Volume 92, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We evaluated the performance of a point-of-contact circulating cathodic antigen assay (POC-CCA) to detect schistosome infections in primary school children ( = 1,801) living in areas with low, moderate, and high prevalence in western Kenya. The commercially available assay (CCA-1) and a second, experimental formulation (CCA-2) were compared against Kato-Katz stool examinations and an anti-schistosome enzyme-linked immunosorbent assay (ELISA). A latent class model based on the four tests was used to establish “true infection status” in three different zones based on their distance from Lake Victoria. As a screening tool for community treatment according to World Health Organization (WHO) guidelines, the Kato-Katz examination was in closest agreement with the latent class model, followed by the experimental CCA-2, soluble adult worm antigen preparation (SWAP) ELISA, and CCA-1, which had high sensitivity compared with the other tests but was consistently the least specific. Our experience suggests that POC-CCA tests offer a field-friendly alternative to Kato-Katz, but need further interpretation for appropriate field use.


Article metrics loading...

Loading full text...

Full text loading...



  1. Fenwick A, Webster JP, Bosque-Oliva E, Blair L, Fleming FM, Zhang Y, Stothard JR, Gabrielli AF, Clements ACA, Kabatereine NB, Toure S, Dembele R, Nyandindi U, Mwansa J, Koukounari A, , 2009. The Schistosomiasis Control Initiative (SCI): rationale, development and implementation from 2002–2008. Parasitology 136: 17191730.[Crossref]
  2. Barreto ML, Silva JT, Mott KE, Lehman JS, Jr, 1978. Stability of faecal egg excretion in Schistosoma mansoni infection. Trans R Soc Trop Med Hyg 103: 347354.
  3. Utzinger J, N'Goran EK, Caffrey CR, Keiser J, , 2010. From innovation to application: social-ecological context, diagnostics, drugs and integrated control of schistosomiasis. Acta Trop 2558: S121S137.
  4. Stothard JR, , 2009. Improving control of African schistosomiasis: towards effective use of rapid diagnostic tests within an appropriate disease surveillance model. Trans R Soc Trop Med Hyg 103: 325332.[Crossref]
  5. Katz N, Chaves A, Pellegrino J, , 1972. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 14: 397400.
  6. Shane HL, Verani JR, Abudho B, Montgomery SP, Blackstock AJ, Mwinzi PNM, Butler SE, Karanja DMS, Secor WE, , 2011. Evaluation of urine CCA assays for detection of Schistosoma mansoni infection in western Kenya. PLoS Negl Trop Dis 5: e951.[Crossref]
  7. Teesdale CH, Fahringer K, Chitsulo L, , 1985. Egg count variability and sensitivity of a thin smear technique for the diagnosis of Schistosoma mansoni . Trans R Soc Trop Med Hyg 79: 369373.[Crossref]
  8. Kongs A, Marks G, Verle P, van der Stuyft P, , 2001. The unreliability of the Kato-Katz technique limits its usefulness for evaluating S. mansoni infections. Trop Med Int Health 6: 163169.[Crossref]
  9. Engels D, Sinzinkayo E, Gryseels B, , 1996. Day-to-day egg count fluctuation in Schistosoma mansoni infection and its operational implications. Am J Trop Med Hyg 57: 571577.
  10. Doenhoff MJ, Chiodini PL, Hamilton JV, , 2004. Specific and sensitive diagnosis of schistosome infection: can it be done? Trends Parasitol 20: 3539.[Crossref]
  11. van Dam GJ, Wichers JH, Falcao Feirreira TM, Ghati D, van Amerongen A, Deelder AM, , 2004. Diagnosis of schistosomiasis by reagent strip test for detection of circulating cathodic antigen. J Clin Microbiol 42: 54585461.[Crossref]
  12. Coulibaly JT, Knopp S, N'Guessan NA, Silué KD, Fürst T, Lohourignon LK, Brou JK, N'Gbesso YK, Vounatsou P, N'Goran EK, Utzinger J, , 2011. Accuracy of urine circulating cathodic antigen (CCA) test for Schistosoma mansoni diagnosis in different settings of Côte d'Ivoire. PLoS Negl Trop Dis 5: e1384.[Crossref]
  13. Tchuem Tchuenté LA, Kueté Fouodo CJ, Kamwa Ngassam RI, Sumo L, Dongmo Noumedem C, Kenfack CM, Gipwe NF, Nana ED, Stothard JR, Rollinson D, , 2012. Evaluation of circulating cathodic antigen (CCA) urine-tests for diagnosis of Schistosoma mansoni infection in Cameroon. PLoS Negl Trop Dis 6: e1758.[Crossref]
  14. Navaratnam AM, Mutumba-Nakalembe MJ, Stothard JR, Kabatereine NB, Fenwick A, Sousa-Figueiredo JC, , 2012. Notes on the use of urine-CCA dipsticks for detection of intestinal schistosomiasis in preschool children. Trans R Soc Trop Med Hyg 106: 619622.[Crossref]
  15. Colley DG, Binder S, Campbell C, King CH, Tchuem Tchuenté LA, N'Goran EK, Erko B, Karanja DM, Kabatereine NB, van Lieshout L, Rathbun S, , 2013. A five-country evaluation of a point-of-care circulating cathodic antigen urine assay for the prevalence of Schistosoma mansoni . Am J Trop Med Hyg 88: 426432.[Crossref]
  16. Erko B, Medhin G, Teklehaymanot T, Begarege A, Legesse M, , 2013. Evaluation of urine-circulating cathodic antigen (Urine-CCA) cassette test for the detection of Schistosoma mansoni infection in areas of moderate prevalence in Ethiopia. Trop Med Int Health 18: 10291035.[Crossref]
  17. Adriko M, Standley CJ, Tinkitina B, Tukahebwa EM, Fenwick A, Fleming FM, Sousa-Figueiredo JC, Stothard JR, Kabatereine NB, , 2014. Evaluation of circulating cathodic antigen (CCA) urine-cassette assay as a survey tool for Schistosoma mansoni in different transmission settings within Bugiri District, Uganda. Acta Trop 136: 5057.[Crossref]
  18. Carabin H, Balolong E, Joseph L, McGarvey ST, Johansen MV, Fernandez T, Willingham AL, Olveda R, , 2005. Estimating sensitivity and specificity of a faecal examination method for Schistosoma japonicum infection in cats, dogs, water buffaloes, pigs, and rats in western Samar and Sorsogon Provinces, the Philippines. Int J Parasitol 35: 15171524.[Crossref]
  19. Koukounari A, Webster JP, Donnelly CA, Bray BC, Naples J, Bosompem K, Shiff C, , 2009. Sensitivities and specificities of diagnostic tests and infection prevalence of Schistosoma haematobium estimated from data on adults in villages northwest of Accra, Ghana. Am J Trop Med Hyg 80: 435441.
  20. Tarafder MR, Carabin H, Joseph L, Balolong E, Jr Olveda R, McGarvey ST, , 2010. Estimating the sensitivity and specificity of Kato-Katz stool examination technique for detection of hookworms, Ascaris lumbricoides and Trichuris trichiura infections in humans in the absence of a ‘gold standard.’ Int J Parasitol 40: 399404.[Crossref]
  21. World Health Organization, 2006. Preventive Chemotherapy in Human Helminthiasis: Coordinated Use of Anthelminthic Drugs in Control Interventions: A Manual for Health Professionals and Program Managers. Geneva, Switzerland: World Health Organization.
  22. Handzel T, Karanja DMS, Addiss DG, Hightower AW, Rosen DH, Colley DG, Andove J, Slutsker L, Secor WE, , 2003. Geographic distribution of schistosomiasis and soil-transmitted helminths in western Kenya: implications for anthelminthic mass treatment. Am J Trop Med Hyg 69: 318323.
  23. Bai J, Perron P, , 2003. Computation and analysis of multiple structural change models. J Appl Econ 18: 122.[Crossref]
  24. Dendukuri N, Hadgu A, Wang L, , 2009. Modeling conditional dependence between diagnostic tests: a multiple latent variable model. Stat Med 28: 442461.[Crossref]
  25. Bartko JJ, , 1966. The intraclass correlation coefficient as a measure of reliability. Psychol Rep 19: 311.[Crossref]
  26. Fleiss JL, Levin B, Paik MC, , 2003. Statistical Methods for Rates and Proportions, 3rd Ed. New York, NY: John Wiley and Sons.[Crossref]
  27. Landis JR, Koch GG, , 1977. The measurement of observer agreement for categorical data. Biometrics 33: 159174.[Crossref]
  28. Standley CJ, Lwambo NJS, Lange CN, Kariuki HC, Adriko M, Stothard J, , 2010. Performance of circulating cathodic antigen (CCA) urine-dipsticks for rapid detection of intestinal schistosomiasis in schoolchildren from shoreline communities of Lake Victoria. Parasit Vectors 3: 7.[Crossref]
  29. Standley CJ, Adriko M, Arinaitwe M, Atuhaire A, Kazibwe F, Fenwick A, Kabatereine NB, Stothard JR, , 2010. Epidemiology and control of intestinal schistosomiasis on the Sesse Islands, Uganda: integrating malacology and parasitology to tailor local treatment recommendations. Parasit Vectors 3: 64.[Crossref]
  30. Sousa-Figueiredo JC, Betson M, Kabatereine NB, Stothard JR, , 2013. The urine circulating cathodic antigen (CCA) dipstick: a valid substitute for microscopy for mapping and point-of-care diagnosis of intestinal schistosomiasis. PLoS Negl Trop Dis 7: e2008.[Crossref]
  31. Coulibaly JT, N'Gbesso YK, Knopp S, N'Guessan NA, Silué KD, van Dam GJ, N'Goran EK, Utzinger J, , 2013. Accuracy of urine circulating cathodic antigen test for the diagnosis of Schistosoma mansoni in preschool-aged children before and after treatment. PLoS Negl Trop Dis 7: e2109.[Crossref]
  32. Worrell CM, Bartoces M, Karanja DMS, Ochola EA, Matete DO, Mwinzi PNM, Montgomery SP, Secor WE, , 2015. Cost analysis of tests for the detection of Schistosoma mansoni infection in children in western Kenya. Am J Trop Med Hyg 92: 12331239.[Crossref]

Data & Media loading...

  • Received : 15 Oct 2014
  • Accepted : 11 Mar 2015

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error