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Journal of Clinical Microbiology, June 2004, p. 2694-2700, Vol. 42, No. 6
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.6.2694-2700.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Comparison of Blood Smear, Antigen Detection, and Nested-PCR Methods for Screening Refugees from Regions Where Malaria Is Endemic after a Malaria Outbreak in Quebec, Canada

Momar Ndao,1* Etienne Bandyayera,1 Evelyne Kokoskin,1 Theresa W. Gyorkos,2 J. Dick MacLean,1 and Brian J. Ward1

National Reference Centre for Parasitology, McGill University Centre for Tropical Diseases,1 McGill University Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada2

Received 11 November 2003/ Returned for modification 29 December 2003/ Accepted 16 March 2004

The importation of malaria into a region where it is not endemic raises many concerns, including the timely delivery of appropriate care, safety of the blood supply, and the risk of autochthonous transmission. There is presently no consensus on the best way to screen mobile populations for malaria. Between August 2000 and March 2001, 535 refugees arrived in Quebec, Canada, from Tanzanian camps. Within 4 weeks of resettlement of the first group of 224, the McGill University Centre for Tropical Diseases noted an outbreak of malaria across the province (15 cases over a 3-week period). This group (group 1) was traced and screened for malaria between 3 and 4 months after arrival in Canada. Subsequent groups of 106 and 205 refugees were screened immediately upon arrival in Canada (group 2) and immediately prior to their departure from refugee camps (group 3), respectively. A single EDTA-blood sample was obtained from 521 refugees for testing by thick and thin blood smears (groups 1 and 2), antigen detection (ICT Malaria Pf and OptiMAL; group 1 only), and nested PCR (all groups). Overall, 98 of 521 refugees were found to be infected (18.8%). The vast majority of infections (81 of 98) were caused by Plasmodium falciparum alone. Using PCR as the "gold standard," both microscopy (sensitivity, 50%; specificity, 100%) and antigen detection (ICT sensitivity, 37.5%; ICT specificity, 100%; OptiMAL sensitivity, 29.1%; OptiMAL specificity, 95.6%) performed poorly. None of the PCR-positive subjects were symptomatic at the time of testing, and only two had recently had symptoms compatible with malaria (with or without diagnosis and treatment). Active surveillance of migrants from regions of intense malaria transmission can reduce the risk of morbidity in the migrant population and mitigate against transmission to the host population. Our data demonstrate that PCR is, by far, the most powerful tool for such surveillance.

* Corresponding author. Mailing address: National Reference Centre for Parasitology, McGill University Centre for Tropical Diseases, Montreal General Hospital, Room R3-137, Montreal, Quebec, Canada H3G 1A4. Phone: (514) 934-8347. Fax: (514) 934-8347. E-mail: momar.ndao{at}staff.mcgill.ca.

Journal of Clinical Microbiology, June 2004, p. 2694-2700, Vol. 42, No. 6
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.6.2694-2700.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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