1
|
Rogier E, Herman C, Huber CS, Hamre KES, Pierre B, Mace KE, Présumé J, Mondélus G, Romilus I, Elismé T, Eisele TP, Druetz T, Existe A, Boncy J, Lemoine JF, Udhayakumar V, Chang MA. Nationwide Monitoring for Plasmodium falciparum Drug-Resistance Alleles to Chloroquine, Sulfadoxine, and Pyrimethamine, Haiti, 2016-2017. Emerg Infect Dis 2021; 26:902-909. [PMID: 32310062 PMCID: PMC7181918 DOI: 10.3201/eid2605.190556] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Haiti is striving for zero local malaria transmission by the year 2025. Chloroquine remains the first-line treatment, and sulfadoxine/pyrimethamine (SP) has been used for mass drug-administration pilot programs. In March 2016, nationwide molecular surveillance was initiated to assess molecular resistance signatures for chloroquine and SP. For 778 samples collected through December 2017, we used Sanger sequencing to investigate putative resistance markers to chloroquine (Pfcrt codons 72, 74, 75, and 76), sulfadoxine (Pfdhps codons 436, 437, 540, 581, 613), and pyrimethamine (Pfdhfr codons 50, 51, 59, 108, 164). No parasites harbored Pfcrt point mutations. Prevalence of the Pfdhfr S108N single mutation was 47%, and we found the triple mutant Pfdhfr haplotype (108N, 51I, and 59R) in a single isolate. We observed no Pfdhps variants except in 1 isolate (A437G mutation). These data confirm the lack of highly resistant chloroquine and SP alleles in Haiti and support the continued use of chloroquine and SP.
Collapse
|
2
|
van den Hoogen LL, Herman C, Présumé J, Romilus I, Existe A, Boncy J, Joseph V, Stresman G, Tetteh KKA, Drakeley C, Chang MA, Lemoine JF, Eisele TP, Rogier E, Ashton RA. Rapid Screening for Non-falciparum Malaria in Elimination Settings Using Multiplex Antigen and Antibody Detection: Post Hoc Identification of Plasmodium malariae in an Infant in Haiti. Am J Trop Med Hyg 2021; 104:2139-2145. [PMID: 33819177 PMCID: PMC8176464 DOI: 10.4269/ajtmh.20-1450] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/24/2020] [Indexed: 01/24/2023] Open
Abstract
Haiti is targeting malaria elimination by 2025. The Grand'Anse department in southwestern Haiti experiences one-third to half of all nationally reported Plasmodium falciparum cases. Although there are historical reports of Plasmodium vivax and Plasmodium malariae, today, non-falciparum infections would remain undetected because of extensive use of falciparum-specific histidine-rich protein 2 (HRP2) rapid diagnostic tests (RDT) at health facilities. A recent case-control study was conducted in Grand'Anse to identify risk factors for P. falciparum infection using HRP2-based RDTs (n = 1,107). Post hoc multiplex Plasmodium antigenemia and antibody (IgG) detection by multiplex bead assay revealed one blood sample positive for pan-Plasmodium aldolase, negative for P. falciparum HRP2, and positive for IgG antibodies to P. malariae. Based on this finding, we selected 52 samples with possible P. malariae infection using IgG and antigenemia data and confirmed infection status by species-specific PCR. We confirmed one P. malariae infection in a 6-month-old infant without travel history. Congenital P. malariae could not be excluded. However, our finding-in combination with historical reports of P. malariae-warrants further investigation into the presence and possible extent of non-falciparum malaria in Haiti. Furthermore, we showed the use of multiplex Plasmodium antigen and IgG detection in selecting samples of interest for subsequent PCR analysis, thereby reducing costs as opposed to testing all available samples by PCR. This is of specific use in low-transmission or eliminating settings where infections are rare.
Collapse
Affiliation(s)
- Lotus L. van den Hoogen
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | | | | | | | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Gillian Stresman
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michelle A. Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean F. Lemoine
- Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth A. Ashton
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| |
Collapse
|
3
|
van den Hoogen LL, Stresman G, Présumé J, Romilus I, Mondélus G, Elismé T, Existe A, Hamre KES, Ashton RA, Druetz T, Joseph V, Beeson JG, Singh SK, Boncy J, Eisele TP, Chang MA, Lemoine JF, Tetteh KKA, Rogier E, Drakeley C. Selection of Antibody Responses Associated With Plasmodium falciparum Infections in the Context of Malaria Elimination. Front Immunol 2020; 11:928. [PMID: 32499783 PMCID: PMC7243477 DOI: 10.3389/fimmu.2020.00928] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/28/2020] [Accepted: 04/21/2020] [Indexed: 12/30/2022] Open
Abstract
In our aim to eliminate malaria, more sensitive tools to detect residual transmission are quickly becoming essential. Antimalarial antibody responses persist in the blood after a malaria infection and provide a wider window to detect exposure to infection compared to parasite detection metrics. Here, we aimed to select antibody responses associated with recent and cumulative exposure to malaria using cross-sectional survey data from Haiti, an elimination setting. Using a multiplex bead assay, we generated data for antibody responses (immunoglobulin G) to 23 Plasmodium falciparum targets in 29,481 participants across three surveys. This included one community-based survey in which participants were enrolled during household visits and two sentinel group surveys in which participants were enrolled at schools and health facilities. First, we correlated continuous antibody responses with age (Spearman) to determine which showed strong age-related associations indicating accumulation over time with limited loss. AMA-1 and MSP-119 antibody levels showed the strongest correlation with age (0.47 and 0.43, p < 0.001) in the community-based survey, which was most representative of the underlying age structure of the population, thus seropositivity to either of these antibodies was considered representative of cumulative exposure to malaria. Next, in the absence of a gold standard for recent exposure, we included antibody responses to the remaining targets to predict highly sensitive rapid diagnostic test (hsRDT) status using receiver operating characteristic curves. For this, only data from the survey with the highest hsRDT prevalence was used (7.2%; 348/4,849). The performance of the top two antigens in the training dataset (two-thirds of the dataset; n = 3,204)-Etramp 5 ag 1 and GLURP-R0 (area-under-the-curve, AUC, 0.892 and 0.825, respectively)-was confirmed in the test dataset (remaining one-third of the dataset; n = 1,652, AUC 0.903 and 0.848, respectively). As no further improvement was seen by combining seropositivity to GLURP-R0 and Etramp 5 ag 1 (p = 0.266), seropositivity to Etramp 5 ag 1 alone was selected as representative of current or recent exposure to malaria. The validation of antibody responses associated with these exposure histories simplifies analyses and interpretation of antibody data and facilitates the application of results to evaluate programs.
Collapse
Affiliation(s)
- Lotus L. van den Hoogen
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Gina Mondélus
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Tamara Elismé
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | | | - Karen E. S. Hamre
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States
- CDC Foundation, Atlanta, GA, United States
| | - Ruth A. Ashton
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, QC, Canada
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - James G. Beeson
- Burnet Institute, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Central Clinical School and Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - Susheel K. Singh
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Michelle A. Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jean F. Lemoine
- Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Kevin K. A. Tetteh
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
4
|
van den Hoogen LL, Présumé J, Romilus I, Mondélus G, Elismé T, Sepúlveda N, Stresman G, Druetz T, Ashton RA, Joseph V, Eisele TP, Hamre KES, Chang MA, Lemoine JF, Tetteh KKA, Boncy J, Existe A, Drakeley C, Rogier E. Quality control of multiplex antibody detection in samples from large-scale surveys: the example of malaria in Haiti. Sci Rep 2020; 10:1135. [PMID: 31980693 PMCID: PMC6981173 DOI: 10.1038/s41598-020-57876-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022] Open
Abstract
Measuring antimalarial antibodies can estimate transmission in a population. To compare outputs, standardized laboratory testing is required. Here we describe the in-country establishment and quality control (QC) of a multiplex bead assay (MBA) for three sero-surveys in Haiti. Total IgG data against 21 antigens were collected for 32,758 participants. Titration curves of hyperimmune sera were included on assay plates, assay signals underwent 5-parameter regression, and inspection of the median and interquartile range (IQR) for the y-inflection point was used to determine assay precision. The medians and IQRs were similar for Surveys 1 and 2 for most antigens, while the IQRs increased for some antigens in Survey 3. Levey-Jennings charts for selected antigens provided a pass/fail criterion for each assay plate and, of 387 assay plates, 13 (3.4%) were repeated. Individual samples failed if IgG binding to the generic glutathione-S-transferase protein was observed, with 659 (2.0%) samples failing. An additional 455 (1.4%) observations failed due to low bead numbers (<20/analyte). The final dataset included 609,438 anti-malaria IgG data points from 32,099 participants; 96.6% of all potential data points if no QC failures had occurred. The MBA can be deployed with high-throughput data collection and low inter-plate variability while ensuring data quality.
Collapse
Affiliation(s)
- Lotus L van den Hoogen
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Gina Mondélus
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Tamara Elismé
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Nuno Sepúlveda
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
- Centre of Statistics and Applications, University of Lisbon, Lisbon, Portugal
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Canada
| | - Ruth A Ashton
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
| | - Karen E S Hamre
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CDC Foundation, Atlanta, Georgia, USA
| | - Michelle A Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jean F Lemoine
- Ministère de la santé publique et de la population, Port-au-Prince, Haiti
| | - Kevin K A Tetteh
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | | | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|