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Utility and costs of reactive case detection using molecular detection and genotyping in Thailand, a near-elimination setting with predominantly Plasmodium vivax transmission
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- Cotter, Chris (author)
- Uppsala universitet,Institutionen för kvinnors och barns hälsa,University of California San Francisco
- (creator_code:org_t)
- English.
- Other publication (other academic/artistic)
Abstract
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- In Thailand, progress toward malaria elimination has slowed, largely due to the challenge of residual Plasmodium vivax transmission. Screening and testing for malaria in the vicinity of recent passively-identified index cases, also called reactive case detection (RACD), is commonly used in near-elimination settings, but standard diagnostics such as microscopy miss low-level infections. We assessed the utility, costs, and cost-effectiveness of RACD using loop-mediated isothermal amplification (LAMP) versus standard RACD using microscopy to detect infections in RACD. We also assessed the utility of microsatellite genotyping to determine relatedness of index and RACD-identified infections. Each of 27 microscopy-positive index cases reported through passive surveillance (20 Plasmodium vivax, 5 P. falciparum, and 2 mixed P. falciparum/ P. vivax infections) triggered RACD, whereby 1,973 index case household members or surrounding neighbors received malaria testing. Of these, no infections were detected in RACD by microscopy, but 12 (0.6%) confirmed or probable infections were detected in RACD by molecular testing using LAMP, out of which four infections were confirmed by PCR. Among these four, one (25%) was genetically related to the index case suggesting low levels of local transmission. The average cost per individual screened for RACD using microscopy and RACD using LAMP was $15 and $22, respectively, and the incremental cost effectiveness ratio to detect infections was $1,191 per additional infection detected. In this near elimination setting, RACD using molecular detection and genotyping can make RACD a more effective strategy by identifying additional infections and transmission foci to facilitate a better understanding regarding local patterns of transmission.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
Keyword
- malaria
- surveillance
- genetic surveillance
- reactive case detection
- LAMP
- Plasmodium vivax
- cost
- cost-effectiveness
Publication and Content Type
- vet (subject category)
- ovr (subject category)
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