背景:在撒哈拉以南非洲(SSA),恶性疟原虫导致大多数疟疾病例。尽管它在疾病严重程度和耐药性中起着至关重要的作用,SSA中有关恶性疟原虫遗传多样性和感染复数(MOI)的综合数据很少。这项研究总结了有关遗传多样性和MOI的可用信息,专注于关键标记(msp-1,msp-2,glurp,和微型卫星)。系统综述旨在评估它们对疟疾传播动态的影响,并为加强SSA的疟疾控制措施提供见解。
方法:按照系统评价和荟萃分析(PRISMA)指南的首选报告项目进行审查。两名审稿人进行了文章筛选,评估偏见风险(RoB),并执行数据抽象。采用STATA第17版随机效应模型进行Meta分析。
结果:该综述包括52篇文章:39项横断面研究和13项随机对照试验(RCT)/队列研究,涉及来自23个SSA国家的11,640个基因分型的寄生虫分离株。总体合并平均预期杂合性为0.65(95%CI:0.51-0.78)。区域,值变化:东(0.58),中央(0.84),南方(0.74),西非(0.69)。msp-1等位基因K1,MAD20和RO33的总体合并等位基因频率为61%,44%,40%,分别,而msp-2I/C3D7和FC27等位基因分别为61%和55%。中非报告的频率更高(K1:74%,MAD20:51%,RO33:48%)比东非(K1:46%,MAD20:42%,RO33:31%)。对于msp-2,东非有60%和55%的I/C3D7和FC27等位基因,而西非有62%和50%,分别。glurp的合并等位基因频率为66%。总体合并平均MOI为2.09(95%CI:1.88-2.30),具有区域差异:东部(2.05),Central(2.37),南方(2.16),西非(1.96)。多克隆恶性疟原虫感染的总体患病率为63%(95%CI:56-70),地区患病率如下:东部(62%),西部(61%),中央(65%),南非(71%)。
结论:该研究表明,SSA中恶性疟原虫寄生虫遗传多样性和MOI的区域差异很大。这些发现表明,需要考虑到恶性疟原虫感染的特定区域因素,对疟疾控制策略和监测工作进行研究。
BACKGROUND: In sub-Saharan Africa (SSA), Plasmodium falciparum causes most of the malaria cases. Despite its crucial roles in disease severity and drug resistance, comprehensive data on Plasmodium falciparum genetic diversity and multiplicity of infection (MOI) are sparse in SSA. This study summarizes available information on genetic diversity and MOI, focusing on key markers (msp-1, msp-2, glurp, and microsatellites). The systematic
review aimed to evaluate their influence on malaria transmission dynamics and offer insights for enhancing malaria control measures in SSA.
METHODS: The
review was conducted following the Preferred Reporting Items for Systematic
Review and Meta-Analysis (PRISMA) guidelines. Two reviewers conducted article screening, assessed the risk of bias (RoB), and performed data abstraction. Meta-analysis was performed using the random-effects model in STATA version 17.
RESULTS: The
review included 52 articles: 39 cross-sectional studies and 13 Randomized Controlled Trial (RCT)/cohort studies, involving 11,640 genotyped parasite isolates from 23 SSA countries. The overall pooled mean expected heterozygosity was 0.65 (95% CI: 0.51-0.78). Regionally, values varied: East (0.58), Central (0.84), Southern (0.74), and West Africa (0.69). Overall pooled allele frequencies of msp-1 alleles K1, MAD20, and RO33 were 61%, 44%, and 40%, respectively, while msp-2 I/C 3D7 and FC27 alleles were 61% and 55%. Central Africa reported higher frequencies (K1: 74%, MAD20: 51%, RO33: 48%) than East Africa (K1: 46%, MAD20: 42%, RO33: 31%). For msp-2, East Africa had 60% and 55% for I/C 3D7 and FC27 alleles, while West Africa had 62% and 50%, respectively. The pooled allele frequency for glurp was 66%. The overall pooled mean MOI was 2.09 (95% CI: 1.88-2.30), with regional variations: East (2.05), Central (2.37), Southern (2.16), and West Africa (1.96). The overall prevalence of polyclonal Plasmodium falciparum infections was 63% (95% CI: 56-70), with regional prevalences as follows: East (62%), West (61%), Central (65%), and South Africa (71%).
CONCLUSIONS: The study shows substantial regional variation in Plasmodium falciparum parasite genetic diversity and MOI in SSA. These findings suggest a need for malaria control strategies and surveillance efforts considering regional-specific factors underlying Plasmodium falciparum infection.