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Epidemiology of subpatent Plasmodium falciparum infection: implications for detection of hotspots with imperfect diagnostics
Open accessAbstract
BACKGROUND: At the local level, malaria transmission clusters in hotspots, which may be a group of households that experience higher than average exposure to infectious mosquitoes. Active case detection often relying on rapid diagnostic tests for mass screen and treat campaigns has been proposed as a method to detect and treat individuals in hotspots. Data from a cross-sectional survey conducted in north-western Tanzania were used to examine the spatial distribution of Plasmodium falciparum and the relationship between household exposure and parasite density. METHODS: Dried blood spots were collected from consenting individuals from four villages during a survey conducted in 2010. These were analysed by PCR for the presence of P. falciparum, with the parasite density of positive samples being estimated by quantitative PCR. Household exposure was estimated using the distance-weighted PCR prevalence of infection. Parasite density simulations were used to estimate the proportion of infections that would be treated using a screen and treat approach with rapid diagnostic tests (RDT) compared to targeted mass drug administration (tMDA) and Mass Drug Administration (MDA). RESULTS: Polymerase chain reaction PCR analysis revealed that of the 3,057 blood samples analysed, 1,078 were positive. Mean distance-weighted PCR prevalence per household was 34.5%. Parasite density was negatively associated with transmission intensity with the odds of an infection being subpatent increasing with household exposure (OR 1.09 per 1% increase in exposure). Parasite density was also related to age, being highest in children five to ten years old and lowest in those > 40 years. Simulations of different tMDA strategies showed that treating all individuals in households where RDT prevalence was above 20% increased the number of infections that would have been treated from 43 to 55%. However, even with this strategy, 45% of infections remained untreated. CONCLUSION: The negative relationship between household exposure and parasite density suggests that DNA-based detection of parasites is needed to provide adequate sensitivity in hotspots. Targeting MDA only to households with RDT-positive individuals may allow a larger fraction of infections to be treated. These results suggest that community-wide MDA, instead of screen and treat strategies, may be needed to successfully treat the asymptomatic, subpatent parasite reservoir and reduce transmission in similar settings.
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“Pregnancy poses a unique challenge for falciparum malaria diagnosis, as parasites sequester in the placenta and the circulating parasitaemia is very low and therefore undetectable by peripheral blood smear microscopy or rapid diagnostic test [7–10].”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [10]
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“Such submicroscopic infections may negatively affect health and constitute reservoirs for continued disease transmission [10] since they are usually asymptomatic and therefore remain untreated during pregnancy.”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [10]
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“The possibility of overestimating ITNs use due to self-reporting cannot be excluded as the participant may try to please the interviewer [10].”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [10]
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“and could, therefore, become an emergency [10] or evolve to severe disease if undetected or diagnosis was delayed.”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [10]
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“These low-density parasitemias serve as a reservoir for continued transmission of the disease and may contribute to negative health. 9-11”
From What is the burden of submicroscopic malaria in pregnancy in central India? (2015) · cites this paper as [10]
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Metadata
- Authors
- Mosha, J. F., Sturrock, H. J., Greenhouse, B., Greenwood, B., Sutherland, C. J., Gadalla, N., Atwal, S., Drakeley, C., Kibiki, G., Bousema, T., Chandramohan, D., & Gosling, R.
- Affiliations
- National Institute for Medical Research (TZ)
- University of California, San Francisco (US)
- London School of Hygiene & Tropical Medicine (GB)
- Kilimanjaro Christian Medical Centre (TZ)
- Radboud University Medical Center (NL)
- Corresponding author
- Mosha, Jacklin F
- ORCID
- Venue
- Malaria Journal
- Published
- 2013-07-01
- Volume
- 12
- Issue
- 1
- Pages
- 221-221
- ISSN
- 1475-2875 (ISSN-L)
- PMC
- PMC3701503
- OpenAlex
- W2144009871
- Cited by
- 114
- References
- 40
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 12 · 2020: 6 · 2019: 5 · 2018: 14 · 2017: 11 · 2016: 18 · 2015: 14 · 2014: 14 · 2013: 1
- FWCI
- 15.98
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Malaria Journal (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IHI Repository (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Funders
- Bill and Melinda Gates Foundation (OPP1013170)
- Wellcome Trust (084289MA)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Travel-related health issues
- Keywords
- Plasmodium falciparum, malaria hotspots, parasite density, household exposure, spatial distribution of infection, rapid diagnostic tests, mass drug administration, screen-and-treat, asymptomatic malaria, parasite reservoir, transmission intensity, northwestern Tanzania
- MeSH terms
- Adolescent, Adult, Blood, Child, Child, Preschool, Female, Humans, Infant, Male, Middle Aged, Plasmodium falciparum, Tanzania, DNA, Protozoan, Polymerase Chain Reaction, Malaria, Falciparum, Young Adult, Asymptomatic Infections, Parasite Load
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