Circulating Anodic Antigen (CAA): A Highly Sensitive Diagnostic Biomarker to Detect Active Schistosoma Infections—Improvement and Use during SCORE
American Journal of Tropical Medicine and Hygiene, vol. 103, pp. 50–57
Abstract
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was funded in 2008 to conduct research that would support country schistosomiasis control programs. As schistosomiasis prevalence decreases in many places and elimination is increasingly within reach, a sensitive and specific test to detect infection with Schistosoma mansoni and Schistosoma haematobium has become a pressing need. After obtaining broad input, SCORE supported Leiden University Medical Center (LUMC) to modify the serum-based antigen assay for use with urine, simplify the assay, and improve its sensitivity. The urine assay eventually contributed to several of the larger SCORE studies. For example, in Zanzibar, we demonstrated that urine filtration, the standard parasite egg detection diagnostic test for S. haematobium, greatly underestimated prevalence in low-prevalence settings. In Burundi and Rwanda, the circulating anodic antigen (CAA) assay provided critical information about the limitations of the stool-based Kato–Katz parasite egg-detection assay for S. mansoni in low-prevalence settings. Other SCORE-supported CAA work demonstrated that frozen, banked urine specimens yielded similar results to fresh ones; pooling of specimens may be a useful, cost-effective approach for surveillance in some settings; and the assay can be performed in local laboratories equipped with adequate centrifuge capacity. These improvements in the assay continue to be of use to researchers around the world. However, additional work will be needed if widespread dissemination of the CAA assay is to occur, for example, by building capacity in places besides LUMC and commercialization of the assay. Here, we review the evolution of the CAA assay format during the SCORE period with emphasis on urine-based applications.
Authors 17
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Leiden University Medical Center
Affiliation as printed
Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands;
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Leiden University Medical Center
Affiliation as printed
Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands;
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Swiss Tropical and Public Health Institute · University of Basel
Affiliation as printed
Swiss Tropical and Public Health Institute, Basel, Switzerland;
University of Basel, Basel, Switzerland;
Swiss Tropical and Public Health Institute, Basel, Switzerland;; University of Basel, Basel, Switzerland;
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MRC Clinical Trials Unit at UCL · University College London
Affiliation as printed
MRC Clinical Trials Unit, University College London, London, United Kingdom;
SCI Foundation, London, United Kingdom;
MRC Clinical Trials Unit, University College London, London, United Kingdom;; SCI Foundation, London, United Kingdom;
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Affiliation as printed
Sante Publique France, Paris, France;
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African Leaders Malaria Alliance · Rwanda Biomedical Center · Ministry of Health
Affiliation as printed
African Leaders Malaria Alliance, Dar-es-Salam, Tanzania;
Malaria and Other Parasitic Diseases Division, Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda;
African Leaders Malaria Alliance, Dar-es-Salam, Tanzania;; Malaria and Other Parasitic Diseases Division, Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda;
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Rwanda Biomedical Center · Ministry of Health
Affiliation as printed
Malaria and Other Parasitic Diseases Division, Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda;
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Affiliation as printed
Consult AG Statistical Services, Zurich, Switzerland;
SCI Foundation, London, United Kingdom;
Consult AG Statistical Services, Zurich, Switzerland;; SCI Foundation, London, United Kingdom;
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African Academy of Sciences · Institute of Primate Research · National Museums of Kenya · Alliance for Accelerating Excellence in Science in Africa
Affiliation as printed
African Academy of Sciences, Alliance for Accelerating Excellence in Science in Africa, Nairobi, Kenya;
Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya;
African Academy of Sciences, Alliance for Accelerating Excellence in Science in Africa, Nairobi, Kenya;; Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya;
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The University of Texas at San Antonio Health Science Center
Affiliation as printed
Department of Biochemistry and Structural Biology, University of Texas Health, San Antonio, Texas;
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Centers for Disease Control and Prevention · Division of Parasitic Diseases and Malaria
Affiliation as printed
Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Ministry of Health and Wellness
Affiliation as printed
Ministry of Health and Wellness, Castries, St. Lucia;
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National Institute for Medical Research
Affiliation as printed
Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania;
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Affiliation as printed
Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia;
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Affiliation as printed
Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia;
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Affiliation as printed
Department of Microbiology, University of Georgia, Athens, Georgia;
Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia;
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Leiden University Medical Center
Affiliation as printed
Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
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