Publication: Clustering of malaria in households in the Greater Mekong Subregion: operational implications for reactive case detection
Issued Date
2021-12-01
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14752875
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2-s2.0-85113496300
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Mahidol University
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SCOPUS
Bibliographic Citation
Malaria Journal. Vol.20, No.1 (2021)
Suggested Citation
Mavuto Mukaka, Pimnara Peerawaranun, Daniel M. Parker, Ladda Kajeechiwa, Francois H. Nosten, Thuy Nhien Nguyen, Tran Tinh Hien, Rupam Tripura, Thomas J. Peto, Koukeo Phommasone, Mayfong Mayxay, Paul N. Newton, Mallika Imwong, Nicholas P.J. Day, Arjen M. Dondorp, Nicholas J. White, Lorenz von Seidlein Clustering of malaria in households in the Greater Mekong Subregion: operational implications for reactive case detection. Malaria Journal. Vol.20, No.1 (2021). doi:10.1186/s12936-021-03879-9 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77154
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Title
Clustering of malaria in households in the Greater Mekong Subregion: operational implications for reactive case detection
Other Contributor(s)
Faculty of Tropical Medicine, Mahidol University
Amsterdam Institute for Global Health and Development
Oxford University Clinical Research Unit
Mahosot Hospital, Lao
Mahidol University
Nuffield Department of Medicine
University of California, Irvine
Amsterdam UMC - University of Amsterdam
University of Health Sciences
Amsterdam Institute for Global Health and Development
Oxford University Clinical Research Unit
Mahosot Hospital, Lao
Mahidol University
Nuffield Department of Medicine
University of California, Irvine
Amsterdam UMC - University of Amsterdam
University of Health Sciences
Abstract
Background: Malaria reactive case detection is the testing and, if positive, treatment of close contacts of index cases. It is included in national malaria control programmes of countries in the Greater Mekong Subregion to accelerate malaria elimination. Yet the value of reactive case detection in the control and elimination of malaria remains controversial because of the low yield, limited evidence for impact, and high demands on resources. Methods: Data from the epidemiological assessments of large mass drug administration (MDA) studies in Myanmar, Vietnam, Cambodia and Laos were analysed to explore malaria infection clustering in households. The proportion of malaria positive cases among contacts screened in a hypothetical reactive case detection programme was then determined. The parasite density thresholds for rapid diagnostic test (RDT) detection was assumed to be > 50/µL (50,000/mL), for dried-blood-spot (DBS) based PCR > 5/µL (5000/mL), and for ultrasensitive PCR (uPCR) with a validated limit of detection at 0.0022/µL (22/mL). Results: At baseline, before MDA, 1223 Plasmodium infections were detected by uPCR in 693 households. There was clustering of Plasmodium infections. In 637 households with asymptomatic infections 44% (278/637) had more than one member with Plasmodium infections. In the 132 households with symptomatic infections, 65% (86/132) had more than one member with Plasmodium infections. At baseline 4% of households had more than one Plasmodium falciparum infection, but three months after MDA no household had more than one P. falciparum infected member. Reactive case detection using DBS PCR would have detected ten additional cases in six households, and an RDT screen would have detected five additional cases in three households among the 169 households with at least one RDT positive case. This translates to 19 and 9 additional cases identified per 1000 people screened, respectively. Overall, assuming all febrile RDT positive patients would seek treatment and provoke reactive case detection using RDTs, then 1047 of 1052 (99.5%) Plasmodium infections in these communities would have remained undetected. Conclusion: Reactive case detection in the Greater Mekong subregion is predicted to have a negligible impact on the malaria burden, but it has substantial costs in terms of human and financial resources.