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Maddren R, Anderson RM. Measuring heterogeneities in soil-transmitted helminth transmission and control. Trends Parasitol 2024; 40:45-59. [PMID: 38087679 DOI: 10.1016/j.pt.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
The global effort over the past decade to control soil-transmitted helminths (STH) has resulted in communities with endemic infection reaching low prevalence levels suitable for the validation of elimination as a public health problem (EPHP), defined by the World Health Organisation (WHO) as <2% of infections classified as moderate or heavy intensity. The spatial scale in which this is validated is currently undefined. As the burden of STH infection decreases, the degree of aggregation of infection within individuals in a population increases. Identifying these remaining pockets of infection requires fine-scale monitoring and evaluation (M&E) programmes that are rarely implemented within current national neglected tropical disease (NTD) control. This review examines various heterogeneities that characterise the epidemiology of STH infections, and discusses their impact on control policy formulation.
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Affiliation(s)
- Rosie Maddren
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
| | - Roy M Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Crellen T, Haswell M, Sithithaworn P, Sayasone S, Odermatt P, Lamberton PHL, Spencer SEF, Déirdre Hollingsworth T. Diagnosis of helminths depends on worm fecundity and the distribution of parasites within hosts. Proc Biol Sci 2023; 290:20222204. [PMID: 36651047 PMCID: PMC9845982 DOI: 10.1098/rspb.2022.2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
Helminth transmission and morbidity are dependent on the number of mature parasites within a host; however, observing adult worms is impossible for many natural infections. An outstanding challenge is therefore relating routine diagnostics, such as faecal egg counts, to the underlying worm burden. This relationship is complicated by density-dependent fecundity (egg output per worm reduces due to crowding at high burdens) and the skewed distribution of parasites (majority of helminths aggregated in a small fraction of hosts). We address these questions for the carcinogenic liver fluke Opisthorchis viverrini, which infects approximately 10 million people across Southeast Asia, by analysing five epidemiological surveys (n = 641) where adult flukes were recovered. Using a mechanistic model, we show that parasite fecundity varies between populations, with surveys from Thailand and Laos demonstrating distinct patterns of egg output and density-dependence. As the probability of observing faecal eggs increases with the number of mature parasites within a host, we quantify diagnostic sensitivity as a function of the worm burden and find that greater than 50% of cases are misdiagnosed as false negative in communities close to elimination. Finally, we demonstrate that the relationship between observed prevalence from routine diagnostics and true prevalence is nonlinear and strongly influenced by parasite aggregation.
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Affiliation(s)
- Thomas Crellen
- School of Biodiversity One Health and Veterinary Medicine, Graham Kerr Building, University of Glasgow, 82 Hillhead Street, Glasgow G12 8QQ, UK
- Wellcome Centre for Integrative Parasitology, Sir Graeme Davies Building, University of Glasgow, 120 University Place, Glasgow G12 8TA, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK
| | - Melissa Haswell
- Office of the Deputy Vice Chancellor, Indigenous Strategy and Services and School of Geosciences, John Woolley Building, University of Sydney, Sydney, New South Wales 2050, Australia
- School of Public Health and Social Work, Kelvin Grove Campus, Queensland University of Technology, Brisbane City, Queensland 4000, Australia
| | - Paiboon Sithithaworn
- Department of Parasitology, Khon Kaen University, 123 Thanon Mittraphap, Khon Kaen 40002, Thailand
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Samsenthai Road, Sisattanak district, Vientiane, Lao PDR
| | - Peter Odermatt
- Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Petersplatz 1, Basel 4001, Switzerland
| | - Poppy H. L. Lamberton
- School of Biodiversity One Health and Veterinary Medicine, Graham Kerr Building, University of Glasgow, 82 Hillhead Street, Glasgow G12 8QQ, UK
- Wellcome Centre for Integrative Parasitology, Sir Graeme Davies Building, University of Glasgow, 120 University Place, Glasgow G12 8TA, UK
| | | | - T. Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, UK
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