Serological Assessment of Malaria and Lymphatic Filariasis in the Dominican Republic Open Access

Abstract

Background:

The island of Hispaniola, comprised of the Dominican Republic and Haiti, is the only island in the Caribbean with active malaria transmission and accounts for 95% of the lymphatic filariasis (LF) burden in the Americas.

 

Methods:

A cross-sectional, household cluster survey was conducted in bateyes—agricultural settlement villages home to Haitian migrant workers, their descendants, and ethnic Dominicans—in the Dominican Republic from March to April 2016 to estimate the prevalence of malaria and LF by rapid antigen test and microscopy. The study also included collection of dried blood spots from one adult and one other randomly selected household resident of any age to estimate the seroprevalence of malaria and LF antibodies using a multiplex bead assay.

 

Results:

This study reports serology results from 1,331 samples with matched diagnostic results (median age: 34 years; range: 2—96). Although no (0%) person was Plasmodium-positive by RDT or microscopy, overall seroprevalence to P. falciparum antigens MSP-1, AMA-1, CSP, and LSA-1 was 16.9%, 10.0%, 1.5%, and 1.2%, respectively. Seroprevalence of long-lived antibodies MSP-1 and AMA-1 increased with age from 2.5% and 1.3%, respectively, in those <10 years of age to 23.8% and 19.1% in those ≥60 years of age. Seroprevalence of short-lived antibodies CSP and LSA-1 was uniformly low across age groups. For LF, six individuals were FTS-positive (0.5%), but none (0%) were microfilariae-positive. Overall seroprevalence to Wb123, Bm14, and Bm33 antibodies was 1.3%, 16.2%, and 7.7%, respectively. Seroprevalence to Bm14, but not Bm33 or Wb123, increased with age. Univariate analysis for malaria seropositivity (MSP-1) revealed significantly higher odds of infection in the Southwest region and among those without access to a bed net, but no significant difference by ethnicity, when considered by itself. Multivariable analysis for malaria seropositivity (MSP-1) revealed that ethnicity was significantly associated with infection when considered alongside other factors.

 

Conclusion:

These results indicate very low recent exposure to malaria and LF in the Dominican Republic and provide important data to prospectively monitor transmission elimination in Hispaniola.

Table of Contents

Chapter I: Background .................................................................................... 1

Malaria .......................................................................................................... 2

Biology .......................................................................................................... 3

Serology ........................................................................................................ 5

Clinical Manifestation .....................................................................................7

Lymphatic Filariasis ........................................................................................ 9

Biology .......................................................................................................... 9

Serology ........................................................................................................ 11

Clinical Manifestation .................................................................................... 12

Vector Distribution ........................................................................................ 14

Dominican Republic ....................................................................................... 15

Chapter II: Manuscript ................................................................................... 17

Introduction .................................................................................................. 18

Methods ........................................................................................................ 20

Survey Designs ............................................................................................... 20

Data Collection .............................................................................................. 21

Ethical approval ............................................................................................. 22

Serology Assays for Antibodies ........................................................................ 22

Data Analysis ................................................................................................. 26

Results .......................................................................................................... 27

Survey Demographics ..................................................................................... 27

Malaria Descriptive Analysis ........................................................................... 28

Lymphatic Filariasis Descriptive Analysis ......................................................... 29

Household Risk Factor Analysis ....................................................................... 31

Discussion ..................................................................................................... 31

Malaria in the Dominican Republic .................................................................. 32

Lyphatic Filariasis in the Dominican Republic .................................................. 36

Tables ........................................................................................................... 39

Figures .......................................................................................................... 44

Chapter III: Summary & Future Public Health Implications ............................... 53

Summary ....................................................................................................... 54

Future Public Health Implications .................................................................... 54

References ...................................................................................................... 56

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Dominican Republic lymphatic filariasis elimination malaria
Committee Chair / Thesis Advisor	Lauren Christiansen-Lindquist, Emory University
Committee Members	Gregory S. Noland, The Carter Center
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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