- INTRODUCTION
- METHODS
- RESULTS
- Study population demographics.
- Plasmodium falciparum prevalence.
- Age-specific Plasmodium falciparum prevalence.
- Gender-specific Plasmodium falciparum prevalence.
- Comparison of Plasmodium falciparum prevalence between catchment areas.
- Plasmodium falciparum MOI.
- Plasmodium falciparum density.
- Risk factors associated with asymptomatic microscopic infections.
- Risk factors associated with asymptomatic submicroscopic infections compared with asymptomatic microscopic infections.
- Risk factors associated with asymptomatic submicroscopic infections.
- Risk factors associated with asymptomatic (combined microscopic and submicroscopic) infections.
- DISCUSSION
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Seasonal Variation in the Epidemiology of Asymptomatic Plasmodium falciparum Infections across Two Catchment Areas in Bongo District, Ghana
Kathryn E. Tiedje
Kathryn E. Tiedje
School of BioSciences, Bio21 Institute/University of Melbourne, Melbourne, Australia;
Department of Microbiology, New York University, New York, New York;
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Department of Microbiology, New York University, New York, New York;
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Abraham R. Oduro
Abraham R. Oduro
Navrongo Health Research Center, Navrongo, Ghana;
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Godfred Agongo
Godfred Agongo
Navrongo Health Research Center, Navrongo, Ghana;
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Thomas Anyorigiya
Thomas Anyorigiya
Navrongo Health Research Center, Navrongo, Ghana;
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Daniel Azongo
Daniel Azongo
Navrongo Health Research Center, Navrongo, Ghana;
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Timothy Awine
Timothy Awine
Navrongo Health Research Center, Navrongo, Ghana;
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Anita Ghansah
Anita Ghansah
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana;
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Mercedes Pascual
Mercedes Pascual
Department of Ecology and Evolution, University of Chicago, Chicago, Illinois;
Santa Fe Institute, Sante Fe, New Mexico
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Santa Fe Institute, Sante Fe, New Mexico
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Kwadwo A. Koram
Kwadwo A. Koram
Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana;
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Karen P. Day
Karen P. Day
School of BioSciences, Bio21 Institute/University of Melbourne, Melbourne, Australia;
Department of Microbiology, New York University, New York, New York;
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Department of Microbiology, New York University, New York, New York;
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Understanding the epidemiology of asymptomatic Plasmodium falciparum infections is critical for countries to move toward malaria elimination. Using different methods for parasite detection, we evaluated how seasonality, spatial location, and other factors affect the age-specific epidemiology of asymptomatic malaria in Bongo District, Ghana. Asymptomatic prevalence by microscopy decreased significantly from 42.5% at the end of the wet to 27.5% at the end of the dry season (P < 0.001). Using the 18S rRNA polymerase chain reactions (PCRs), all microscopy-negative samples were screened and prevalence of submicroscopic infections also decreased significantly from the wet (55.4%) to the dry (20.7%) season (P < 0.001). Combining detection methods, 74.4% and 42.5% of the population in the wet and dry seasons, respectively, had evidence of a P. falciparum infection. Interestingly in those > 20 years of age, we found evidence of infection in 64.3% of the population in the wet and 27.0% in the dry season. Using both microscopy and PCR, the asymptomatic P. falciparum reservoir peaks at the end of the wet season and infections in all age groups constitute the reservoir of malaria infection. At the end of the wet season, spatial heterogeneity in the prevalence and density of P. falciparum infections was observed between the two catchment areas surveyed in Bongo District. These results indicate that if elimination is to succeed, interventions will need to target not just P. falciparum infections in children but also in adults, and be implemented toward the end of the dry season in this area of West Africa.
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Author Notes
Financial support: This research was supported by the Fogarty International Center at National Institutes of Health (Program on the Ecology and Evolution of Infectious Diseases (EEID), Grant number: R01-TW009670); and the National Institute of Allergy and Infectious Disease, National Institutes of Health (Grant number: R01-AI084156).
Authors' addresses: Kathryn E. Tiedje, School of BioSciences, Bio21 Institute/University of Melbourne, Melbourne, Australia, E-mail: kathryn.tiedje@unimelb.edu.au. Abraham R. Oduro, Godfred Agongo, Thomas Anyorigiya, Daniel Azongo, and Timothy Awine, Navrongo Health Research Center, Navrongo, Ghana, E-mails: abraham.oduro@navrongo-hrc.org, godfred.agongo@navrongo-hrc.org, thomas.anyorigiya@navrongo-hrc.org, daniel.azongo@navrongo-hrc.org, and timothy.awine@navrongo-hrc.org. Anita Ghansah, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana, E-mail: aghansah@noguchi.ug.edu.gh. Mercedes Pascual, Department of Ecology and Evolution, University of Chicago, Chicago, IL, E-mail: pascualmm@uchicago.edu. Kwadwo A. Koram, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana, E-mail: kkoram@noguchi.ug.edu.gh. Karen P. Day, School of Biosciences, University of Melbourne, Melbourne, Australia, E-mail: karen.day@unimelb.edu.au.
- INTRODUCTION
- METHODS
- RESULTS
- Study population demographics.
- Plasmodium falciparum prevalence.
- Age-specific Plasmodium falciparum prevalence.
- Gender-specific Plasmodium falciparum prevalence.
- Comparison of Plasmodium falciparum prevalence between catchment areas.
- Plasmodium falciparum MOI.
- Plasmodium falciparum density.
- Risk factors associated with asymptomatic microscopic infections.
- Risk factors associated with asymptomatic submicroscopic infections compared with asymptomatic microscopic infections.
- Risk factors associated with asymptomatic submicroscopic infections.
- Risk factors associated with asymptomatic (combined microscopic and submicroscopic) infections.
- DISCUSSION
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
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1.
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2.
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3.
Lindblade K, Steinhardt L, Samuels A, Kachur SP, Slutsker L, 2013. The silent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti Infect Ther 11: 623–639.
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4.
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5.
Gerardin J, Ouédraogo AL, McCarthy K, Eckhoff P, Wenger E, 2015. Characterization of the infectious reservoir of malaria with an agent-based model calibrated to age-stratified parasite densities and infectiousness. Malar J 14: 231.
-
6.
Bousema T, Okell L, Felger I, Drakeley C, 2014. Asymptomatic malaria infections: detectability, transmissibility and public health relevance. Nat Rev Microbiol 12: 833–840.
-
7.
Newby G, Hwang J, Koita K, Chen I, Greenwood B, von Seidlein L, Shanks GD, Slutsker LM, Kachur SP, Wegbreit J, Ippolito MM, Poirot E, Gosling R, 2015. Review of mass drug administration for malaria and its operational challenges. Am J Trop Med Hyg 93: 125–134.
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8.
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-
9.
Kyabayinze DJ, Tibenderana JK, Odong GW, Rwakimari JB, Counihan H, 2008. Operational accuracy and comparative persistent antigenicity of HRP2 rapid diagnostic tests for Plasmodium falciparum malaria in a hyperendemic region of Uganda. Malar J 7: 221.
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