National Malaria Control Programme of Madagascar, 2017. National Strategic Plan for Malaria Control in Madagascar 2018–2022. Progressive Malaria Elimination from Madagascar. Madagascar: Ministry of Health of Madagascar.
Howes RE, Mioramalala SA, Ramiranirina B, Franchard T, Rakotorahalahy AJ, Bisanzio D, Gething PW, Zimmerman PA, Ratsimbasoa A, 2016. Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning. Malar J 15: 502.
Kang SY et al. 2018. Spatio-temporal mapping of Madagascar’s malaria indicator survey results to assess Plasmodium falciparum endemicity trends between 2011 and 2016. BMC Med 16: 71.
Institut National de la Statistique (INSTAT), Programme National de Lutte contre le Paludisme (PNLP), and ICF International, 2011. Madagascar Malaria Indicator Survey 2011 [Enquête sur les Indicateurs du Paludisme (EIPM)]. Calverton, MC: INSTAT, PNLP, and ICF International.
Institut National de la Statistique (INSTAT), Programme National de Lutte contre le Paludisme (PNLP), Institut Pasteur de Madagascar (IPM), and ICF International, 2013. Madagascar Malaria Indicator Survey 2013 [Enquête sur les Indicateurs du Paludisme (EIPM)]. Calverton, MC: INSTAT, PNLP, IPM and ICF International.
Institut National de la Statistique (INSTAT), Programme National de Lutte contre le Paludisme (PNLP), Institut Pasteur de Madagascar (IPM), and ICF International, 2016. Madagascar Malaria Indicator Survey 2016 [Enquête sur les Indicateurs du Paludisme (EIPM)]. Calverton, MD: INSTAT, PNLP, IPM and ICF International.
malERA Refresh Consultative Panel on Characterising the Reservoir and Measuring Transmission, 2017. malERA: an updated research agenda for characterising the reservoir and measuring transmission in malaria elimination and eradication. PLoS Med 14: e1002452.
Cohen JM, Le Menach A, Pothin E, Eisele TP, Gething PW, Eckhoff PA, Moonen B, Schapira A, Smith DL, 2017. Mapping multiple components of malaria risk for improved targeting of elimination interventions. Malar J 16: 459.
Menard D et al. 2010. Plasmodium vivax clinical malaria is commonly observed in Duffy-negative Malagasy people. Proc Natl Acad Sci USA 107: 5967–5971.
Mehlotra RK et al. 2017. Long-term in vitro culture of Plasmodium vivax isolates from Madagascar maintained in Saimiri boliviensis blood. Malar J 16: 442.
WHO, 2017. World Malaria Report 2017. Geneva, Switzerland: World Health Organization.
Miller LH, Mason SJ, Clyde DF, McGinniss MH, 1976. The resistance factor to Plasmodium vivax in blacks. The Duffy-blood-group genotype, FyFy. N Engl J Med 295: 302–304.
Howes RE et al. 2011. The global distribution of the Duffy blood group. Nat Commun 2: 266.
Howes RE et al. 2015. Plasmodium vivax transmission in Africa. PLoS Negl Trop Dis 9: e0004222.
Zimmerman PA, 2017. Plasmodium vivax infection in Duffy-negative people in Africa. Am J Trop Med Hyg 97: 636–638.
Tofanelli S, Bertoncini S, Castri L, Luiselli D, Calafell F, Donati G, Paoli G, 2009. On the origins and admixture of Malagasy: new evidence from high-resolution analyses of paternal and maternal lineages. Mol Biol Evol 26: 2109–2124.
Ratovonjato J et al. 2014. Entomological and parasitological impacts of indoor residual spraying with DDT, alphacypermethrin and deltamethrin in the western foothill area of Madagascar. Malar J 13: 21.
National Malaria Control Programme of Madagascar, 2015. National Strategic Plan for Malaria Control in Madagascar 2013–2017: Consolidating the Gains with a View to Elimination of Malaria from Madagascar, 2015–2017 Revision. Madagascar: Ministry of Health of Madagascar.
McNamara DT, Kasehagen LJ, Grimberg BT, Cole-Tobian J, Collins WE, Zimmerman PA, 2006. Diagnosing infection levels of four human malaria parasite species by a polymerase chain reaction/ligase detection reaction fluorescent microsphere-based assay. Am J Trop Med Hyg 74: 413–421.
Farr TG et al. 2007. The shuttle radar topography mission. Rev Geophys 45: RG2004.
World Wildlife Fund (WWF) and U.S. Geological Survey, 2007. HydroSHEDS Database. Available at: http://hydrosheds.org/. Accessed January 29, 2018.
WHO, 2011. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Geneva, Switzerland: World Health Organization.
Waltmann A et al. 2015. High rates of asymptomatic, sub-microscopic Plasmodium vivax infection and disappearing Plasmodium falciparum malaria in an area of low transmission in Solomon Islands. PLoS Negl Trop Dis 9: e0003758.
Rosas-Aguirre A, Ponce OJ, Carrasco-Escobar G, Speybroeck N, Contreras-Mancilla J, Gamboa D, Pozo E, Herrera S, Llanos-Cuentas A, 2015. Plasmodium vivax malaria at households: spatial clustering and risk factors in a low endemicity urban area of the northwestern Peruvian coast. Malar J 14: 176.
Okell LC, Bousema T, Griffin JT, Ouedraogo AL, Ghani AC, Drakeley CJ, 2012. Factors determining the occurrence of submicroscopic malaria infections and their relevance for control. Nat Commun 3: 1237.
Cheng Q, Cunningham J, Gatton ML, 2015. Systematic review of sub-microscopic P. vivax infections: prevalence and determining factors. PLoS Negl Trop Dis 9: e3413.
Ihantamalala FA, Rakotoarimanana FMJ, Ramiadantsoa T, Rakotondramanga JM, Pennober G, Rakotomanana F, Cauchemez S, Metcalf CJE, Herbreteau V, Wesolowski A, 2018. Spatial and temporal dynamics of malaria in Madagascar. Malar J 17: 58.
Girond F et al. 2017. Analysing trends and forecasting malaria epidemics in Madagascar using a sentinel surveillance network: a web-based application. Malar J 16: 72.
Kesteman T et al. 2016. Multiple causes of an unexpected malaria outbreak in a high-transmission area in Madagascar. Malar J 15: 57.
Menard D et al. 2013. Whole genome sequencing of field isolates reveals a common duplication of the Duffy binding protein gene in Malagasy Plasmodium vivax strains. PLoS Negl Trop Dis 7: e2489.
Gruenberg M et al. 2018. Plasmodium vivax molecular diagnostics in community surveys: pitfalls and solutions. Malar J 17: 55.
Churcher TS, Trape JF, Cohuet A, 2015. Human-to-mosquito transmission efficiency increases as malaria is controlled. Nat Commun 6: 6054.
Churcher TS, Bousema T, Walker M, Drakeley C, Schneider P, Ouedraogo AL, Basanez MG, 2013. Predicting mosquito infection from Plasmodium falciparum gametocyte density and estimating the reservoir of infection. eLife 2: e00626.
Bousema T, Okell L, Felger I, Drakeley C, 2014. Asymptomatic malaria infections: detectability, transmissibility and public health relevance. Nat Rev Microbiol 12: 833–840.
Okell LC, Griffin JT, Kleinschmidt I, Hollingsworth TD, Churcher TS, White MJ, Bousema T, Drakeley CJ, Ghani AC, 2011. The potential contribution of mass treatment to the control of Plasmodium falciparum malaria. PLoS One 6: e20179.
Bjorkman A, Cook J, Sturrock H, Msellem M, Ali A, Xu W, Molteni F, Gosling R, Drakeley C, Mårtensson A, 2017. Spatial distribution of falciparum malaria infections in Zanzibar: implications for focal drug administration strategies targeting asymptomatic parasite carriers. Clin Infect Dis 64: 1236–1243.
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Community prevalence of infection is a widely used, standardized metric for evaluating malaria endemicity. Conventional methods for measuring prevalence include light microscopy and rapid diagnostic tests (RDTs), but their detection thresholds are inadequate for diagnosing low-density infections. The significance of submicroscopic malaria infections is poorly understood in Madagascar, a country of heterogeneous malaria epidemiology. A cross-sectional community survey in the western foothills of Madagascar during the March 2014 transmission season found malaria infection to be predominantly submicroscopic and asymptomatic. Prevalence of Plasmodium infection diagnosed by microscopy, RDT, and molecular diagnosis was 2.4%, 4.1%, and 13.8%, respectively. This diagnostic discordance was greatest for Plasmodium vivax infection, which was 98.5% submicroscopic. Village location, insecticide-treated bednet ownership, and fever were significantly associated with infection outcomes, as was presence of another infected individual in the household. Duffy-negative individuals were diagnosed with P. vivax, but with reduced odds relative to Duffy-positive hosts. The observation of high proportions of submicroscopic infections calls for a wider assessment of the parasite reservoir in other regions of the island, particularly given the country’s current focus on malaria elimination and the poorly documented distribution of the non–P. falciparum parasite species.
Financial support: This study was funded by a National Institutes of Health grant (R01 AI097366 to P. A. Z.). The funding body had no role in the study design, analysis, interpretation, or decision to publish this manuscript.
Authors’ addresses: Rosalind E. Howes and Su Y. Kang, Malaria Atlas Project, Oxford Big Data Institute, University of Oxford, Oxford, United Kingdom, E-mails: rosalind.howes@bdi.ox.ac.uk and su.kang@bdi.ox.ac.uk. Thierry Franchard, Tovonahary Angelo Rakotomanga, Brune Ramiranirina, Stéphanie Ramboarina, and Arsène Ratsimbasoa, National Malaria Control Programme of Madagascar, Antananarivo, Madagascar, E-mails: franchty@gmail.com, tovo_angelo@yahoo.fr, brune.estelle@gmail.com, sramboa@gmail.com, and aratsimbasoa@gmail.com. Melinda Zikursh, Estee Y. Cramer, Daniel J. Tisch, and Peter A. Zimmerman, The Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, E-mails: mjb57@case.edu, eyc17@case.edu, dxt37@case.edu, and paz@case.edu.
National Malaria Control Programme of Madagascar, 2017. National Strategic Plan for Malaria Control in Madagascar 2018–2022. Progressive Malaria Elimination from Madagascar. Madagascar: Ministry of Health of Madagascar.
Howes RE, Mioramalala SA, Ramiranirina B, Franchard T, Rakotorahalahy AJ, Bisanzio D, Gething PW, Zimmerman PA, Ratsimbasoa A, 2016. Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning. Malar J 15: 502.
Kang SY et al. 2018. Spatio-temporal mapping of Madagascar’s malaria indicator survey results to assess Plasmodium falciparum endemicity trends between 2011 and 2016. BMC Med 16: 71.
Institut National de la Statistique (INSTAT), Programme National de Lutte contre le Paludisme (PNLP), and ICF International, 2011. Madagascar Malaria Indicator Survey 2011 [Enquête sur les Indicateurs du Paludisme (EIPM)]. Calverton, MC: INSTAT, PNLP, and ICF International.
Institut National de la Statistique (INSTAT), Programme National de Lutte contre le Paludisme (PNLP), Institut Pasteur de Madagascar (IPM), and ICF International, 2013. Madagascar Malaria Indicator Survey 2013 [Enquête sur les Indicateurs du Paludisme (EIPM)]. Calverton, MC: INSTAT, PNLP, IPM and ICF International.
Institut National de la Statistique (INSTAT), Programme National de Lutte contre le Paludisme (PNLP), Institut Pasteur de Madagascar (IPM), and ICF International, 2016. Madagascar Malaria Indicator Survey 2016 [Enquête sur les Indicateurs du Paludisme (EIPM)]. Calverton, MD: INSTAT, PNLP, IPM and ICF International.
malERA Refresh Consultative Panel on Characterising the Reservoir and Measuring Transmission, 2017. malERA: an updated research agenda for characterising the reservoir and measuring transmission in malaria elimination and eradication. PLoS Med 14: e1002452.
Cohen JM, Le Menach A, Pothin E, Eisele TP, Gething PW, Eckhoff PA, Moonen B, Schapira A, Smith DL, 2017. Mapping multiple components of malaria risk for improved targeting of elimination interventions. Malar J 16: 459.
Menard D et al. 2010. Plasmodium vivax clinical malaria is commonly observed in Duffy-negative Malagasy people. Proc Natl Acad Sci USA 107: 5967–5971.
Mehlotra RK et al. 2017. Long-term in vitro culture of Plasmodium vivax isolates from Madagascar maintained in Saimiri boliviensis blood. Malar J 16: 442.
WHO, 2017. World Malaria Report 2017. Geneva, Switzerland: World Health Organization.
Miller LH, Mason SJ, Clyde DF, McGinniss MH, 1976. The resistance factor to Plasmodium vivax in blacks. The Duffy-blood-group genotype, FyFy. N Engl J Med 295: 302–304.
Howes RE et al. 2011. The global distribution of the Duffy blood group. Nat Commun 2: 266.
Howes RE et al. 2015. Plasmodium vivax transmission in Africa. PLoS Negl Trop Dis 9: e0004222.
Zimmerman PA, 2017. Plasmodium vivax infection in Duffy-negative people in Africa. Am J Trop Med Hyg 97: 636–638.
Tofanelli S, Bertoncini S, Castri L, Luiselli D, Calafell F, Donati G, Paoli G, 2009. On the origins and admixture of Malagasy: new evidence from high-resolution analyses of paternal and maternal lineages. Mol Biol Evol 26: 2109–2124.
Ratovonjato J et al. 2014. Entomological and parasitological impacts of indoor residual spraying with DDT, alphacypermethrin and deltamethrin in the western foothill area of Madagascar. Malar J 13: 21.
National Malaria Control Programme of Madagascar, 2015. National Strategic Plan for Malaria Control in Madagascar 2013–2017: Consolidating the Gains with a View to Elimination of Malaria from Madagascar, 2015–2017 Revision. Madagascar: Ministry of Health of Madagascar.
McNamara DT, Kasehagen LJ, Grimberg BT, Cole-Tobian J, Collins WE, Zimmerman PA, 2006. Diagnosing infection levels of four human malaria parasite species by a polymerase chain reaction/ligase detection reaction fluorescent microsphere-based assay. Am J Trop Med Hyg 74: 413–421.
Farr TG et al. 2007. The shuttle radar topography mission. Rev Geophys 45: RG2004.
World Wildlife Fund (WWF) and U.S. Geological Survey, 2007. HydroSHEDS Database. Available at: http://hydrosheds.org/. Accessed January 29, 2018.
WHO, 2011. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Geneva, Switzerland: World Health Organization.
Waltmann A et al. 2015. High rates of asymptomatic, sub-microscopic Plasmodium vivax infection and disappearing Plasmodium falciparum malaria in an area of low transmission in Solomon Islands. PLoS Negl Trop Dis 9: e0003758.
Rosas-Aguirre A, Ponce OJ, Carrasco-Escobar G, Speybroeck N, Contreras-Mancilla J, Gamboa D, Pozo E, Herrera S, Llanos-Cuentas A, 2015. Plasmodium vivax malaria at households: spatial clustering and risk factors in a low endemicity urban area of the northwestern Peruvian coast. Malar J 14: 176.
Okell LC, Bousema T, Griffin JT, Ouedraogo AL, Ghani AC, Drakeley CJ, 2012. Factors determining the occurrence of submicroscopic malaria infections and their relevance for control. Nat Commun 3: 1237.
Cheng Q, Cunningham J, Gatton ML, 2015. Systematic review of sub-microscopic P. vivax infections: prevalence and determining factors. PLoS Negl Trop Dis 9: e3413.
Ihantamalala FA, Rakotoarimanana FMJ, Ramiadantsoa T, Rakotondramanga JM, Pennober G, Rakotomanana F, Cauchemez S, Metcalf CJE, Herbreteau V, Wesolowski A, 2018. Spatial and temporal dynamics of malaria in Madagascar. Malar J 17: 58.
Girond F et al. 2017. Analysing trends and forecasting malaria epidemics in Madagascar using a sentinel surveillance network: a web-based application. Malar J 16: 72.
Kesteman T et al. 2016. Multiple causes of an unexpected malaria outbreak in a high-transmission area in Madagascar. Malar J 15: 57.
Menard D et al. 2013. Whole genome sequencing of field isolates reveals a common duplication of the Duffy binding protein gene in Malagasy Plasmodium vivax strains. PLoS Negl Trop Dis 7: e2489.
Gruenberg M et al. 2018. Plasmodium vivax molecular diagnostics in community surveys: pitfalls and solutions. Malar J 17: 55.
Churcher TS, Trape JF, Cohuet A, 2015. Human-to-mosquito transmission efficiency increases as malaria is controlled. Nat Commun 6: 6054.
Churcher TS, Bousema T, Walker M, Drakeley C, Schneider P, Ouedraogo AL, Basanez MG, 2013. Predicting mosquito infection from Plasmodium falciparum gametocyte density and estimating the reservoir of infection. eLife 2: e00626.
Bousema T, Okell L, Felger I, Drakeley C, 2014. Asymptomatic malaria infections: detectability, transmissibility and public health relevance. Nat Rev Microbiol 12: 833–840.
Okell LC, Griffin JT, Kleinschmidt I, Hollingsworth TD, Churcher TS, White MJ, Bousema T, Drakeley CJ, Ghani AC, 2011. The potential contribution of mass treatment to the control of Plasmodium falciparum malaria. PLoS One 6: e20179.
Bjorkman A, Cook J, Sturrock H, Msellem M, Ali A, Xu W, Molteni F, Gosling R, Drakeley C, Mårtensson A, 2017. Spatial distribution of falciparum malaria infections in Zanzibar: implications for focal drug administration strategies targeting asymptomatic parasite carriers. Clin Infect Dis 64: 1236–1243.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 1762 | 1645 | 149 |
Full Text Views | 669 | 27 | 5 |
PDF Downloads | 256 | 28 | 4 |