Evaluation of Point-of-Contact Circulating Cathodic Antigen Assays for the Detection of Schistosoma mansoni Infection in Low-, Moderate-, and High-Prevalence Schools in Western Kenya

Karen T. Foo Department of Public Health Sciences, Division of Global Health/IHCAR, Karolinska Institute, Stockholm, Sweden; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya

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Anna J. Blackstock Department of Public Health Sciences, Division of Global Health/IHCAR, Karolinska Institute, Stockholm, Sweden; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya

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Elizabeth A. Ochola Department of Public Health Sciences, Division of Global Health/IHCAR, Karolinska Institute, Stockholm, Sweden; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya

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Daniel O. Matete Department of Public Health Sciences, Division of Global Health/IHCAR, Karolinska Institute, Stockholm, Sweden; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya

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Pauline N. M. Mwinzi Department of Public Health Sciences, Division of Global Health/IHCAR, Karolinska Institute, Stockholm, Sweden; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya

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Susan P. Montgomery Department of Public Health Sciences, Division of Global Health/IHCAR, Karolinska Institute, Stockholm, Sweden; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya

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Diana M. S. Karanja Department of Public Health Sciences, Division of Global Health/IHCAR, Karolinska Institute, Stockholm, Sweden; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya

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W. Evan Secor Department of Public Health Sciences, Division of Global Health/IHCAR, Karolinska Institute, Stockholm, Sweden; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya

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We evaluated the performance of a point-of-contact circulating cathodic antigen assay (POC-CCA) to detect schistosome infections in primary school children (N = 1,801) living in areas with low, moderate, and high Schistosoma mansoni 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.

Author Notes

* Address correspondence to W. Evan Secor, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS: D-65, Atlanta, GA 30329-4027. E-mail: was4@cdc.gov

Financial support: This project was funded by the University of Georgia Research Foundation, Inc, which is funded by the Bill and Melinda Gates Foundation for this SCORE project, the Division of Parasitic Diseases and Malaria/CDC and the United States Agency for International Development (USAID).

Authors' addresses: Karen T. Foo, Anna J. Blackstock, Susan P. Montgomery, and W. Evan Secor, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: karen.t.foo@gmail.com, hyp9@cdc.gov, zqu6@cdc.gov, and was4@cdc.gov. Elizabeth A. Ochola, Daniel O. Matete, Pauline N. M. Mwinzi, and Diana M. S. Karanja, Neglected Tropical Diseases Unit, Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya, E-mails: eakinyi@kemricdc.org, dmatete@kemricdc.org, pmwinzi@kemricdc.org, and dkaranja@kemricdc.org.

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