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

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  • 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

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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