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Coffeng LE, Vlaminck J, Cools P, Denwood M, Albonico M, Ame SM, Ayana M, Dana D, Cringoli G, de Vlas SJ, Fenwick A, French M, Kazienga A, Keiser J, Knopp S, Leta G, Matoso LF, Maurelli MP, Montresor A, Mirams G, Mekonnen Z, Corrêa-Oliveira R, Pinto SA, Rinaldi L, Sayasone S, Steinmann P, Thomas E, Vercruysse J, Levecke B. A general framework to support cost-efficient fecal egg count methods and study design choices for large-scale STH deworming programs-monitoring of therapeutic drug efficacy as a case study. PLoS Negl Trop Dis 2023; 17:e0011071. [PMID: 37196017 PMCID: PMC10228800 DOI: 10.1371/journal.pntd.0011071] [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: 01/07/2023] [Revised: 05/30/2023] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) control programs currently lack evidence-based recommendations for cost-efficient survey designs for monitoring and evaluation. Here, we present a framework to provide evidence-based recommendations, using a case study of therapeutic drug efficacy monitoring based on the examination of helminth eggs in stool. METHODS We performed an in-depth analysis of the operational costs to process one stool sample for three diagnostic methods (Kato-Katz, Mini-FLOTAC and FECPAKG2). Next, we performed simulations to determine the probability of detecting a truly reduced therapeutic efficacy for different scenarios of STH species (Ascaris lumbricoides, Trichuris trichiura and hookworms), pre-treatment infection levels, survey design (screen and select (SS); screen, select and retest (SSR) and no selection (NS)) and number of subjects enrolled (100-5,000). Finally, we integrated the outcome of the cost assessment into the simulation study to estimate the total survey costs and determined the most cost-efficient survey design. PRINCIPAL FINDINGS Kato-Katz allowed for both the highest sample throughput and the lowest cost per test, while FECPAKG2 required both the most laboratory time and was the most expensive. Counting of eggs accounted for 23% (FECPAKG2) or ≥80% (Kato-Katz and Mini-FLOTAC) of the total time-to-result. NS survey designs in combination with Kato-Katz were the most cost-efficient to assess therapeutic drug efficacy in all scenarios of STH species and endemicity. CONCLUSIONS/SIGNIFICANCE We confirm that Kato-Katz is the fecal egg counting method of choice for monitoring therapeutic drug efficacy, but that the survey design currently recommended by WHO (SS) should be updated. Our generic framework, which captures laboratory time and material costs, can be used to further support cost-efficient choices for other important surveys informing STH control programs. In addition, it can be used to explore the value of alternative diagnostic techniques, like automated egg counting, which may further reduce operational costs. TRIAL REGISTRATION ClinicalTrials.gov NCT03465488.
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Affiliation(s)
- Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johnny Vlaminck
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Piet Cools
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Matthew Denwood
- Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | | | - Shaali M. Ame
- Laboratory Division, Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Mio Ayana
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Daniel Dana
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Michael French
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
- RTI International, Washington District of Columbia, United States of America
| | - Adama Kazienga
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Gemechu Leta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
- Nursing school, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Maria P. Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Rodrigo Corrêa-Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Simone A. Pinto
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Jozef Vercruysse
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Abaya SW, Mereta ST, Tulu FD, Mekonnen Z, Ayana M, Girma M, Vineer HR, Mor SM, Caminade C, Graham-Brown J. Prevalence of Human and Animal Fasciolosis in Butajira and Gilgel Gibe Health Demographic Surveillance System Sites in Ethiopia. Trop Med Infect Dis 2023; 8:tropicalmed8040208. [PMID: 37104334 PMCID: PMC10143227 DOI: 10.3390/tropicalmed8040208] [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: 03/01/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Fasciolosis is regarded as a major challenge to livestock productivity worldwide, but the burden of disease in humans has only started to receive some attention in the past three decades. The aim of this study was to determine the prevalence of human and animal fasciolosis and its determinant factors in the Gilgel Gibe and Butajira Health and Demographic Surveillance System (HDSS) sites in Ethiopia. A study was undertaken among 389 households across the two sites. Face-to-face interviews were conducted to investigate the knowledge, attitudes and practices of households with regard to fasciolosis. Stools from 377 children aged 7–15 years, and 775 animals (cattle, goats and sheep) were analyzed using a proprietary Fasciola hepatica (F. hepatica) coproantigen ELISA kit. The prevalence of fasciolosis in children was 0.5% and 1% in Butajira and Gilgel Gibe HDSS sites, respectively. The overall prevalence of animal fasciolosis was 29%, 29.2%, and 6% among cattle, sheep, and goats, respectively. More than half of the respondents from Gilgel Gibe (59%, n = 115) did not know that humans can be infected with F. hepatica. The majority of respondents in Gilgel Gibe (n = 124, 64%) and Butajira (n = 95, 50%) did not know the transmission route for fasciolosis. Grazing animals were 7 times more likely to be infected with fasciolosis than animals in cut-and-carry production systems (adjusted odds ratio [AOR] = 7.2; 95% confidence interval [CI]: 3.91–13.17). The findings indicated a lack of knowledge amongst local populations about fasciolosis. Thus, there is a need for public health awareness campaigns about fasciolosis in the study areas.
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Tiruneh A, Zemene E, Abdissa Mizana B, Girma H, Dereje E, Sharew B, Ayana M, Mekonnen Z. Schistosoma mansoni Infections and Morbidities Among School Children in Hotspot Areas of Jimma Town, Southwest Ethiopia: A Cross-Sectional Study. Environ Health Insights 2023; 17:11786302231161047. [PMID: 36969091 PMCID: PMC10034345 DOI: 10.1177/11786302231161047] [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] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Schistosoma mansoni is endemic in all regions of Ethiopia. School-age children are highly vulnerable to schistosomiasis-related morbidities. This study aimed to determine the prevalence of S. mansoni and morbidities among schoolchildren in schistosomiasis hotspot areas of Jimma Town. METHODS Cross-sectional study was conducted among schoolchildren in Jimma Town. Stool sample was examined using Kato-Katz for the detection of S. mansoni. RESULTS A total of 332 schoolchildren were included in the study. The prevalence of S. mansoni and STHs was 20.2% and 19.9%, respectively. Males (adjusted odds ratio (AOR) = 4.9; 95% CI: 2.4-10.1; p = .001), swimming habits (AOR = 3.0; 95% CI: 1.1-8.3; p = .033) and schools attended (AOR = 4.3; 95% CI: 1.4-13.6; p = .012, AOR = 3.8; 95% CI: 1.3-10.9; p = .014) were associated factors for S. mansoni infections. Blood in stool (AOR = 2.0; CI: 1.0-4.1; p = .045) and feeling general malaise (AOR = 4.0; CI: 1.4-11.3; p = .007) were significantly associated with S. mansoni infection-related morbidities. Moreover, prevalence of stunting among schoolchildren 6 to 11 years of age was 29.7% (71/239). CONCLUSION The transmission of S. mansoni among schoolchildren is moderate. Sex, swimming habits and schools attended were associated with S. mansoni infections. Blood in stool and general malaise were clinical characteristics associated with S. mansoni infections. Integration of health promotion is needed to achieve control and elimination goals. Attention should also be given to stunted growth of the children.
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Affiliation(s)
- Abebaw Tiruneh
- School of Medical Laboratory Sciences,
Institute of Health, Jimma University, Jimma, Ethiopia
| | - Endalew Zemene
- School of Medical Laboratory Sciences,
Institute of Health, Jimma University, Jimma, Ethiopia
| | - Biru Abdissa Mizana
- Department of Midwifery, Institute of
Health, Jimma University, Jimma, Ethiopia
| | - Hundaol Girma
- Molecular Biology and NTD Research
Center, Jimma University, Jimma, Ethiopia
| | - Eden Dereje
- Molecular Biology and NTD Research
Center, Jimma University, Jimma, Ethiopia
| | - Bizuwork Sharew
- School of Medical Laboratory Sciences,
Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mio Ayana
- School of Medical Laboratory Sciences,
Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences,
Institute of Health, Jimma University, Jimma, Ethiopia
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Tadege B, Mekonnen Z, Dana D, Sharew B, Dereje E, Loha E, Verweij JJ, Casaert S, Vlaminck J, Ayana M, Levecke B. Assessment of environmental contamination with soil-transmitted helminths life stages at school compounds, households and open markets in Jimma Town, Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010307. [PMID: 35377880 PMCID: PMC9009776 DOI: 10.1371/journal.pntd.0010307] [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: 10/27/2021] [Revised: 04/14/2022] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background It remains largely unknown where and how infections with soil-transmitted helminths (STHs; Ascaris, Trichuris, Necator and Ancylostoma) occur. We therefore aimed to identify possible sources of infection by assessing the environmental contamination in an STH-endemic area. Methods We first performed a series of laboratory experiments designed to optimize a soil straining-flotation method to detect and quantify Ascaris and Trichuris eggs in soil, and to validate the diagnostic performance of the optimized method when followed by microscopy and qPCR. In a second phase, we applied this method to assess the level of STH contamination in 399 environmental samples collected from 10 school compounds, 50 households and 9 open markets in Jimma Town (Ethiopia). Subsequently, we explored associations between the environmental contamination and both the corresponding STH epidemiology at the level of the schools and the household characteristics. Finally, we assessed the knowledge, attitude and practice (KAP) towards STHs in school children. Principal findings Our soil straining-flotation method has an analytical sensitivity of 50 eggs per 100 grams of soil and egg recovery rate of 36.0% (Ascaris) and 8.0% (Trichuris). The analysis of field samples with both microscopy and qPCR revealed the presence of 8 different helminth species of medical importance, including but not limited to the human STHs. There was a significant association between the environmental contamination and prevalence of any STH infections at the school level only. The KAP indicated a lack of knowledge and awareness of STHs. Conclusions/Significance Our optimized straining-flotation method has a moderate diagnostic performance and revealed that life stages of helminths are ubiquitous in the environment, which might be due to the poor sanitary facilities at both the schools and the households, and a poor level of KAP towards STHs. Further research is required to gain more insights into the contribution of these life stages to transmission. The recent strategies to control the morbidity caused by intestinal worms have mainly been focusing on large scale deworming programs during which drugs are administered to at-risk populations. Although these large-scale deworming programs have been successful in reducing the disease burden, re-infection in the absence of other intervention measures is unavoidable. Although there is a consensus on how infections with intestinal worms are transmitted, it remains unclear where hot spots of infectious life stages can be found in endemic communities, which in turn impedes both the design and the validation of interventions that prevent (re-)infection. We optimized a laboratory method to detect life stages in soil samples and applied this method to examine soil contamination at school compounds, households and open markets in Jimma Town (Ethiopia). Finally, we assessed the household characteristics, and the knowledge, attitude, and practice towards intestinal worms among school children. Generally, our results indicated (i) a moderate performance of our laboratory method, (ii) the ubiquitous presence of life stages in the environment, (iii) a poor level of sanitary facilities at both the schools and the households and (iv) a poor level of knowledge, attitude and practices towards intestinal worms.
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Affiliation(s)
- Bamlaku Tadege
- School of Medicine, Hawassa University, Hawassa, Ethiopia
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
- * E-mail: (BT); (BL)
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
- Molecular Biology and NTDs Research Center, Jimma University, Jimma, Ethiopia
| | - Daniel Dana
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
- Molecular Biology and NTDs Research Center, Jimma University, Jimma, Ethiopia
| | - Bizuwarek Sharew
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Eden Dereje
- Molecular Biology and NTDs Research Center, Jimma University, Jimma, Ethiopia
| | - Eskindir Loha
- Chr. Michelsen Institute, Bergen, Norway
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Jaco J. Verweij
- Microvida, Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Stijn Casaert
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Mio Ayana
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
- Molecular Biology and NTDs Research Center, Jimma University, Jimma, Ethiopia
| | - Bruno Levecke
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
- * E-mail: (BT); (BL)
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Gebrezgabiher G, Yewhalaw D, Ayana M, Hailu A, Mekonnen Z. Impact of ivermectin mass drug administration on burden of soil-transmitted helminths in onchocerciasis control and elimination programs, Yeki district, southwest Ethiopia. PLoS One 2022; 17:e0263625. [PMID: 35143567 PMCID: PMC8830686 DOI: 10.1371/journal.pone.0263625] [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: 09/27/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
Community-directed treatment with ivermectin (CDTi) is the primary strategy employed to control and eliminate human onchocerciasis in Ethiopia. After long-term mass distribution for onchocerciasis, ivermectin is expected to have additional benefits beyond the envisioned targets by reducing the burden of other co-endemic parasitic infections as to STHs. To date, studies focused on the collateral impact of CDTi on STH in Ethiopia are scanty. Two community-based cross-sectional surveys (baseline in 1997 and post-CDTi in 2017) were conducted to evaluate the impact of long-term CDTi employed to control and eliminate onchocerciasis on the burden of STH infections in Yeki district of southwest Ethiopia. Stool samples were collected and examined using Ritchie`s concentration and Kato-Katz techniques in the baseline and current study, respectively. Overall, 188(38.3%, 95% Confidence interval (CI) 34.1–42.7%) individuals were positive at least for any of the STH species from 491 study participants in the post-CDTi. The prevalence of A. lumbricoides, hookworms, and T. trichiura was 11.2% (95% CI 8.7–14.3%), 16.3% (95% CI 13.3–19.8%), and 29.9% (95% CI 26.1–34.1%), respectively. Individuals aged 5–9 years had a significantly higher prevalence of A. lumbricoides (Adjusted odds ratio (AOR) 6.5, 95% CI 1.7–25.4), T. trichuria (AOR 8, 95% CI 2.6–25.1), and any STH infection (AOR 5, 95% CI 1.7–14.7) than those of ≥ 51 years. Also, significantly higher prevalences of T. trichuria infection were observed in individuals aged 10–14 years (AOR 4.1, 95% CI 1.7–9.9), 15–20 years (AOR 3.1, 95% CI 1.2–8.1), 21–30 years (AOR 2.4, 95% CI 1.1–5.5), and 31–40 years (AOR 3.2, 95% CI 1.3–7.5) compared with those of ≥ 51 years. The prevalence of A. lumbricoides was significantly higher in males (AOR 0.5, 95% CI 0.3–0.9). Of the 491 study participants, only data from 400 individuals who had not been involved in a mass drug administration (MDA) with other STH anthelmintics were considered in the comparative analysis. Before CDTi, the prevalence of A. lumbricoides, T. trichiura, hookworm, and any STH infection was 47.1% (95% CI 41.6–52.7%), 3.3% (95% CI 1.8–5.9%), 37.9% (95% CI 32.7–43.5%), and 58.8% (95% CI 53.2–64.1%), respectively. Long-term CDTi considerably reduced the prevalences of A. lumbricoides and hookworm by 76.2% and 56.9%, respectively (p < 0.001). Nonetheless, CDTi did not affect the prevalence of T. trichiura infection and, in contrast, it was significantly higher in the current study (P < 0.001). Overall post-CDTi prevalence of any STH infection was considerably lower than reported in the baseline (p < 0.001). It is evidenced that long-term CDTi for onchocerciasis control and elimination had additional benefits by reducing the prevalence of STH infections specifically of A. lumbricoides and hookworm, but had no impact on infections with T. trichuria. Our finding of additional health benefits of large-scale ivermectin administration taking it will aid to increase positive engagement and sustain participation of communities during MDA campaigns, and strengthen governmental and non-governmental organizations (NGOs) support for the undergoing national onchocerciasis elimination program.
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Affiliation(s)
- Gebremedhin Gebrezgabiher
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- College of Veterinary Medicine, Samara University, Samara, Ethiopia
- * E-mail:
| | - Delenasaw Yewhalaw
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
| | - Mio Ayana
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Asrat Hailu
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Dana D, Roose S, Vlaminck J, Ayana M, Mekonnen Z, Geldhof P, Levecke B. Longitudinal assessment of the exposure to Ascaris lumbricoides through copromicroscopy and serology in school children from Jimma Town, Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010131. [PMID: 35041666 PMCID: PMC8797258 DOI: 10.1371/journal.pntd.0010131] [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: 07/27/2021] [Revised: 01/28/2022] [Accepted: 01/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background We previously demonstrated that serology holds promise as an alternative diagnostic tool to copromicroscopy to monitor and evaluate deworming programs targeting soil-transmitted helminths (STHs). Here we explored the dynamics of anti-Ascaris antibodies (Ab) and evaluated the Ab-isotype of choice to assess the longitudinal exposure to Ascaris in Ethiopian school children. Methodology Between October 2018 and February 2020, stool and blood samples were collected every four months from school children (4 to 6 years of age). Stool samples were analyzed by duplicate Kato-Katz to assess the presence and intensity of any STH infection. Plasma Ab-responses against the total extract of Ascaris suum lung third stage larvae were measured through in-house Ab-ELISA’s for seven different Ab-isotypes. Principal findings At baseline, 42.4% of the 66 children were excreting eggs of any STH, Trichuris (37.9%) being the most prevalent. The cumulative prevalence (proportion of children tested that positive at least once over the entire study period) was 56.1% for Trichuris and 31.8% for Ascaris. For Ascaris, re-infections were frequently observed, whereas for Trichuris, children often remained excreting eggs following drug administration. When measuring anti-Ascaris Ab-levels, the cumulative seroprevalence was generally higher (IgG4: 60.6%; IgG1: 50.0%; IgE: 36.4%). The individual anti-Ascaris IgG4 levels at baseline were positively associated with the fecal egg counts averaged over the study period, the rate of egg-appearance and the number of positive test results. There was no apparent cross-reactivity between the anti-Ascaris IgG4 Ab-ELISA and Trichuris. Conclusions/Significance We demonstrate that the children are exposed to STH before the age of four and that the exposure to Ascaris is underestimated when measured with copromicroscopy. Compared to other Ab-isotypes, IgG4 is the Ab-isotype of choice to measure Ascaris exposure in STH endemic settings. Finally, the results also highlight that measuring anti-Ascaris IgG4 levels holds promise as a tool to identify individuals at higher risk for continued exposure to this STH. World-wide large-scale deworming programs are being implemented to control the morbidity attributable to intestinal worms. Our group has recently shown that diagnostic tools that detect anti-parasite antibodies hold promise as an alternative to the current diagnostic standard (detecting worm eggs in stool using microscopy) to monitor and evaluate the progress of these programs towards the set targets. In the present study, we further explored the potential of antibody-based assays by monitoring the exposure of Ethiopian school children during a 17-month period to worm infections. Our results indicated that children in this area are exposed to intestinal worms from an early age onwards and that, based on serological results, more children are exposed to worm infections than measured by the current diagnostic standard. In addition, we demonstrated that test results of the antibody assay at the start of the study were positively associated with mean egg counts averaged over the study period, the rate of egg-appearance and the number of positive stool tests, highlighting that such assay holds promise as a tool to identify individuals at higher high risk for continued exposure to worms, and ultimately improve control programs.
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Affiliation(s)
- Daniel Dana
- School of Laboratory Science, Faculty of Health Science, Institute of Health Jimma University, Jimma, Ethiopia
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
- * E-mail: (DD); (BL)
| | - Sara Roose
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Mio Ayana
- School of Laboratory Science, Faculty of Health Science, Institute of Health Jimma University, Jimma, Ethiopia
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Zeleke Mekonnen
- School of Laboratory Science, Faculty of Health Science, Institute of Health Jimma University, Jimma, Ethiopia
| | - Peter Geldhof
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
- * E-mail: (DD); (BL)
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Walker M, Cools P, Albonico M, Ame SM, Ayana M, Dana D, Keiser J, Matoso LF, Montresor A, Mekonnen Z, Corrêa-Oliveira R, Pinto SA, Sayasone S, Vercruysse J, Vlaminck J, Levecke B. Individual responses to a single oral dose of albendazole indicate reduced efficacy against soil-transmitted helminths in an area with high drug pressure. PLoS Negl Trop Dis 2021; 15:e0009888. [PMID: 34665810 PMCID: PMC8555840 DOI: 10.1371/journal.pntd.0009888] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/13/2021] [Revised: 10/29/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Albendazole (ALB) is administered annually to millions of children through global deworming programs targeting soil-transmitted helminths (STHs: Ascaris lumbricoides, Trichuris trichiura and hookworms, Necator americanus and Ancylostoma duodenale). However, due to the lack of large individual patient datasets collected using standardized protocols and the application of population-based statistical methods, little is known about factors that may affect individual responses to treatment. METHODOLOGY/PRINCIPAL FINDINGS We re-analyzed 645 individual patient data from three standardized clinical trials designed to assess the efficacy of a single 400 mg oral dose of ALB against STHs in schoolchildren from different study sites, each with varying history of drug pressure based on duration of mass drug administration programs: Ethiopia, low; Lao People's Democratic Republic (PDR), moderate; Pemba Island (Tanzania), high. Using a Bayesian statistical modelling approach to estimate individual responses (individual egg reduction rates, ERRi), we found that efficacy was lower in Pemba Island, particularly for T. trichiura. For this STH, the proportion of participants with a satisfactory response (ERRi ≥50%), was 65% in Ethiopia, 61% in Lao PDR but only 29% in Pemba Island. There was a significant correlation between ERRi and infection intensity prior to drug administration (ERRi decreasing as a function of increasing infection intensity). Individual age and sex also affected the drug response, but these were of negligible clinical significance and not consistent across STHs and study sites. CONCLUSIONS/SIGNIFICANCE We found decreased efficacy of ALB against all the STHs analyzed in Pemba Island (Tanzania), an area with high drug pressure. This does not indicate causality, as this association may also be partially explained by differences in infection intensity prior to drug administration. Notwithstanding, our results indicate that without alternative treatment regimens, program targets will not be achievable on Pemba Island because of inadequate efficacy of ALB. TRIAL REGISTRATION The study was registered on Clinicaltrials.gov (ID: NCT03465488) on March 7, 2018.
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Affiliation(s)
- Martin Walker
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United Kingdom
- London Centre for Neglected Tropical Disease Research, Imperial College London, London, United Kingdom
- * E-mail: (MW); (BL)
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Shaali M. Ame
- Laboratory Division, Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Mio Ayana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Daniel Dana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
- Nursing school, Federal University of Minas Gerais, Brazil
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Rodrigo Corrêa-Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Simone A, Pinto
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail: (MW); (BL)
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Vlaminck J, Cools P, Albonico M, Ame S, Ayana M, Dana D, Keiser J, Matoso LF, Montresor A, Mekonnen Z, Corrêa-Oliveira R, Pinto SA, Sayasone S, Vercruysse J, Levecke B. An in-depth report of quality control on Kato-Katz and data entry in four clinical trials evaluating the efficacy of albendazole against soil-transmitted helminth infections. PLoS Negl Trop Dis 2020; 14:e0008625. [PMID: 32956390 PMCID: PMC7549791 DOI: 10.1371/journal.pntd.0008625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/06/2020] [Revised: 10/12/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Efforts to control soil-transmitted helminth (STH) infections have intensified over the past decade. Field-survey data on STH prevalence, infection intensity and drug efficacy is necessary to guide the implementation of control programs and should be of the best possible quality. METHODOLOGY During four clinical trials designed to evaluate the efficacy of albendazole against STHs in Brazil, Ethiopia, Lao PDR and Tanzania, quality control (QC) was performed on the duplicate Kato-Katz thick smears and the data entry. We analyzed datasets following QC on both fecal egg counts (FECs) and data entry, and compared the prevalence of any STH infection and moderate-to-heavy intensity (MHI) infections and the drug efficacy against STH infections. RESULTS Across the four study sites, a total of 450 out of 4,830 (9.3%) Kato-Katz thick smears were re-examined. Discrepancies in FECs varied from ~3% (hookworms) to ~6.5% (Ascaris lumbricoides and Trichuris trichiura). The difference in STH prevalence and prevalence of MHI infections using the datasets with and without QC of the FECs did not exceed 0.3%, except for hookworm infections in Tanzania, where we noted a 2.2 percentage point increase in MHI infections (pre-QC: 1.6% vs. post-QC: 3.8%). There was a 100% agreement in the classification of drug efficacy of albendazole against STH between the two datasets. In total, 201 of the 28,980 (0.65%) data entries that were made to digitize the FECs were different between both data-entry clerks. Nevertheless, the overall prevalence of STH, the prevalence of MHI infections and the classification of drug efficacy remained largely unaffected. CONCLUSION/SIGNIFICANCE In these trials, where staff was informed that QC would take place, minimal changes in study outcomes were reported following QC on FECs or data entry. Nevertheless, imposing QC did reduce the number of errors. Therefore, application of QC together with proper training of the personnel and the availability of clear standard operating procedures is expected to support higher data quality.
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Affiliation(s)
- Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail: (JV); (BL)
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Shaali Ame
- Laboratory Division, Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Mio Ayana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Daniel Dana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
- Nursing school, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Simone A. Pinto
- Nursing school, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail: (JV); (BL)
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Levecke B, Cools P, Albonico M, Ame S, Angebault C, Ayana M, Behnke JM, Bethony JM, Cringoli G, Dana D, Guillard B, Viet Hoa NT, Kang G, Kattula D, Keiser J, Kotze AC, Matoso LF, Maurelli MP, McCarthy JS, Mekonnen Z, Mirams G, Montresor A, Oliveira RC, Periago MV, Pinto SA, Rinaldi L, Sayasone S, Sumo L, Tchuem-Tchuenté LA, Cam Thach DT, Thomas E, Zeynudin A, Verweij JJ, Vlaminck J, Vercruysse J. Identifying thresholds for classifying moderate-to-heavy soil-transmitted helminth intensity infections for FECPAKG2, McMaster, Mini-FLOTAC and qPCR. PLoS Negl Trop Dis 2020; 14:e0008296. [PMID: 32614828 PMCID: PMC7413557 DOI: 10.1371/journal.pntd.0008296] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/13/2019] [Revised: 08/07/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
The World Health Organization (WHO) has defined moderate-to-heavy intensity (M&HI) infections with soil-transmitted helminths (Ascaris lumbricoides, Trichuris trichiura and the two hookworms, Ancylostoma duodenale and Necator americanus) based on specific values of eggs per gram of stool, as measured by the Kato-Katz method. There are a variety of novel microscopy and DNA-based methods but it remains unclear whether applying current WHO thresholds on to these methods allows for a reliable classification of M&HI infections. We evaluated both WHO and method-specific thresholds for classifying the M&HI infections for novel microscopic (FECPAKG2, McMaster and Mini-FLOTAC) and DNA-based (qPCR) diagnostic methods. For this, we determined method-specific thresholds that best classified M&HI infections (defined by Kato-Katz and WHO thresholds; reference method) in two multi-country drug efficacy studies. Subsequently, we verified whether applying these method-specific thresholds improved the agreement in classifying M&HI infections compared to the reference method. When we applied the WHO thresholds, the new microscopic methods mainly misclassified M&HI as low intensity, and to a lesser extent low intensity infection as M&HI. For FECPAKG2, applying the method-specific thresholds significantly improved the agreement for Ascaris (moderate → substantial), Trichuris and hookworms (fair → moderate). For Mini-FLOTAC, a significantly improved agreement was observed for hookworms only (fair → moderate). For the other STHs, the agreement was almost perfect and remained unchanged. For McMaster, the method-specific thresholds revealed a fair to a substantial agreement but did not significantly improve the agreement. For qPCR, the method-specific thresholds based on genome equivalents per ml of DNA moderately agreed with the reference method for hookworm and Trichuris infections. For Ascaris, there was a substantial agreement. We defined method-specific thresholds that improved the classification of M&HI infections. Validation studies are required before they can be recommended for general use in assessing M&HI infections in programmatic settings.
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Affiliation(s)
- Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail:
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Shaali Ame
- Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | | | - Mio Ayana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jerzy M. Behnke
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Jeffrey M. Bethony
- Microbiology, Immunology, and Tropical Medicine, George Washington University Medical Center, Washington D.C., United States of America
| | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Daniel Dana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Nguyen Thi Viet Hoa
- Department of Parasitology, National Institute of Malariology, Parasitology and Entomology, Ha Noi, Vietnam
| | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Deepthi Kattula
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland & University of Basel, Basel, Switzerland
| | - Andrew C. Kotze
- Division of Agriculture and Food, Commonwealth Scientific and Industrial Research Organization, St. Lucia, Australia
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou - FIOCRUZ, Belo Horizonte, Brazil
| | - Maria P. Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - James S. McCarthy
- QIMR Berghofer Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Rodrigo Corrêa Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou - FIOCRUZ, Belo Horizonte, Brazil
| | - Maria V. Periago
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou - FIOCRUZ, Belo Horizonte, Brazil
| | - Simone A. Pinto
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou - FIOCRUZ, Belo Horizonte, Brazil
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane Capital, Lao People’s Democratic Republic
| | - Laurentine Sumo
- Centre for Schistosomiasis and Parasitology, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Dang Thi Cam Thach
- Department of Parasitology, National Institute of Malariology, Parasitology and Entomology, Ha Noi, Vietnam
| | | | - Ahmed Zeynudin
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
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Dana D, Vlaminck J, Mekonnen Z, Ayana M, Vogt F, Verdonck K, Tweya H, Timire C, Geldhof P, Levecke B. Diagnostic sensitivity of direct wet mount microscopy for soil-transmitted helminth infections in Jimma Town, Ethiopia. J Infect Dev Ctries 2020; 14:66S-71S. [PMID: 32614799 DOI: 10.3855/jidc.11733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/04/2019] [Accepted: 01/17/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Soil-transmitted helminthiasis (STH) remains a major public health problem in school children in Ethiopia. Although direct wet mount microscopy (DWMM) is the means to diagnose parasitic diseases in health care facilities in Ethiopia, it remains unclear what its diagnostic performance is for STH. METHODOLOGY A cross-sectional study was performed in Jimma Town (Ethiopia) and included 600 children from 10 primary schools. The diagnostic sensitivity of DWMM was compared to a composite reference standard (CRS) consisting of Kato-Katz, McMaster and Mini-FLOTAC. We also explored the impact of intensity of infection (the highest faecal egg counts (FECs; expressed as eggs per gram of stool (EPG)) across the CRS) on the diagnostic sensitivity of DWMM. RESULTS Based on the CRS, there were 210 Ascaris (35.0%), 312 Trichuris (52.0%) and 102 hookworm cases (17.0%). The median intensity of infections equalled 2,057 EPG for Ascaris, 200 EPG for Trichuris and 110 EPG for hookworms. The sensitivity of DWMM was 73.8% for Ascaris, but was around 17% for both Trichuris and hookworms. The sensitivity significantly increased with intensity of STH. For Ascaris, the odds for detecting an infection intensity of 1,000 EPG was 6.2 times higher than detecting an infection of 100 EPG. For Trichuris and hookworms, these odds ratios were 7.1 and 14. CONCLUSIONS The diagnostic sensitivity of DWMM is low for STH, but it is able to detect those subjects that are in the highest need of treatment, and hence contributes to the global goal to eliminate STH as a public health problem.
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Affiliation(s)
- Daniel Dana
- School of Medical Laboratory Science, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Zeleke Mekonnen
- School of Medical Laboratory Science, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Mio Ayana
- School of Medical Laboratory Science, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Florian Vogt
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Hannock Tweya
- The International Union against Tuberculosis and Lung Disease, Paris, France.
| | - Collins Timire
- The International Union against Tuberculosis and Lung Disease, Paris, France.
| | - Peter Geldhof
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
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Cools P, van Lieshout L, Koelewijn R, Addiss D, Ajjampur SSR, Ayana M, Bradbury RS, Cantera JL, Dana D, Fischer K, Imtiaz R, Kabagenyi J, Lok J, McCarthy J, Mejia R, Mekonnen Z, Njenga SM, Othman N, Shao H, Traub R, Van Esbroeck M, Vercruysse J, Vlaminck J, Williams SA, Verweij JJ, van Hellemond JJ, Levecke B. First international external quality assessment scheme of nucleic acid amplification tests for the detection of Schistosoma and soil-transmitted helminths, including Strongyloides: A pilot study. PLoS Negl Trop Dis 2020; 14:e0008231. [PMID: 32544158 PMCID: PMC7319349 DOI: 10.1371/journal.pntd.0008231] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 08/26/2019] [Revised: 06/26/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nucleic acid amplification tests (NAATs) are increasingly being used as diagnostic tools for soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, Necator americanus, Ancylostoma duodenale and A. ceylanicum), Strongyloides stercoralis and Schistosoma in human stool. Currently, there is a large diversity of NAATs being applied, but an external quality assessment scheme (EQAS) for these diagnostics is lacking. An EQAS involves a blinded process where test results reported by a laboratory are compared to those reported by reference or expert laboratories, allowing for an objective assessment of the diagnostic performance of a laboratory. In the current study, we piloted an international EQAS for these helminths (i) to investigate the feasibility of designing and delivering an EQAS; (ii) to assess the diagnostic performance of laboratories; and (iii) to gain insights into the different NAAT protocols used. METHODS AND PRINCIPAL FINDINGS A panel of twelve stool samples and eight DNA samples was validated by six expert laboratories for the presence of six helminths (Ascaris, Trichuris, N. americanus, Ancylostoma, Strongyloides and Schistosoma). Subsequently this panel was sent to 15 globally dispersed laboratories. We found a high degree of diversity among the different DNA extraction and NAAT protocols. Although most laboratories performed well, we could clearly identify the laboratories that were poorly performing. CONCLUSIONS/SIGNIFICANCE We showed the technical feasibility of an international EQAS for the NAAT of STHs, Strongyloides and Schistosoma. In addition, we documented that there are clear benefits for participating laboratories, as they can confirm and/or improve the diagnostic performance of their NAATs. Further research should aim to identify factors that explain poor performance of NAATs.
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Affiliation(s)
- Piet Cools
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
| | - Lisette van Lieshout
- Leiden University Medical Center, Leiden, The Netherlands
- Dutch Foundation for Quality Assessment in Medical Laboratories, Nijmegen, The Netherlands
| | - Rob Koelewijn
- Dutch Foundation for Quality Assessment in Medical Laboratories, Nijmegen, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - David Addiss
- The Task Force for Global Health, Decatur, Georgia, United States of America
| | | | | | - Richard S. Bradbury
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Kerstin Fischer
- Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Rubina Imtiaz
- Children Without Worms, Decatur, Georgia, United States of America
| | - Joyce Kabagenyi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - James Lok
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - James McCarthy
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Rojelio Mejia
- Baylor College of Medicine, Houston, Texas, United States of America
| | | | | | | | - Hongguang Shao
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | | | - Jozef Vercruysse
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
| | - Steven A. Williams
- Smith College, Northampton, Massachusetts, United States of America
- University of Massachusetts, Amherst, Massachusetts, United States of America
| | | | - Jaap J. van Hellemond
- Dutch Foundation for Quality Assessment in Medical Laboratories, Nijmegen, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruno Levecke
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
- * E-mail:
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Dana D, Vlaminck J, Ayana M, Tadege B, Mekonnen Z, Geldhof P, Levecke B. Evaluation of copromicroscopy and serology to measure the exposure to Ascaris infections across age groups and to assess the impact of 3 years of biannual mass drug administration in Jimma Town, Ethiopia. PLoS Negl Trop Dis 2020; 14:e0008037. [PMID: 32282815 PMCID: PMC7179930 DOI: 10.1371/journal.pntd.0008037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/17/2019] [Revised: 04/23/2020] [Accepted: 01/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The scientific community has recently summarized the desired characteristics for diagnostic tools across the different phases of a soil-transmitted helminth (STH) mass drug administration (MDA) program. Although serology meets some of the desired criteria, there is a scarcity of data on baseline serological profiles in human populations, both prior to and during MDA programs. METHODS In this study, we compared the copromicroscopic and the serological infection profiles in 600 school-aged children (SAC) and 600 adults at the advent of the MDA program in Jimma Town, Ethiopia. The serological profiles were examined by two ELISAs that measure IgG4 responses to the Ascaris suum haemoglobin antigen (AsHb) and a somatic extract of lung stage larvae (AsLungL3). Three years into the MDA program, we sampled another group of 600 SAC from the same schools to assess the reduction in prevalence and intensity of Ascaris infections measured by copromicroscopy and serology. PRINCIPAL FINDINGS Prior to the start of MDA, copromicroscopy revealed an Ascaris prevalence of 31.0% and a mean fecal egg count of 2,919 eggs per gram (EPG) in SAC. Following three years of biannual treatment, the prevalence reduced to 13.2% (57.8% reduction) and the mean fecal egg count to 1,513 EPG (48.1% reduction). This reduction was also reflected in the serological results. The seroprevalence reduced with 40.9% and 27.4% and the mean optical density ratio reduced with 44.2% and 38.2% as measured by the AsHb or AsLungL3 ELISA respectively. We also showed that, despite a decreasing coproprevalence, seroprevalence to Ascaris increased with age. CONCLUSIONS This study is the first to provide IgG4 response profiles of an endemic population to two different A. suum antigens. The results suggest that exposure to the infectious stages of Ascaris reaches beyond SAC alone. Furthermore, it highlights the possible use of serological assays to monitor changes in STH exposure during MDA programs.
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Affiliation(s)
- Daniel Dana
- School of Laboratory Science, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail: (JV); (BL)
| | - Mio Ayana
- School of Laboratory Science, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Bamlaku Tadege
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- School of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Zeleke Mekonnen
- School of Laboratory Science, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Peter Geldhof
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail: (JV); (BL)
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Ayana M, Cools P, Mekonnen Z, Biruksew A, Dana D, Rashwan N, Prichard R, Vlaminck J, Verweij JJ, Levecke B. Comparison of four DNA extraction and three preservation protocols for the molecular detection and quantification of soil-transmitted helminths in stool. PLoS Negl Trop Dis 2019; 13:e0007778. [PMID: 31658264 PMCID: PMC6837582 DOI: 10.1371/journal.pntd.0007778] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 02/07/2019] [Revised: 11/07/2019] [Accepted: 09/12/2019] [Indexed: 12/27/2022] Open
Abstract
Background A DNA extraction and preservation protocol that yields sufficient and qualitative DNA is pivotal for the success of any nucleic acid amplification test (NAAT), but it still poses a challenge for soil-transmitted helminths (STHs), including Ascaris lumbricoides, Trichuris trichiura and the two hookworms (Necator americanus and Ancylostoma duodenale). In the present study, we assessed the impact of different DNA extraction and preservativation protocols on STH-specific DNA amplification from stool. Methodology and principal findings In a first experiment, DNA was extracted from 37 stool samples with variable egg counts for T. trichiura and N. americanus applying two commercial kits, both with and without a prior bead beating step. The DNA concentration of T. trichiura and N. americanus was estimated by means of qPCR. The results showed clear differences in DNA concentration across both DNA extraction kits, which varied across both STHs. They also indicated that adding a bead beating step substantially improved DNA recovery, particularly when the FECs were high. In a second experiment, 20 stool samples with variable egg counts for A. lumbricoides, T. trichiura and N. americanus were preserved in either 96% ethanol, 5% potassium dichromate or RNAlater and were stored at 4°C for 65, 245 and 425 days. DNA was extracted using the DNeasy Blood & Tissue kit with a bead beating step. Stool samples preserved in ethanol proved to yield higher DNA concentrations as FEC increased, although stool samples appeared to be stable over time in all preservatives. Conclusions The choice of DNA extraction kit significantly affects the outcome of NAATs. Given the clear benefit of bead beating and our validation of ethanol for (long-term) preservation, we recommend that these aspects of the protocol should be adopted by any stool sampling and DNA extraction protocol for downstream NAAT-based detection and quantification of STHs. DNA-based tools are increasingly being used for the diagnosis of intestinal worm infections in both clinical and research laboratories. However, recovering DNA from intestinal worm eggs in stool remains a challenge since this DNA is protected by a very rigid egg shell. Furthermore, stool contains inhibitors that can affect test results and these should be removed during DNA extraction. Prior to DNA extraction, samples are often preserved, but the impact of the type of preservatives and the duration of preservation remains poorly studied. In the present study, we assessed the impact of four DNA extraction and three preservation protocols on the downstream performance of a DNA-based diagnostic tool for intestinal worms. We found significant differences in DNA recovery across the DNA and preservation protocols, but DNA from worm eggs in stool proved to be stable over time in all preservatives.
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Affiliation(s)
- Mio Ayana
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Sciences, Ghent University, Ghent, Belgium
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Sciences, Ghent University, Ghent, Belgium
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abdissa Biruksew
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Daniel Dana
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Sciences, Ghent University, Ghent, Belgium
| | - Nour Rashwan
- Institute of Parasitology, McGill University, Montreal, Quebec, Canada
| | - Roger Prichard
- Institute of Parasitology, McGill University, Montreal, Quebec, Canada
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Sciences, Ghent University, Ghent, Belgium
| | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Sciences, Ghent University, Ghent, Belgium
- * E-mail:
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Vlaminck J, Cools P, Albonico M, Ame S, Ayana M, Cringoli G, Dana D, Keiser J, Maurelli MP, Matoso LF, Montresor A, Mekonnen Z, Mirams G, Corrêa-Oliveira R, Pinto SA, Rinaldi L, Sayasone S, Thomas E, Vercruysse J, Verweij JJ, Levecke B. Therapeutic efficacy of albendazole against soil-transmitted helminthiasis in children measured by five diagnostic methods. PLoS Negl Trop Dis 2019; 13:e0007471. [PMID: 31369562 PMCID: PMC6675043 DOI: 10.1371/journal.pntd.0007471] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 02/04/2019] [Accepted: 05/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background Preventive chemotherapy (PC) with benzimidazole drugs is the backbone of soil-transmitted helminth (STH) control programs. Over the past decade, drug coverage has increased and with it, the possibility of developing anthelmintic resistance. It is therefore of utmost importance to monitor drug efficacy. Currently, a variety of novel diagnostic methods are available, but it remains unclear whether they can be used to monitor drug efficacy. In this study, we compared the efficacy of albendazole (ALB) measured by different diagnostic methods in a head-to-head comparison to the recommended single Kato-Katz. Methods An ALB efficacy trial was performed in 3 different STH-endemic countries (Ethiopia, Lao PDR and Tanzania), each with a different PC-history. During these trials, stool samples were evaluated with Kato-Katz (single and duplicate), Mini-FLOTAC, FECPAKG2, and qPCR. The reduction rate in mean eggs per gram of stool (ERR) and mean genome equivalents / ml of DNA extract (GERR) were calculated to estimate drug efficacy. Principal findings and conclusions The results of the efficacy trials showed that none of the evaluated diagnostic methods could provide reduction rates that were equivalent to a single Kato-Katz for all STH. However, despite differences in clinical sensitivity and egg counts, they agreed in classifying efficacy according to World Health Organization (WHO) guidelines. This demonstrates that diagnostic methods for assessing drug efficacy should be validated with their intended-use in mind and that other factors like user-friendliness and costs will likely be important factors in driving the choice of diagnostics. In addition, ALB efficacy against STH infections was lower in sites with a longer history of PC. Yet, further research is needed to identify factors that contribute to this finding and to verify whether reduced efficacy can be associated with mutations in the β-tubulin gene that have previously been linked to anthelmintic resistance. Trial registration ClinicalTrials.gov NCT03465488. During the last decade, the scale of deworming programs that aim to eliminate the morbidity caused by intestinal worms has increased to a level that is unprecedented in history. It is therefore of utmost importance to monitor any change in therapeutic efficacy that may arise from emerging drug resistance. Currently, a variety of novel methods have been described, but it remains unclear whether they can be used for monitoring drug efficacy. We applied different diagnostic methods to measure the efficacy of a commonly administered drug in deworming programs in 3 countries with different historical exposure to deworming programs. Compared to the standard diagnostic method, all diagnostic methods revealed good agreement in classifying the therapeutic efficacy according to World Health Organization guidelines, despite clear differences in diagnostic performance. We also noticed that the drug efficacy was lower in countries where drug pressure has been high. However, more research is necessary to identify factors that explain this variation in drug efficacy, including but not limited to the frequency in mutations in genes that are known to be linked with anthelmintic resistance.
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Affiliation(s)
- Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Shaali Ame
- Laboratory Division, Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Mio Ayana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Daniel Dana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria P. Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
- Nursing school, Federal University of Minas Gerais, Brazil
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Rodrigo Corrêa-Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Simone A. Pinto
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | | | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail:
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Cools P, Vlaminck J, Albonico M, Ame S, Ayana M, José Antonio BP, Cringoli G, Dana D, Keiser J, Maurelli MP, Maya C, Matoso LF, Montresor A, Mekonnen Z, Mirams G, Corrêa-Oliveira R, Pinto SA, Rinaldi L, Sayasone S, Thomas E, Verweij JJ, Vercruysse J, Levecke B. Diagnostic performance of a single and duplicate Kato-Katz, Mini-FLOTAC, FECPAKG2 and qPCR for the detection and quantification of soil-transmitted helminths in three endemic countries. PLoS Negl Trop Dis 2019; 13:e0007446. [PMID: 31369558 PMCID: PMC6675048 DOI: 10.1371/journal.pntd.0007446] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 02/13/2019] [Accepted: 05/07/2019] [Indexed: 12/20/2022] Open
Abstract
Background Because the success of deworming programs targeting soil-transmitted helminths (STHs) is evaluated through the periodically assessment of prevalence and infection intensities, the use of the correct diagnostic method is of utmost importance. The STH community has recently published for each phase of a deworming program the minimal criteria that a potential diagnostic method needs to meet, the so-called target product profiles (TPPs). Methodology We compared the diagnostic performance of a single Kato-Katz (reference method) with that of other microscopy-based methods (duplicate Kato-Katz, Mini-FLOTAC and FECPAKG2) and one DNA-based method (qPCR) for the detection and quantification of STH infections in three drug efficacy trials in Ethiopia, Lao PDR, and Tanzania. Furthermore, we evaluated a selection of minimal diagnostic criteria of the TPPs. Principal findings All diagnostic methods showed a clinical sensitivity of ≥90% for all STH infections of moderate-to-heavy intensities. For infections of very low intensity, only qPCR resulted in a sensitivity that was superior to a single Kato-Katz for all STHs. Compared to the reference method, both Mini-FLOTAC and FECPAKG2 resulted in significantly lower fecal egg counts for some STHs, leading to a substantial underestimation of the infection intensity. For qPCR, there was a positive significant correlation between the egg counts of a single Kato-Katz and the DNA concentration. Conclusions/Significance Our results indicate that the diagnostic performance of a single Kato-Katz is underestimated by the community and that diagnostic specific thresholds to classify intensity of infection are warranted for Mini-FLOTAC, FECPAKG2 and qPCR. When we strictly apply the TPPs, Kato-Katz is the only microscopy-based method that meets the minimal diagnostic criteria for application in the planning, monitoring and evaluation phase of an STH program. qPCR is the only method that could be considered in the phase that aims to seek confirmation for cessation of program. Trial registration ClinicalTrials.gov NCT03465488 To control the burden caused by intestinal worms, the World Health Organization recommends large-scale deworming programs where anti-worm drugs are administered to at-risk populations. The decision to scale down drug distribution is based on the periodically assessment of prevalence and intensity of infections using a standard diagnostic method. Today, the scientific community strongly doubts whether this method can be used throughout the program. This is in particular when it fails to detect infections of low intensity, and hence may result in prematurely stopping the distribution of drugs. We compared the diagnostic performance of alternative diagnostic methods in three drug efficacy trials in two African and one Asian country. The diagnostic methods were based on demonstration of worm eggs or worm DNA in stool. We also checked the results with minimal diagnostic criteria which have been recently been proposed by the scientific community. Our results indicate that of all diagnostic methods based on demonstration of worm eggs, only the current standard method fulfills the diagnostic criteria for planning, monitoring and evaluation phases of deworming program. Furthermore, we showed that DNA-based methods could be considered in the phase that aims to seek confirmation for cessation of the deworming program.
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Affiliation(s)
- Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Italy
| | - Shaali Ame
- Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Mio Ayana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Daniel Dana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria P. Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Catalina Maya
- Engineering Institute of National Autonomous University of Mexico, Mexico City, Mexico
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Rodrigo Corrêa-Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Simone A. Pinto
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | | | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail:
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Ayana M, Vlaminck J, Cools P, Ame S, Albonico M, Dana D, Keiser J, Manly H, Matoso LF, Mekonnen Z, Montresor A, Correa-Oliveira R, Rinaldi L, Sayasone S, Sowerby SJ, Tesfaye L, Vercruysse J, Mirams G, Levecke B. Correction: Modification and optimization of the FECPAKG2 protocol for the detection and quantification of soil-transmitted helminth eggs in human stool. PLoS Negl Trop Dis 2019; 13:e0007224. [PMID: 30830914 PMCID: PMC6398824 DOI: 10.1371/journal.pntd.0007224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ayana M, Vlaminck J, Cools P, Ame S, Albonico M, Dana D, Keiser J, Manly H, Matoso LF, Mekonnen Z, Montresor A, Correa-Oliveira R, Rinaldi L, Sayasone S, Sowersby S, Tesfaye L, Vercruysse J, Mirams G, Levecke B. Modification and optimization of the FECPAKG2 protocol for the detection and quantification of soil-transmitted helminth eggs in human stool. PLoS Negl Trop Dis 2018; 12:e0006655. [PMID: 30321180 PMCID: PMC6224113 DOI: 10.1371/journal.pntd.0006655] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 05/16/2018] [Revised: 11/08/2018] [Accepted: 06/29/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Standard diagnosis of human soil-transmitted helminth (STH) infections is based on the microscopic detection of helminth eggs in stool and supports programmatic decision making in control programs. However, the current standard diagnostic techniques still show a number of limitations. Recently, the FECPAKG2 method was developed to detect helminth infections and asses drug efficacy in sheep or cattle. It includes a device that takes digital images of helminth eggs that have been concentrated into one microscopic field of view and stores these images online for future evaluation. The goal of this study was to introduce a standard operating procedure (SOP) for the detection and quantification of human STH eggs using the FECPAKG2 and to optimize 2 crucial steps of the protocol, namely the sedimentation step (aimed at separating sinking eggs from floating debris) and the accumulation step (aimed at concentrating the eggs by flotation). METHODOLOGY/PRINCIPAL FINDINGS A total of 55 stool samples from naturally infected children were used from 4 different geographical areas (Ethiopia, Laos, Tanzania and Brazil). The results showed that Trichuris eggs generally moved slower than eggs of the other two STH species during both sedimentation in water in the FECPAKG2 sedimenter as during accumulation in flotation solution in the FECPAKG2 cassettes. The highest number of eggs were present in the slurry of the sedimenter after overnight sedimentation (Ascaris: 95.7%, Trichuris: 89.8% and hookworm: 94.2% of the eggs). A minimum of 24 minutes were needed to ensure the accumulation of at least 80% of the eggs from all three STH species in the FECPAKG2 cassette (Ascaris: 96.1%; Trichuris: 88.2% and hookworm: 87.6%). CONCLUSIONS/SIGNIFICANCE This study introduces for the first time a SOP for the FECPAKG2 method. Different aspects of the method for diagnosing human STH infections were optimized. Our study forms the basis for a thorough and objective evaluation of the system as a diagnostic tool that could be implemented in STH control programs.
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Affiliation(s)
- Mio Ayana
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Piet Cools
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Shaali Ame
- Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Daniel Dana
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
- Nursing school, Federal university of Minas Gerais, Belo Horizonte, Brazil
| | - Zeleke Mekonnen
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | | | - Rodrigo Correa-Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Somphou Sayasone
- National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Stephen Sowersby
- Department of Biochemistry, University of Otago, Otago, New Zealand
| | - Lensa Tesfaye
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | | | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
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Bajiro M, Dana D, Ayana M, Emana D, Mekonnen Z, Zawdie B, Garbi A, Kure A, Zeynudin A. Prevalence of Schistosoma mansoni infection and the therapeutic efficacy of praziquantel among school children in Manna District, Jimma Zone, southwest Ethiopia. Parasit Vectors 2016; 9:560. [PMID: 27772528 PMCID: PMC5075754 DOI: 10.1186/s13071-016-1833-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 01/06/2016] [Accepted: 10/05/2016] [Indexed: 01/17/2023] Open
Abstract
Background Intestinal schistosomiasis is one of the neglected tropical parasitic diseases caused by Schistosoma mansoni. Currently, the control measures for the disease are mainly based on mass drug administration (MDA) with praziquantel (PZQ) targeting the school-age children. In Ethiopia, the potential foci for schistosomiasis and therapeutic efficacy of PZQ among school-age children remain poorly explored. Therefore, we determined both the prevalence and intensity of S. mansoni infection and the therapeutic efficacy of PZQ among school children in the Manna District (new foci for S. mansoni), Jimma Zone, southwest Ethiopia. Methods A cross-sectional study was conducted among the school children aged between 6 and 18 years in three primary schools in Manna district from March to April 2014. For diagnosis of S. mansoni, a single stool sample was obtained from each child and processed using single Kato Katz and examined under light microscopy. A questionnaire was used to collect demographic information of the school children participated in the study. School children excreting eggs of S. mansoni were administered with 40 mg/kg of PZQ and re-examined after three weeks post-treatment. The therapeutic efficacy of PZQ against S. mansoni was evaluated by means of cure rate and egg reduction rate. Results The overall prevalence of S. mansoni among the school children in the three primary schools in Manna District was 24.0 %. Higher prevalence was recorded for males 25.6 % (61/238) than for females 22.5 % (59/262). Majority (27.5 %) of infection intensity was light with mean faecal egg count (FEC) of 202 eggs per gram (EPG). The therapeutic efficacy of PZQ at a dose of 40 mg/kg was highly efficient (cure rate of 99.1 % and egg reduction rate of 99.9 %) among the school children in the three primary schools in Manna District. Conclusions The school children in the three primary schools of Manna District, Jimma Zone were at moderate risk of the morbidity caused by S. mansoni (prevalence > 10 % and < 50 % according to WHO threshold), and hence a biannual MDA with PZQ is required. PZQ available on the local market was found efficient and can be recommended for individual treatment in absence of MDA. The therapeutic efficacy of PZQ at 40 mg/kg against S. mansoni was high in the study area. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1833-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mitiku Bajiro
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
| | - Daniel Dana
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Mio Ayana
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Daniel Emana
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Zeleke Mekonnen
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Belay Zawdie
- Departement of Biomedical Sciences, Jimma University, Jimma, Ethiopia
| | - Asfaw Garbi
- Departement of Biomedical Sciences, Jimma University, Jimma, Ethiopia
| | - Ashenafi Kure
- Public Health Laboratory, South Nations Nationalities and People's Regional State Health Bureau, Hawassa, Ethiopia
| | - Ahmed Zeynudin
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
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Bekana T, Mekonnen Z, Zeynudin A, Ayana M, Getachew M, Vercruysse J, Levecke B. Comparison of Kato-Katz thick-smear and McMaster egg counting method for the assessment of drug efficacy against soil-transmitted helminthiasis in school children in Jimma Town, Ethiopia. Trans R Soc Trop Med Hyg 2016; 109:669-71. [PMID: 26385937 DOI: 10.1093/trstmh/trv073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is a paucity of studies that compare efficacy of drugs obtained by different diagnostic methods. METHODS We compared the efficacy of a single oral dose albendazole (400 mg), measured as egg reduction rate, against soil-transmitted helminth infections in 210 school children (Jimma Town, Ethiopia) using both Kato-Katz thick smear and McMaster egg counting method. RESULTS Our results indicate that differences in sensitivity and faecal egg counts did not imply a significant difference in egg reduction rate estimates. CONCLUSION The choice of a diagnostic method to assess drug efficacy should not be based on sensitivity and faecal egg counts only.
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Affiliation(s)
- Teshome Bekana
- Department of Biomedical Science, Faculty of Public Health and Medical Science, Mettu University, Mettu, Ethiopia
| | - Zeleke Mekonnen
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Ahmed Zeynudin
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mio Ayana
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mestawet Getachew
- Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Belgium
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Kure A, Mekonnen Z, Dana D, Bajiro M, Ayana M, Vercruysse J, Levecke B. Comparison of individual and pooled stool samples for the assessment of intensity of Schistosoma mansoni and soil-transmitted helminth infections using the Kato-Katz technique. Parasit Vectors 2015; 8:489. [PMID: 26400064 PMCID: PMC4581403 DOI: 10.1186/s13071-015-1101-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 04/28/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our group has recently provided a proof-of-principle for the examination of pooled stool samples using McMaster technique as a strategy for the rapid assessment of intensity of soil-transmitted helminth infections (STH, Ascaris lumbricoides, Trichuris trichiura and hookworm). In the present study we evaluated this pooling strategy for the assessment of intensity of both STH and Schistosoma mansoni infections using the Kato-Katz technique. METHODS A cross-sectional survey was conducted in 360 children aged 5-18 years from six schools in Jimma Zone (southwest Ethiopia). We performed faecal egg counts (FECs) in both individual and pooled samples (pools sizes of 5, 10 and 20) to estimate the number of eggs per gram of stool (EPG) using the Kato-Katz technique. We also assessed the time to screen both individual and pooled samples. RESULTS Except for hookworms, there was a significant correlation (correlation coefficient = 0.53-0.95) between the mean of individual FECs and the FECs of pooled samples for A. lumbricoides, T. trichiura and S. mansoni, regardless of the pool size. Mean FEC were 2,596 EPG, 125 EPG, 47 EPG, and 41 EPG for A. lumbricoides, T. trichiura, S. mansoni and hookworm, respectively. There was no significant difference in FECs between the examination of individual and pooled stool samples, except for hookworms. For this STH, pools of 10 resulted in a significant underestimation of infection intensity. The total time to obtain individual FECs was 65 h 5 min. For pooled FECs, this was 19 h 12 min for pools of 5, 14 h 39 min for pools of 10 and 12 h 42 min for pools of 20. CONCLUSIONS The results indicate that pooling of stool sample holds also promise as a rapid assessment of infections intensity for STH and S. mansoni using the Kato-Katz technique. In this setting, the time in the laboratory was reduced by 70 % when pools of 5 instead of individual stool samples were screened.
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Affiliation(s)
- Ashenafi Kure
- Public Health Laboratory, Southern Nations Nationalities and People's Regional State Health Bureau, Hawassa, Ethiopia.
| | - Zeleke Mekonnen
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
| | - Daniel Dana
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
| | - Mitiku Bajiro
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
| | - Mio Ayana
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium.
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium.
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Dana D, Mekonnen Z, Emana D, Ayana M, Getachew M, Workneh N, Vercruysse J, Levecke B. Prevalence and intensity of soil-transmitted helminth infections among pre-school age children in 12 kindergartens in Jimma Town, southwest Ethiopia. Trans R Soc Trop Med Hyg 2014; 109:225-7. [PMID: 25371496 DOI: 10.1093/trstmh/tru178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-school age children (preSAC) remain difficult to reach in mass drug administration (MDA) programmes to control soil-transmitted helminth (STH) infections. Kindergartens provide a unique platform to increase the coverage of MDA in preSAC in Ethiopia, but surveys assessing STHs among preSAC in kindergartens are scarce. METHODS We report the prevalence and intensity of STH infections among 622 preSAC in 12 kindergartens in Jimma, Ethiopia. RESULTS STHs were found in all kindergartens, with prevalence exceeding 50% in 8 kindergartens. The majority of the infections were of low intensity. CONCLUSIONS This study highlights the importance of kindergartens as an additional opportunity for MDA in Ethiopia.
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Affiliation(s)
- Daniel Dana
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Zeleke Mekonnen
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Daniel Emana
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mio Ayana
- Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mestawet Getachew
- Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Netsanet Workneh
- Department of Paediatrics, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium
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Abstract
OBJECTIVE To explore the views of therapists working with stroke patients on the use of a patient-held record (PHR) for stroke patients. A PHR was developed in the form of a pocket-sized booklet (21 cm x 14.5 cm) in which staff recorded information relating to the patient's management. The aim of the PHR was to facilitate communication and involve patients more directly in their care. METHODS Six semi-structured group interviews were conducted with therapists (25 in total) from one inner city hospital. RESULTS The following themes emerged from the content analysis: (1) Therapists were supportive of plans for a PHR, citing the benefits of greater patient involvement. (2) However, they questioned its feasibility, in particular the issue of patient responsibility and its use with the cognitively impaired. (3) They also questioned its ability to facilitate communication among health professionals because of existing differences in perspectives. (4) These therapists revealed concerns about the effect that information may have on patients. (5) They also raised practical issues about finding the time to make entries, wording and content of entries in the PHR. CONCLUSION Responsibility for the PHR may enhance patients' understanding and involvement in their care, yet ownership alone does not guarantee the confidence needed to encourage dialogue between patients and care providers. Furthermore, it is doubtful whether a PHR can hope to overcome the fundamental differences in the philosophies of care which the therapists reported.
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Affiliation(s)
- M Ayana
- Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK
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