 10.1016/j.vetpar.2018.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/23/2017] [Accepted: 01/01/2018] [Indexed: 10/18/2022]
Abstract
The tapeworm Taenia solium is endemic in Zambia, however its socioeconomic cost is unknown. During a large-scale interventional study conducted in Zambia, baseline economic costs of human and porcine T. solium infections were measured. Questionnaire surveys were conducted within three neighbourhoods in Zambia's Eastern province in 2015 and 2016. A human health questionnaire, capturing costs of clinical symptoms commonly attributable to human cysticercosis and taeniasis, was conducted in randomly selected households (n = 267). All pig-keeping households were administered a pig socioeconomic questionnaire (n = 271) that captured pig demographic data, costs of pig-keeping, and economic losses from porcine cysticercosis. Of all respondents 62% had reportedly experienced at least one of the surveyed symptoms. Seizure-like episodes were reported by 12%, severe chronic headaches by 36%, and vision problems by 23% of respondents. These complaints resulted in 147 health care consultations and 17 hospitalizations in the five years preceding the study, and an estimated productivity loss of 608 working days per year. Of all pigs 69% were bought within villages. Nearly all adult pigs were sold to local traders, and tongue palpation for detection of cysticerci was commonly performed. Reportedly, 95% of pig owners could not sell tongue-positive pigs, while infected pigs fetched only 45% of the normal sale value. These preliminary costing data indicate that human and porcine T. solium infections substantially impact endemic areas of Eastern Zambia. A full socioeconomic burden assessment may enable improved T. solium management in sub-Saharan Africa.
Collapse
Affiliation(s)
- Emma C Hobbs
- Ross University School of Veterinary Medicine, Basseterre, St. Kitts, Saint Kitts and Nevis, West Indies; Institute of Tropical Medicine, Antwerp, Belgium; Ghent University, Merelbeke, Belgium.
| | | | | | | | | | | | | | | | | | - Angela Colston
- Global Alliance for Livestock Veterinary Medicines (GALVmed), Nairobi, Kenya
| | - Arve Lee Willingham
- Ross University School of Veterinary Medicine, Basseterre, St. Kitts, Saint Kitts and Nevis, West Indies
| | | | - Pierre Dorny
- Institute of Tropical Medicine, Antwerp, Belgium; Ghent University, Merelbeke, Belgium
| | | | | |
Collapse
|
20
|
Chembensofu M, Mwape KE, Van Damme I, Hobbs E, Phiri IK, Masuku M, Zulu G, Colston A, Willingham AL, Devleesschauwer B, Van Hul A, Chota A, Speybroeck N, Berkvens D, Dorny P, Gabriël S. Re-visiting the detection of porcine cysticercosis based on full carcass dissections of naturally Taenia solium infected pigs. Parasit Vectors 2017; 10:572. [PMID: 29145875 PMCID: PMC5693468 DOI: 10.1186/s13071-017-2520-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/02/2017] [Indexed: 01/28/2023] Open
Abstract
Background Taenia solium is a neglected zoonotic parasite. The performances of existing tools for the diagnosis of porcine cysticercosis need further assessment, and their shortcomings call for alternatives. The objective of this study was to evaluate the performance of tongue palpation and circulating antigen detection for the detection of porcine cysticercosis in naturally infected pigs of slaughter age compared to full carcass dissections (considered the gold standard). Additionally, alternative postmortem dissection procedures were investigated. A total of 68 rural pigs of slaughter age randomly selected in the Eastern Province of Zambia were dissected. Dissections were conducted on full carcasses (or half carcass in case cysticerci were already detected in the first half), including all the organs. Total cysticercus counts, location and stages were recorded and collected cysticerci were identified morphologically and molecularly. All sera were analysed with the B158/B60 antigen detecting ELISA (Ag-ELISA). Results Key findings were the high occurrence of T. solium infected pigs (56%) and the presence of T. solium cysticerci in the livers of 26% of infected animals. More than half of the infected carcasses contained viable cysticerci. Seven carcasses had T. hydatigena cysticerci (10%), out of which five carcasses were co-infected with T. hydatigena and T. solium; two carcasses (3%) had only T. hydatigena cysticerci. Compared to full carcass dissection, the specificity of the Ag-ELISA to detect infected carcasses was estimated at 67%, the sensitivity at 68%, increasing to 90% and 100% for the detection of carcasses with one or more viable cysticerci, and more than 10 viable cysts, respectively. Tongue palpation only detected 10% of the cases, half carcass dissection 84%. Selective dissection of the diaphragm, tongue and heart or masseters can be considered, with an estimated sensitivity of 71%, increasing to 86% in carcasses with more than 10 cysticerci. Conclusions Depending on the aim of the diagnosis, a combination of Ag-ELISA and selective dissection, including investigating the presence of T. hydatigena, can be considered. Full carcass dissection should include the dissection of the liver, kidneys, spleen and lungs, and results should be interpreted carefully, as small cysticerci can easily be overlooked.
Collapse
Affiliation(s)
- Mwelwa Chembensofu
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - K E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - I Van Damme
- Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - E Hobbs
- Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium.,One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, P.O. Box 334, Basseterre, St Kitts, Saint Kitts and Nevis.,Department of Biomedical Sciences, Institute of Tropical Medicine, Kronenburgstraat 25, 2000, Antwerp, Belgium
| | - I K Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - M Masuku
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - G Zulu
- District Medical Office, Ministry of Health, P.O. Box 30205, Lusaka, Zambia
| | - A Colston
- Global Alliance for Livestock Veterinary Medicines, P.O. Box 52773 - 00100, Valley Arcade, Nairobi, Kenya
| | - A L Willingham
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, P.O. Box 334, Basseterre, St Kitts, Saint Kitts and Nevis
| | - B Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsman 14, 1050, Brussels, Belgium
| | - A Van Hul
- Department of Biomedical Sciences, Institute of Tropical Medicine, Kronenburgstraat 25, 2000, Antwerp, Belgium
| | - A Chota
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - N Speybroeck
- Université catholique de Louvain, Institute of Health and Society (IRSS), School of Public Health, 1200 Woluwe-Saint-Lambert, Brussels, Belgium
| | - D Berkvens
- Department of Biomedical Sciences, Institute of Tropical Medicine, Kronenburgstraat 25, 2000, Antwerp, Belgium
| | - P Dorny
- Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium.,Department of Biomedical Sciences, Institute of Tropical Medicine, Kronenburgstraat 25, 2000, Antwerp, Belgium
| | - S Gabriël
- Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium.
| |
Collapse
|
21
|
Poncin M, Zulu G, Voute C, Ferreras E, Muleya CM, Malama K, Pezzoli L, Mufunda J, Robert H, Uzzeni F, Luquero FJ, Chizema E, Ciglenecki I. Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia. Bull World Health Organ 2017; 96:86-93. [PMID: 29403111 PMCID: PMC5791774 DOI: 10.2471/blt.16.189241] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
Abstract
Objective To describe the implementation and feasibility of an innovative mass vaccination strategy – based on single-dose oral cholera vaccine – to curb a cholera epidemic in a large urban setting. Method In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated. Findings Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign – 2.31 United States dollars (US$) per dose – included the relatively low cost of local delivery – US$ 0.41 per dose. Conclusion We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.
Collapse
Affiliation(s)
- Marc Poncin
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | - Gideon Zulu
- Republic of Zambia Ministry of Health, Lusaka, Zambia
| | - Caroline Voute
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | | | | | | | | | | | - Hugues Robert
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | - Florent Uzzeni
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | | | | | - Iza Ciglenecki
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| |
Collapse
|
22
|
Mwape KE, Phiri IK, Praet N, Dorny P, Muma JB, Zulu G, Speybroeck N, Gabriël S. Study and ranking of determinants of Taenia solium infections by classification tree models. Am J Trop Med Hyg 2014; 92:56-63. [PMID: 25404073 DOI: 10.4269/ajtmh.13-0593] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Taenia solium taeniasis/cysticercosis is an important public health problem occurring mainly in developing countries. This work aimed to study the determinants of human T. solium infections in the Eastern province of Zambia and rank them in order of importance. A household (HH)-level questionnaire was administered to 680 HHs from 53 villages in two rural districts and the taeniasis and cysticercosis status determined. A classification tree model (CART) was used to define the relative importance and interactions between different predictor variables in their effect on taeniasis and cysticercosis. The Katete study area had a significantly higher taeniasis and cysticercosis prevalence than the Petauke area. The CART analysis for Katete showed that the most important determinant for cysticercosis infections was the number of HH inhabitants (6 to 10) and for taeniasis was the number of HH inhabitants > 6. The most important determinant in Petauke for cysticercosis was the age of head of household > 32 years and for taeniasis it was age < 55 years. The CART analysis showed that the most important determinant for both taeniasis and cysticercosis infections was the number of HH inhabitants (6 to 10) in Katete district and age in Petauke. The results suggest that control measures should target HHs with a high number of inhabitants and older individuals.
Collapse
Affiliation(s)
- Kabemba E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Pretoria, South Africa; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Laboratory of Veterinary Parasitology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Department of Disease Control, School of Veterinary Medicine, University of Zambia, Zambia; Petauke District Hospital, Petauke, Zambia; Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Isaac K Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Pretoria, South Africa; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Laboratory of Veterinary Parasitology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Department of Disease Control, School of Veterinary Medicine, University of Zambia, Zambia; Petauke District Hospital, Petauke, Zambia; Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Praet
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Pretoria, South Africa; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Laboratory of Veterinary Parasitology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Department of Disease Control, School of Veterinary Medicine, University of Zambia, Zambia; Petauke District Hospital, Petauke, Zambia; Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Dorny
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Pretoria, South Africa; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Laboratory of Veterinary Parasitology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Department of Disease Control, School of Veterinary Medicine, University of Zambia, Zambia; Petauke District Hospital, Petauke, Zambia; Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - John B Muma
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Pretoria, South Africa; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Laboratory of Veterinary Parasitology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Department of Disease Control, School of Veterinary Medicine, University of Zambia, Zambia; Petauke District Hospital, Petauke, Zambia; Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Gideon Zulu
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Pretoria, South Africa; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Laboratory of Veterinary Parasitology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Department of Disease Control, School of Veterinary Medicine, University of Zambia, Zambia; Petauke District Hospital, Petauke, Zambia; Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Niko Speybroeck
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Pretoria, South Africa; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Laboratory of Veterinary Parasitology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Department of Disease Control, School of Veterinary Medicine, University of Zambia, Zambia; Petauke District Hospital, Petauke, Zambia; Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Sarah Gabriël
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Pretoria, South Africa; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Laboratory of Veterinary Parasitology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Department of Disease Control, School of Veterinary Medicine, University of Zambia, Zambia; Petauke District Hospital, Petauke, Zambia; Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
23
|
Praet N, Verweij JJ, Mwape KE, Phiri IK, Muma JB, Zulu G, van Lieshout L, Rodriguez-Hidalgo R, Benitez-Ortiz W, Dorny P, Gabriël S. Bayesian modelling to estimate the test characteristics of coprology, coproantigen ELISA and a novel real-time PCR for the diagnosis of taeniasis. Trop Med Int Health 2013; 18:608-14. [PMID: 23464616 DOI: 10.1111/tmi.12089] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To estimate and compare the performances of coprology, copro-Ag ELISA and real-time polymerase chain reaction assay (copro-PCR) for detection of Taenia solium tapeworm carriers. METHODS The three diagnostic tests were applied on 817 stool samples collected in two Zambian communities where taeniasis is endemic. A Bayesian approach was used to allow estimation of the test characteristics. Two (0.2%; 95% Confidence Interval (CI): 0-0.8), 67 (8.2%; 95% CI: 6.4-10.3) and 10 (1.2%; 95% CI: 0.5-2.2) samples were positive using coprology, copro-Ag ELISA and copro-PCR, respectively. RESULTS Specificities of 99.9%, 92.0% and 99.0% were determined for coprology, copro-Ag ELISA and copro-PCR, respectively. Sensitivities of 52.5%, 84.5% and 82.7% were determined for coprology, copro-Ag ELISA and copro-PCR, respectively. CONCLUSIONS We urge for additional studies exploring possible cross-reactions of the copro-Ag ELISA and for the use of more sensitive tests, such as copro-PCR, for the detection of tapeworm carriers, which is a key factor in controlling the parasite in endemic areas.
Collapse
Affiliation(s)
- Nicolas Praet
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Mwape KE, Phiri IK, Praet N, Muma JB, Zulu G, Van den Bossche P, de Deken R, Speybroeck N, Dorny P, Gabriël S. Taenia solium Infections in a rural area of Eastern Zambia-a community based study. PLoS Negl Trop Dis 2012; 6:e1594. [PMID: 22479664 PMCID: PMC3313923 DOI: 10.1371/journal.pntd.0001594] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 02/24/2012] [Indexed: 11/18/2022] Open
Abstract
Background Taenia solium taeniosis/cysticercosis is a parasitic infection occurring in many developing countries. Data on the status of human infections in Zambia is largely lacking. We conducted a community-based study in Eastern Zambia to determine the prevalence of human taeniosis and cysticercosis in a rural community. Methods and Findings Stool and serum samples were collected from willing participants. Geographical references of the participants' households were determined and household questionnaires administered. Taeniosis was diagnosed in stool samples by coprology and by the polyclonal antibody-based copro-antigen enzyme-linked immunosorbent assay (copro-Ag ELISA), while cysticercosis was diagnosed in serum by the B158/B60 monoclonal antibody-based antigen ELISA (sero-Ag ELISA). Identification of the collected tapeworm after niclosamide treatment and purgation was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). A total of 255 households from 20 villages participated in the study, 718 stool and 708 serum samples were collected and examined. Forty-five faecal samples (6.3%) were found positive for taeniosis on copro-Ag ELISA while circulating cysticercus antigen was detected in 5.8% (41/708) individuals. The tapeworm recovered from one of the cases was confirmed to be T. solium on PCR-RFLP. Seropositivity (cysticercosis) was significantly positively related to age (p = 0.00) and to copro-Ag positivity (taeniosis) (p = 0.03) but not to gender. Change point analysis revealed that the frequency of cysticercus antigens increased significantly in individuals above the age of 30. Copro-Ag positivity was not related to age or gender. The following risk factors were noted to be present in the study community: free-range pig husbandry system and poor sanitation with 47.8% of the households visited lacking latrines. Conclusions This study has recorded high taeniosis and cysticercosis prevalences and identified the need for further studies on transmission dynamics and impact of the disease on the local people. Taenia solium taeniosis/cysticercosis is a zoonotic infection endemic in many developing countries, with humans as the definitive host (taeniosis) and pigs and humans as the intermediate hosts (cysticercosis). When humans act as the intermediate host, the result can be neurocysticercosis, which is associated with acquired epilepsy, considerable morbidity and even mortality. In Africa, most studies have been carried out in pigs with little or no data in humans available. In this human study, conducted in a rural community in Eastern Zambia, prevalences for taeniosis and cysticercosis were determined at 6.3% and 5.8% respectively, indicating the hyperendemicity of the area. Cysticercosis infection was strongly related with age, with a significant increase in prevalence occurring in individuals from the age of 30 onward. A collected tapeworm was confirmed to be T. solium. Risk factors associated with the transmission and maintenance of the parasite such as free roaming pigs, households without latrines, backyard slaughter of pigs without inspection and consumption of undercooked pork were also present. The findings of this work have identified the need for further research in the transmission dynamics and the burden that this infection has on the resources of poor local people.
Collapse
Affiliation(s)
- Kabemba E. Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Isaac K. Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Nicolas Praet
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - John B. Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | | | | | - Reginald de Deken
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Niko Speybroeck
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Sarah Gabriël
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| |
Collapse
|
25
|
Mwape KE, Praet N, Benitez-Ortiz W, Muma JB, Zulu G, Celi-Erazo M, Phiri IK, Rodriguez-Hidalgo R, Dorny P, Gabriël S. Field evaluation of urine antigen detection for diagnosis of Taenia solium cysticercosis. Trans R Soc Trop Med Hyg 2011; 105:574-8. [PMID: 21862093 DOI: 10.1016/j.trstmh.2011.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 05/20/2011] [Accepted: 05/20/2011] [Indexed: 11/27/2022] Open
Abstract
(Neuro)cysticercosis is an important zoonotic disease caused by infection with Taenia solium metacestode larvae. Existing immunodiagnostic techniques detect antibodies and circulating antigens (Ag) in serum and cerebrospinal fluid (CSF). Blood/CSF collection is an invasive procedure associated with blood-borne infections and is often not well accepted by communities. Detection of circulating Ag in urine has been suggested as an alternative, however this has been evaluated in clinical settings only. The aim of the present study was to evaluate the performance of a urine Ag-ELISA under field conditions. Paired serum and urine samples were obtained from participants in endemic areas of Ecuador (n=748) and Zambia (n=690) and were subjected to a monoclonal antibody-based Ag-ELISA. Calculation of positive and negative agreement indices (AI) showed better agreement in the negative direction both for Ecuadorian and Zambian samples (AI of 93.1 and 86.8, respectively). Using a Bayesian approach to determine the test characteristics, similar sensitivities were obtained for serum and urine Ag detection, whereas a decreased specificity was determined for the urine Ag-ELISA with a lower specificity (78.6%) for Zambian samples than for Ecuadorian samples (88.4%). This study indicates a higher specificity for the serum test under field conditions and promotes further research to improve the urine test.
Collapse
Affiliation(s)
- K E Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Markotter W, York D, Sabeta CT, Shumba W, Zulu G, Le Roux K, Nel LH. Evaluation of a rapid immunodiagnostic test kit for detection of African lyssaviruses from brain material. ACTA ACUST UNITED AC 2010; 76:257-62. [PMID: 20698445 DOI: 10.4102/ojvr.v76i2.50] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
A rapid immunodiagnostic test kit was evaluated against a selection of isolates of lyssavirus genotypes occurring in Africa. The test was carried out in parallel comparison with the fluorescent antibody test (FAT) and isolates representing previously established phylogenetic groups from each genotype were included. The specificity of the rapid immunodiagnostic test compared favourably with the FAT and was found to detect all representatives of genotypes 1, 2, 3 and 4 in brain samples of either field cases or suckling mouse brain inoculates.
Collapse
Affiliation(s)
- W Markotter
- Department of Microbiology and Plant Pathology, University of Pretoria, Pretoria, 0002 South Africa.
| | | | | | | | | | | | | |
Collapse
|
27
|
Muyima NYO, Zulu G, Bhengu T, Popplewell D. The potential application of some novel essential oils as natural cosmetic preservatives in an aqueous cream formulation. FLAVOUR FRAG J 2002. [DOI: 10.1002/ffj.1093] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|