Hannah C. SlaterAmanda RossIngrid FelgerNatalie E. HofmannLeanne RobinsonJackie CookBronner P. GonçalvesAnders BjörkmanAndre Lin OuedraogoUlrika MorrisMwinyi MsellemCristian KoepfliIvo MuellerFitsum TadesseEndalamaw GadisaSmita DasGonzalo DomingoMelissa KapuluJanet MidegaSeth Owusu-AgyeiCécile NabetRenaud PiarrouxOgobara DoumboSafiatou Niare DoumboKwadwo KoramNaomi LucchiVenkatachalam UdhayakumarJacklin MoshaAlfred TionoDaniel ChandramohanRoly GoslingFelista MwingiraRobert SauerweinEleanor M. RileyNicholas J. WhiteFrancois NostenMallika ImwongTeun BousemaChris DrakeleyLucy C. OkellUniversity of Health and Allied Sciences, GhanaWellcome Trust Centre for Human GeneticsPapua New Guinea Institute of Medical ResearchUniversity of Dar Es SalaamNational Institute for Medical Research TangaArmauer Hansen Research InstituteAddis Ababa UniversityLondon School of Hygiene & Tropical MedicinePATH SeattleWalter and Eliza Hall Institute of Medical ResearchUniversity of MelbourneUniversity of Edinburgh, Roslin InstituteUniversity of California, San FranciscoUniversitat BaselSwiss Tropical and Public Health Institute (Swiss TPH)Centers for Disease Control and PreventionUniversity of Notre DameKarolinska University HospitalUniversity of GhanaImperial College LondonMahidol UniversityNuffield Department of Clinical MedicineBurnet InstituteRadboud University Nijmegen Medical CentreInstitut Pasteur, ParisInsermMnazi Mmoja HospitalUniversity of SciencesInstitute for Disease ModelingCentre National de Recherche et de Formation sur le Paludisme2020-01-272020-01-272019-12-01Nature Communications. Vol.10, No.1 (2019)204117232-s2.0-85063728425https://repository.li.mahidol.ac.th/handle/20.500.14594/50028© 2019, The Author(s). Malaria infections occurring below the limit of detection of standard diagnostics are common in all endemic settings. However, key questions remain surrounding their contribution to sustaining transmission and whether they need to be detected and targeted to achieve malaria elimination. In this study we analyse a range of malaria datasets to quantify the density, detectability, course of infection and infectiousness of subpatent infections. Asymptomatically infected individuals have lower parasite densities on average in low transmission settings compared to individuals in higher transmission settings. In cohort studies, subpatent infections are found to be predictive of future periods of patent infection and in membrane feeding studies, individuals infected with subpatent asexual parasite densities are found to be approximately a third as infectious to mosquitoes as individuals with patent (asexual parasite) infection. These results indicate that subpatent infections contribute to the infectious reservoir, may be long lasting, and require more sensitive diagnostics to detect them in lower transmission settings.Mahidol UniversityBiochemistry, Genetics and Molecular BiologyChemistryArticleSCOPUS10.1038/s41467-019-09441-1