A Bayesian approach for the evaluation of six diagnostic assays and the estimation of Cryptosporidium prevalence in dairy calves

The prevalence of Cryptosporidium in calves and the test properties of six diagnostic assays (microscopy (ME), an immunofluorescence assay (IFA), two ELISA and two PCR assays) were estimated using Bayesian analysis. In a first Bayesian approach, the test results of the four conventional techniques were used: ME, IFA and two ELISA. This four-test approach estimated that the calf prevalence was 17% (95% Probability Interval (PI): 0.1-0.28) and that the specificity estimates of the IFA and ELISA were high compared to ME. A six-test Bayesian model was developed using the test results of the 4 conventional assays and 2 PCR assays, resulting in a higher calf prevalence estimate (58% with a 95% PI: 0.5-0.66) and in a different test evaluation: the sensitivity estimates of the conventional techniques decreased in the six-test approach, due to the inclusion of two PCR assays with a higher sensitivity compared to the conventional techniques. The specificity estimates of these conventional assays were comparable in the four-test and six-test approach. These results both illustrate the potential and the pitfalls of a Bayesian analysis in estimating prevalence and test characteristics, since posterior estimates are variables depending both on the data at hand and prior information included in the analysis. The need for sensitive diagnostic assays in epidemiological studies is demonstrated, especially for the identification of subclinically infected animals since the PCR assays identify these animals with reduced oocyst excretion, which the conventional techniques fail to identify.