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Title: The epidemiology of subclinical malaria infections in South-East Asia: Findings from cross-sectional surveys in Thailand-Myanmar border areas, Cambodia, and Vietnam
Authors: Mallika Imwong
Thuy Nhien Nguyen
Rupam Tripura
Tom J. Peto
Sue J. Lee
Khin Maung Lwin
Preyanan Suangkanarat
Atthanee Jeeyapant
Benchawan Vihokhern
Klanarong Wongsaen
Dao Van Hue
Le Thanh Dong
Tam Uyen Nguyen
Yoel Lubell
Lorenz Von Seidlein
Mehul Dhorda
Cholrawee Promnarate
Georges Snounou
Benoit Malleret
Laurent Rénia
Lilly Keereecharoen
Pratap Singhasivanon
Pasathorn Sirithiranont
Jem Chalk
Chea Nguon
Tran Tinh Hien
Nicholas Day
Nicholas J. White
Arjen Dondorp
Francois Nosten
Mahidol University
Center for Malariology, Parasitology and Entomology Control
Institute of Malariology, Parasitology and Entomology
Churchill Hospital
Sorbonne Universite
CNRS Centre National de la Recherche Scientifique
Agency for Science, Technology and Research, Singapore
Yong Loo Lin School of Medicine
National Center for Parasitology, Entomology and Malaria Control
Armed Forces Research Institute of Medical Sciences, Thailand
Keywords: Immunology and Microbiology;Medicine
Issue Date: 30-Sep-2015
Citation: Malaria Journal. Vol.14, No.1 (2015)
Abstract: © 2015 Imwong et al. Background: The importance of the submicroscopic reservoir of Plasmodium infections for malaria elimination depends on its size, which is generally considered small in low transmission settings. The precise estimation of this reservoir requires more sensitive parasite detection methods. The prevalence of asymptomatic, sub-microscopic malaria was assessed by a sensitive, high blood volume quantitative real-time polymerase chain reaction method in three countries of the Greater Mekong Sub-region. Methods: Cross-sectional surveys were conducted in three villages in western Cambodia, four villages along the Thailand-Myanmar border and four villages in southwest Vietnam. Malaria parasitaemia was assessed by Plasmodium falciparum/pan malaria rapid diagnostic tests (RDTs), microscopy and a high volume ultra-sensitive real-time polymerase chain reaction (HVUSqPCR: limit of detection 22 parasites/mL). All villagers older than 6 months were invited to participate. Results: A census before the surveys identified 7355 residents in the study villages. Parasite prevalence was 224/5008 (4 %) by RDT, 229/5111 (5 %) by microscopy, and 988/4975 (20 %) when assessed by HVUSqPCR. Of these 164 (3 %) were infected with P. falciparum, 357 (7 %) with Plasmodium vivax, 56 (1 %) with a mixed infection, and 411 (8 %) had parasite densities that were too low for species identification. A history of fever, male sex, and age of 15 years or older were independently associated with parasitaemia in a multivariate regression model stratified by site. Conclusion: Light microscopy and RDTs identified only a quarter of all parasitaemic participants. The asymptomatic Plasmodium reservoir is considerable, even in low transmission settings. Novel strategies are needed to eliminate this previously under recognized reservoir of malaria transmission.
ISSN: 14752875
Appears in Collections:Scopus 2011-2015

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