title: A comparison of two tests for filarial antigenemia in areas in Sri Lanka and Indonesia with low-level persistence of lymphatic filariasis following mass drug administration.
abstract: BACKGROUND
  Filarial antigen tests are key tools for mapping the distribution of bancroftian filariasis and for detecting areas with persistent infections following mass drug administration (MDA). A recent study showed that the new Alere Filariasis Test Strip (FTS) has better analytical sensitivity than the BinaxNOW Filariasis card test (Card Test) for detecting circulating filarial antigen, and the FTS detected more positive results than the Card Test in a field study performed in a highly endemic area in Liberia.
  
  
  METHODS
  The present study compared the performance of the FTS and the Card Test in community surveys that were conducted in southern Sri Lanka and in Indonesia (Central Java) in areas with low-level persistence of LF following multiple rounds of MDA with diethylcarbamazine plus albendazole. The studies were performed in densely populated semi-urban areas where Wuchereria bancrofti is transmitted by Culex quinquefasciatus.
  
  
  RESULTS
  Antigenemia rates by FTS were 138% higher in the Sri Lanka study (43/852 vs. 18/852) and 21% higher in the Indonesia study (50/778 vs. 41/778) than antigenemia rates by Card Test. Antigenemia rates were significantly higher in males than in females and higher in adults than in children in both study sites. Although overall antigenemia rates and test scores were significantly higher by FTS than by Card Test in both study areas, rates in young children were similar with both tests in both areas.
  
  
  CONCLUSIONS
  These results extend the previously reported superior sensitivity of the FTS to areas with low residual infection rates following MDA, and this could affect mapping and post-MDA survey results in adults. However, our findings suggest that results of transmission assessment surveys (TAS) performed in school-aged children are likely to be similar with both tests.
authors.affiliation: Filariasis Research, Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. tcyahath@yahoo.co.uk.
authors.forename: Thishan C
authors.initials: TC
authors.lastname: Yahathugoda
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. taniawati.supali@gmail.com.
authors.forename: Taniawati
authors.initials: T
authors.lastname: Supali
authors.affiliation: Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, MO, USA. rrao@dom.wustl.edu.
authors.forename: Ramakrishna U
authors.initials: RU
authors.lastname: Rao
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. yenny_djuardi@yahoo.com.
authors.forename: Yenny
authors.initials: Y
authors.lastname: Djuardi
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. difastefanie@gmail.com.
authors.forename: Difa
authors.initials: D
authors.lastname: Stefani
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. femmy.pical@gmail.com.
authors.forename: Femmy
authors.initials: F
authors.lastname: Pical
authors.affiliation: Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, MO, USA. PUfische@DOM.wustl.edu.
authors.forename: Peter U
authors.initials: PU
authors.lastname: Fischer
authors.affiliation: Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, MO, USA. mlloyd@DOM.wustl.edu.
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Lloyd
authors.affiliation: Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate, Ratmalana, Sri Lanka. prasadpremaratne@yahoo.com.
authors.forename: Prasad H
authors.initials: PH
authors.lastname: Premaratne
authors.affiliation: Filariasis Research, Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. miraniweera@yahoo.co.uk.
authors.forename: Mirani V
authors.initials: MV
authors.lastname: Weerasooriya
authors.affiliation: Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, MO, USA. gweil@dom.wustl.edu.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Weil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D000947:Antigens, Helminth / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D004605:Elephantiasis, Filarial / Q000097:blood* / Q000188:drug therapy / Q000469:parasitology; D005260:Female; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D010274:Parasitology / Q000379:methods*; D013188:Sri Lanka; D014958:Wuchereria bancrofti / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D000947:Antigens, Helminth