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Factors determining the occurrence of submicroscopic malaria infections and their relevance for control

Author

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  • Lucy C. Okell

    (MRC Centre for Outbreak Analysis and Modelling, Imperial College London, St Mary’s Campus)

  • Teun Bousema

    (Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
    Radboud University Nijmegen Medical Centre)

  • Jamie T. Griffin

    (MRC Centre for Outbreak Analysis and Modelling, Imperial College London, St Mary’s Campus)

  • André Lin Ouédraogo

    (Centre National de Recherche et de Formation sur le Paludisme)

  • Azra C. Ghani

    (MRC Centre for Outbreak Analysis and Modelling, Imperial College London, St Mary’s Campus)

  • Chris J. Drakeley

    (Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine)

Abstract

Malaria parasite prevalence in endemic populations is an essential indicator for monitoring the progress of malaria control, and has traditionally been assessed by microscopy. However, surveys increasingly use sensitive molecular methods that detect higher numbers of infected individuals, questioning our understanding of the true infection burden and resources required to reduce it. Here we analyse a series of data sets to characterize the distribution and epidemiological factors associated with low-density, submicroscopic infections. We show that submicroscopic parasite carriage is common in adults, in low-endemic settings and in chronic infections. We find a strong, non-linear relationship between microscopy and PCR prevalence in population surveys (n=106), and provide a tool to relate these measures. When transmission reaches very low levels, submicroscopic carriers are estimated to be the source of 20–50% of all human-to-mosquito transmissions. Our findings challenge the idea that individuals with little previous malaria exposure have insufficient immunity to control parasitaemia and suggest a role for molecular screening.

Suggested Citation

  • Lucy C. Okell & Teun Bousema & Jamie T. Griffin & André Lin Ouédraogo & Azra C. Ghani & Chris J. Drakeley, 2012. "Factors determining the occurrence of submicroscopic malaria infections and their relevance for control," Nature Communications, Nature, vol. 3(1), pages 1-9, January.
    • Handle: RePEc:nat:natcom:v:3:y:2012:i:1:d:10.1038_ncomms2241
    DOI: 10.1038/ncomms2241
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    Cited by:

    1. Akua Kyerewaa Botwe & Seth Owusu-Agyei & Muhammad Asghar & Ulf Hammar & Felix Boakye Oppong & Stephaney Gyaase & David Dosoo & Gabriel Jakpa & Ellen Boamah & Mieks Frenken Twumasi & Faith Osier & Anna, 2020. "Profiles of Plasmodium falciparum infections detected by microscopy through the first year of life in Kintampo a high transmission area of Ghana," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-20, October.
    2. Alexis Lamiable & Tiphaine Champetier & Francesco Leonardi & Ethan Cohen & Peter Sommer & David Hardy & Nicolas Argy & Achille Massougbodji & Elaine Nery & Gilles Cottrell & Yong-Jun Kwon & Auguste Ge, 2023. "Revealing invisible cell phenotypes with conditional generative modeling," Nature Communications, Nature, vol. 14(1), pages 1-12, December.
    3. Marcia C Castro & Mathieu Maheu-Giroux & Christinah Chiyaka & Burton H Singer, 2016. "Malaria Incidence Rates from Time Series of 2-Wave Panel Surveys," PLOS Computational Biology, Public Library of Science, vol. 12(8), pages 1-26, August.

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