Lymphatic filariasis epidemiology in Samoa in 2018: geographic clustering and higher antigen prevalence in older age groups

Lau, Colleen L., Meder, Kelley, Mayfield, Helen J,, Kearns, Therese, McPherson, Brady, Naseri, Take, Thomsen, Robert, Hedtke, Shannon M., Sheridan, Sarah, Gass, Katherine, and Graves, Patricia M. (2020) Lymphatic filariasis epidemiology in Samoa in 2018: geographic clustering and higher antigen prevalence in older age groups. PLoS Neglected Tropical Diseases, 14 (12). e0008927.

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Background: Samoa conducted eight nationwide rounds of mass drug administration (MDA) for lymphatic filariasis (LF) between 1999 and 2011, and two targeted rounds in 2015 and 2017 in North West Upolu (NWU), one of three evaluation units (EUs). Transmission Assessment Surveys (TAS) were conducted in 2013 (failed in NWU) and 2017 (all three EUs failed). In 2018, Samoa was the first in the world to distribute nationwide triple-drug MDA using ivermectin, diethylcarbamazine, and albendazole. Surveillance and Monitoring to Eliminate LF and Scabies from Samoa (SaMELFS Samoa) is an operational research program designed to evaluate the effectiveness of triple-drug MDA on LF transmission and scabies prevalence in Samoa, and to compare the usefulness of different indicators of LF transmission. This paper reports results from the 2018 baseline survey and aims to i) investigate antigen (Ag) prevalence and spatial epidemiology, including geographic clustering; ii) compare Ag prevalence between two different age groups (5–9 years versus ≥10 years) as indicators of areas of ongoing transmission; and iii) assess the prevalence of limb lymphedema in those aged ≥15 years.

Methods: A community-based cluster survey was conducted in 30 randomly selected and five purposively selected clusters (primary sampling units, PSUs), each comprising one or two villages. Participants were recruited through household surveys (age ≥5 years) and convenience surveys (age 5–9 years). Alere Filariasis Test Strips (FTS) were used to detect Ag, and prevalence was adjusted for survey design and standardized for age and gender. Adjusted Ag prevalence was estimated for each age group (5–9, ≥10, and all ages ≥5 years) for random and purposive PSUs, and by region. Intraclass correlation (ICC) was used to quantify clustering at regions, PSUs, and households.

Results: A total of 3940 persons were included (1942 children aged 5–9 years, 1998 persons aged ≥10 years). Adjusted Ag prevalence in all ages ≥5 years in randomly and purposively selected PSUs were 4.0% (95% CI 2.8–5.6%) and 10.0% (95% CI 7.4–13.4%), respectively. In random PSUs, Ag prevalence was lower in those aged 5–9 years (1.3%, 95% CI 0.8–2.1%) than ≥10 years (4.7%, 95% CI 3.1–7.0%), and poorly correlated at the PSU level (R-square = 0.1459). Adjusted Ag prevalence in PSUs ranged from 0% to 10.3% (95% CI 5.9–17.6%) in randomly selected and 3.8% (95% CI 1.3–10.8%) to 20.0% (95% CI 15.3–25.8%) in purposively selected PSUs. ICC for Ag-positive individuals was higher at households (0.46) compared to PSUs (0.18) and regions (0.01).

Conclusions: Our study confirmed ongoing transmission of LF in Samoa, in accordance with the 2017 TAS results. Ag prevalence varied significantly between PSUs, and there was poor correlation between prevalence in 5–9 year-olds and older ages, who had threefold higher prevalence. Sampling older age groups would provide more accurate estimates of overall prevalence, and be more sensitive for identifying residual hotspots. Higher prevalence in purposively selected PSUs shows local knowledge can help identify at least some hotspots.

Item ID: 66291
Item Type: Article (Research - C1)
ISSN: 1935-2735
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Copyright Information: © 2020 Lau et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funders: Coalition for Operational Research on Neglected Tropical Diseases (CORNTD), National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: CORNTD OPP1053230, NHMRC 1109035
Date Deposited: 24 Feb 2021 23:54
FoR Codes: 42 HEALTH SCIENCES > 4202 Epidemiology > 420202 Disease surveillance @ 34%
45 INDIGENOUS STUDIES > 4516 Pacific Peoples health and wellbeing > 451605 Pacific Peoples epidemiology @ 33%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3207 Medical microbiology > 320704 Medical parasitology @ 33%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200303 Health surveillance @ 50%
20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200509 Women's and maternal health @ 50%
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