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Community-based molecular and serological surveillance of subclinical malaria in Myanmar

O’Flaherty, K, Oo, WH, Zaloumis, SG, Cutts, JC, Aung, KZ, Thein, MM, Drew, DR, Razook, Z, Barry, Alyssa, Parischa, N, Zaw, NN, Thu, HK, Thi, A, Htay, WYM, Soe, AP, Simpson, JA, Beeson, JG, Agius, PA and Fowkes, FJI 2021, Community-based molecular and serological surveillance of subclinical malaria in Myanmar, BMC Medicine, vol. 19, pp. 1-12, doi: 10.1186/s12916-021-01993-8.

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Title Community-based molecular and serological surveillance of subclinical malaria in Myanmar
Author(s) O’Flaherty, K
Oo, WH
Zaloumis, SG
Cutts, JC
Aung, KZ
Thein, MM
Drew, DR
Razook, Z
Barry, AlyssaORCID iD for Barry, Alyssa orcid.org/0000-0002-1189-2310
Parischa, N
Zaw, NN
Thu, HK
Thi, A
Htay, WYM
Soe, AP
Simpson, JA
Beeson, JG
Agius, PA
Fowkes, FJI
Journal name BMC Medicine
Volume number 19
Article ID 121
Start page 1
End page 12
Total pages 12
Publisher BMC
Place of publication London, Eng.
Publication date 2021
ISSN 1741-7015
1741-7015
Keyword(s) Epidemiology
Immunity
Malaria
Plasmodium
Serosurveillance
Surveillance
Summary Abstract Background In the Greater Mekong Subregion (GMS), current malaria surveillance strategies rely on a network of village health volunteers (VHVs) reporting the results of rapid diagnostic tests (RDTs), known to miss many asymptomatic infections. Integration of more sensitive diagnostic molecular and serological measures into the VHV network may improve surveillance of residual malaria transmission in hard-to-reach areas in the region and inform targeted interventions and elimination responses. However, data on residual malaria transmission that would be captured by these measures in the VHV-led testing and treatment surveillance network in the GMS is unknown. Methods A total of 114 VHVs were trained to collect dried blood spots from villagers undergoing routine RDTs as part of VHV-led active and passive case detection from April 2015 to June 2016. Samples were subjected to molecular testing (quantitative polymerase chain reaction [qPCR]) to determine Plasmodium falciparum and P. vivax infection and serological testing (against P. falciparum and P. vivax antigens) to determine exposure to P. falciparum and P. vivax. Results Over 15 months, 114 VHVs performed 32,194 RDTs and collected samples for molecular (n = 13,157) and serological (n = 14,128) testing. The prevalence of molecular-detectable P. falciparum and P. vivax infection was 3.2% compared to the 0.16% prevalence of Plasmodium spp. by RDT, highlighting the large burden of infections undetected by standard surveillance. Peaks in anti-P. falciparum, but not P. vivax, merozoite IgG seroprevalence coincided with seasonal P. falciparum transmission peaks, even in those with no molecularly detectable parasites. At the individual level, antibody seropositivity was associated with reduced odds of contemporaneous P. falciparum (OR for PfCSP 0.51 [95%CI 0.35, 0.76], p = 0.001, PfAMA1 0.70 [95%CI 0.52, 0.93], p = 0.01, and PfMSP2 0.81 [95%CI 0.61, 1.08], p = 0.15), but not P. vivax infection (OR PvAMA1 1.02 [95%CI 0.73, 1.43], p = 0.89) indicating a potential role of immunity in protection against molecular-detectable P. falciparum parasitaemia. Conclusions We demonstrated that integration and implementation of sample collection for molecular and serological surveillance into networks of VHV servicing hard-to-reach populations in the GMS is feasible, can capture significant levels of ongoing undetected seasonal malaria transmission and has the potential to supplement current routine RDT testing. Improving malaria surveillance by advancing the integration of molecular and serological techniques, through centralised testing approaches or novel point-of-contact tests, will advance progress, and tracking, towards malaria elimination goals in the GMS.
Language eng
DOI 10.1186/s12916-021-01993-8
Indigenous content off
Field of Research 11 Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30153627

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.