Micro-Heterogeneity of Transmission Shapes the Submicroscopic Malaria Reservoir in Coastal Tanzania

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Citation

Rapp, Tyler; Amagai, Kano; Sinai, Cyrus; Basham, Christopher; Loya, Mwajabu; Ngasala, Sifa; Said, Hamza; Muller, Meredith S.; Chhetri, Srijana B.; & Yang, Guozheng, et al. (Preprint). Micro-Heterogeneity of Transmission Shapes the Submicroscopic Malaria Reservoir in Coastal Tanzania. medRxiv. PMCID: PMC10508794

Abstract

BACKGROUND: Asymptomatic malaria may be patent (visible by microscopy) and detectable by rapid malaria diagnostic tests (RDTs), or it may be submicroscopic and only detectable by polymerase chain reaction (PCR).
METHODS: To characterize the submicroscopic reservoir in an area of declining malaria transmission, asymptomatic persons >5 years of age in Bagamoyo District, Tanzania, were screened using RDT, microscopy, and PCR. We investigated the size of the submicroscopic reservoir across villages, determined factors associated with submicroscopic parasitemia, and assessed the natural history of submicroscopic malaria over four weeks.
RESULTS: Among 6,076 participants, Plasmodium falciparum prevalence by RDT, microscopy, and PCR was 9%, 9%, and 28%, respectively, with roughly two-thirds of PCR-positive individuals harboring submicroscopic infection. Adult status, female gender, dry season months, screened windows, and bednet use were associated with submicroscopic carriage. Among 15 villages encompassing 80% of participants, the proportion of submicroscopic carriers increased with decreasing village-level malaria prevalence. Over four weeks, 23% (61/266) of submicroscopic carriers became RDT-positive and were treated, with half exhibiting symptoms. This occurred more frequently in villages with higher malaria prevalence.
CONCLUSIONS: Micro-heterogeneity in transmission impacts the size of the submicroscopic reservoir and the likelihood of submicroscopic carriers developing patent malaria in coastal Tanzania.

URL

https://doi.org/10.1101/2023.09.06.23295089

Reference Type

Journal Article

Year Published

Preprint

Journal Title

medRxiv

Author(s)

Rapp, Tyler
Amagai, Kano
Sinai, Cyrus
Basham, Christopher
Loya, Mwajabu
Ngasala, Sifa
Said, Hamza
Muller, Meredith S.
Chhetri, Srijana B.
Yang, Guozheng
François, Ruthly
Odas, Melic
Mathias, Derrick
Juliano, Jonathan J.
Lin, Feng-Chang
Ngasala, Billy
Lin, Jessica T.

Article Type

Regular

PMCID

PMC10508794

Continent/Country

Tanzania

ORCiD

37732257