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@article{Toor:2019:10.1186/s13071-019-3611-8,
author = {Toor, J and Truscott, JE and Werkman, M and Turner, HC and Phillips, AE and King, CH and Medley, GF and Anderson, RM},
doi = {10.1186/s13071-019-3611-8},
journal = {Parasites and Vectors},
title = {Determining post-treatment surveillance criteria for predicting the elimination of Schistosoma mansoni transmission},
url = {http://dx.doi.org/10.1186/s13071-019-3611-8},
volume = {12},
year = {2019}
}

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TY  - JOUR
AB  - BACKGROUND: The World Health Organization (WHO) has set elimination (interruption of transmission) as an end goal for schistosomiasis. However, there is currently little guidance on the monitoring and evaluation strategy required once very low prevalence levels have been reached to determine whether elimination or resurgence of the disease will occur after stopping mass drug administration (MDA) treatment. METHODS: We employ a stochastic individual-based model of Schistosoma mansoni transmission and MDA impact to determine a prevalence threshold, i.e. prevalence of infection, which can be used to determine whether elimination or resurgence will occur after stopping treatment with a given probability. Simulations are run for treatment programmes with varying probabilities of achieving elimination and for settings where adults harbour low to high burdens of infection. Prevalence is measured based on using a single Kato-Katz on two samples per individual. We calculate positive predictive values (PPV) using PPV ≥ 0.9 as a reliable measure corresponding to ≥ 90% certainty of elimination. We analyse when post-treatment surveillance should be carried out to predict elimination. We also determine the number of individuals across a single community (of 500-1000 individuals) that should be sampled to predict elimination. RESULTS: We find that a prevalence threshold of 1% by single Kato-Katz on two samples per individual is optimal for predicting elimination at two years (or later) after the last round of MDA using a sample size of 200 individuals across the entire community (from all ages). This holds regardless of whether the adults have a low or high burden of infection relative to school-aged children. CONCLUSIONS: Using a prevalence threshold of 0.5% is sufficient for surveillance six months after the last round of MDA. However, as such a low prevalence can be difficult to measure in the field using Kato-Katz, we recommend using 1% two ye
AU  - Toor,J
AU  - Truscott,JE
AU  - Werkman,M
AU  - Turner,HC
AU  - Phillips,AE
AU  - King,CH
AU  - Medley,GF
AU  - Anderson,RM
DO  - 10.1186/s13071-019-3611-8
PY  - 2019///
SN  - 1756-3305
TI  - Determining post-treatment surveillance criteria for predicting the elimination of Schistosoma mansoni transmission
T2  - Parasites and Vectors
UR  - http://dx.doi.org/10.1186/s13071-019-3611-8
UR  - https://www.ncbi.nlm.nih.gov/pubmed/31522690
UR  - http://hdl.handle.net/10044/1/73567
VL  - 12
ER  -

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Professor Sir Roy Anderson FRS, FMedSci

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