PMID- 33130207 OWN - NLM STAT- MEDLINE DCOM- 20210315 LR - 20210315 IS - 1878-3511 (Electronic) IS - 1201-9712 (Linking) VI - 102 DP - 2021 Jan TI - Simulating a Transmission Assessment Survey: An evaluation of current methods used in determining the elimination of the neglected tropical disease, Lymphatic Filariasis. PG - 422-428 LID - S1201-9712(20)32280-3 [pii] LID - 10.1016/j.ijid.2020.10.077 [doi] AB - INTRODUCTION: The World Health Organization (WHO) recommends Transmission Assessment Surveys (TAS) to determine when an evaluation unit (EU) (a designated population survey area) has achieved elimination of transmission of the vector-borne macroparasitic disease Lymphatic Filariasis (LF). These determinations are based on combining data from multiple survey units within an EU; it is unclear how underlying cluster-level variation influences the outcome of the TAS at EU level. We simulate LF infection distribution in an EU and compare three methods for assessing whether LF elimination has occurred based on currently recommended decision thresholds and sampling methods. METHODS: We simulate an EU divided into clusters of varying size and disease prevalence. We produce 1000 samples according to LF TAS examples and WHO guidelines and compare three decision-making approaches: lot quality assurance sampling (LQAS) (recommended by WHO), one-sided interval estimate (CI), and n(th) order statistic (MAX). Summary statistics demonstrating the "pass" rate for the EU under different disease transmission conditions are generated using a versatile SAS(R) macro. RESULTS: As the prevalence of LF decreases, the LQAS and CI approaches produce increased likelihood of a pass outcome for an EU while some cluster units may still have a high likelihood of transmission. The MAX provides an alternative that increases the likelihood of determining a pass only once the whole area has a low likelihood of transmission. LQAS and CI approaches designed to estimate the LF prevalence in the EU miss hotspots that will continue to transmit infection while the MAX approach focuses on identifying clusters with high risk of transmission. CONCLUSIONS: The current TAS methodology has a flaw that may result in false predictions of LF transmission interruption throughout an EU. Modifying the TAS methodology to address results from extreme clusters rather than being based on mean prevalence over an EU will result in greater success for global elimination of LF. CI - Copyright (c) 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved. FAU - Weiss, Paul S AU - Weiss PS AD - Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: paul.weiss@emory.edu. FAU - Michael, Edwin AU - Michael E AD - Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA. FAU - Richards, Frank O Jr AU - Richards FO Jr AD - The Carter Center, Atlanta, GA, USA. LA - eng PT - Comparative Study PT - Journal Article DEP - 20201029 PL - Canada TA - Int J Infect Dis JT - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JID - 9610933 SB - IM MH - Clinical Decision-Making MH - Computer Simulation MH - Disease Eradication MH - Elephantiasis, Filarial/*epidemiology/pathology/prevention & control/transmission MH - Humans MH - Lot Quality Assurance Sampling MH - Neglected Diseases MH - Prevalence MH - Surveys and Questionnaires MH - Tropical Climate OTO - NOTNLM OT - Elimination OT - Lymphatic Filariasis OT - Simulation OT - TAS OT - Transmission Interruption EDAT- 2020/11/02 06:00 MHDA- 2021/03/16 06:00 CRDT- 2020/11/01 20:31 PHST- 2020/07/16 00:00 [received] PHST- 2020/10/23 00:00 [revised] PHST- 2020/10/23 00:00 [accepted] PHST- 2020/11/02 06:00 [pubmed] PHST- 2021/03/16 06:00 [medline] PHST- 2020/11/01 20:31 [entrez] AID - S1201-9712(20)32280-3 [pii] AID - 10.1016/j.ijid.2020.10.077 [doi] PST - ppublish SO - Int J Infect Dis. 2021 Jan;102:422-428. doi: 10.1016/j.ijid.2020.10.077. Epub 2020 Oct 29.