Diagnostic Accuracy and Feasibility of Serological Tests on Filter Paper Samples for Outbreak Detection of T.b. gambiense Human African Trypanosomiasis

Epco Hasker Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Pascal Lutumba Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Dieudonné Mumba Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Veerle Lejon Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Phillipe Büscher Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Victor Kande Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Jean Jacques Muyembe Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Joris Menten Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Jo Robays Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Marleen Boelaert Institute of Tropical Medicine Antwerp, Belgium; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo

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Control of human African trypanosomiasis (HAT) in the Democratic Republic of Congo is based on mass population screening by mobile teams; a costly and labor-intensive approach. We hypothesized that blood samples collected on filter paper by village health workers and processed in a central laboratory might be a cost-effective alternative. We estimated sensitivity and specificity of micro-card agglutination test for trypanosomiasis (micro-CATT) and enzyme-linked immunosorbent assay (ELISA)/T.b. gambiense on filter paper samples compared with parasitology-based case classification and used the results in a Monte Carlo simulation of a lot quality assurance sampling (LQAS) approach. Micro-CATT and ELISA/T.b. gambiense showed acceptable sensitivity (92.7% [95% CI 87.4–98.0%] and 82.2% [95% CI 75.3–90.4%]) and very high specificity (99.4% [95% CI 99.0–99.9%] and 99.8% [95% CI 99.5–100%]), respectively. Conditional on high sample size per lot (≥ 60%), both tests could reliably distinguish a 2% from a zero prevalence at village level. Alternatively, these tests could be used to identify individual HAT suspects for subsequent confirmation.

Author Notes

*Address correspondence to Epco Hasker, Institute of Tropical Medicine, National straat 155, Antwerpen 2000, Belgium. E-mail: ehasker@itg.be

Authors' addresses: Epco Hasker, Institute of Tropical Medicine, Department of Public Health, Epidemiology Unit, Nationalestraat 155, 2000 Antwerp, Belgium, E-mail: ehasker@itg.be. Pascal Lutumba, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo, E-mail: pascal_lutumba@yahoo.fr. Dieudonné Mumba, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo, E-mail: mumbadieudonne@yahoo.fr. Veerle Lejon, Institute of Tropical Medicine, Department of Parasitology, Nationalestraat 155, 2000 Antwerp, Belgium, E-mail: vlejon@itg.be. Phillipe Büscher, Institute of Tropical Medicine, Department of Parasitology, Nationalestraat 155, 2000 Antwerp, Belgium, E-mail: pbuscher@itg.be. Victor Kande, Programme National de Lutte Contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo, E-mail: kandevictor@yahoo.fr. Jean Jacques Muyembe, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo, E-mail: jjmuyembe@yahoo.fr. Joris Menten, Institute of Tropical Medicine, Clinical Trial Unit, Nationalestraat 155, 2000 Antwerp, Belgium, E-mail: jmenten@itg.be. Jo Robays, Institute of Tropical Medicine, Department of Public Health, Epidemiology Unit, Nationalestraat 155, 2000 Antwerp, Belgium, E-mail: Jo.Robays@kce.fgov.be. Marleen Boelaert, Institute of Tropical Medicine, Department of Public Health, Epidemiology Unit, Nationalestraat 155, 2000 Antwerp, Belgium, E-mail: mboelaert@itg.be.

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