title: Diagnostic accuracy and feasibility of serological tests on filter paper samples for outbreak detection of T.b. gambiense human African trypanosomiasis.
abstract: 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 (> or = 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.
authors.affiliation: Institute of Tropical Medicine Antwerp, Belgium. ehasker@itg.be
authors.forename: Epco
authors.initials: E
authors.lastname: Hasker
authors.forename: Pascal
authors.initials: P
authors.lastname: Lutumba
authors.forename: Dieudonné
authors.initials: D
authors.lastname: Mumba
authors.forename: Veerle
authors.initials: V
authors.lastname: Lejon
authors.forename: Phillipe
authors.initials: P
authors.lastname: Büscher
authors.forename: Victor
authors.initials: V
authors.lastname: Kande
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Muyembe
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.forename: Jo
authors.initials: J
authors.lastname: Robays
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
mesh_terms: D000372:Agglutination Tests / Q000592:standards*; D000913:Antibodies, Protozoan / Q000097:blood; D001800:Blood Specimen Collection / Q000295:instrumentation / Q000379:methods; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay / Q000592:standards*; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D007841:Latex Fixation Tests / Q000592:standards; D009010:Monte Carlo Method; D010209:Paper; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D014347:Trypanosoma brucei gambiense / Q000276:immunology*; D014353:Trypanosomiasis, African / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D000913:Antibodies, Protozoan