Common asymptomatic and submicroscopic malaria infections in Western Thailand revealed in longitudinal molecular and serological studies: A challenge to malaria elimination

Elisabeth Baum, Jetsumon Sattabongkot, Jeeraphat Sirichaisinthop, Kirakorn Kiattibutr, Aarti Jain, Omid Taghavian, Ming Chieh Lee, D. Huw Davies, Liwang Cui, Philip L. Felgner, Guiyun Yan

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Abstract

Background: Despite largely successful control efforts, malaria remains a significant public health problem in Thailand. Based on microscopy, the northwestern province of Tak, once Thailand's highest burden area, is now considered a low-transmission region. However, microscopy is insensitive to detect low-level parasitaemia, causing gross underestimation of parasite prevalence in areas where most infections are subpatent. The objective of this study was to assess the current epidemiology of malaria prevalence using molecular and serological detection methods, and to profile the antibody responses against Plasmodium as it relates to age, seasonal changes and clinical manifestations during infection. Three comprehensive cross-sectional surveys were performed in a sentinel village and from febrile hospital patients, and whole blood samples were collected from infants to elderly adults. Genomic DNA isolated from cellular fraction was screened by quantitative-PCR for the presence of Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi. Plasma samples were probed on protein microarray to obtain antibody response profiles from the same individuals. Results: Within the studied community, 90.2 % of Plasmodium infections were submicroscopic and asymptomatic, including a large number of mixed-species infections. Amongst febrile patients, mixed-species infections comprised 68 % of positive cases, all of which went misdiagnosed and undertreated. All samples tested showed serological reactivity to Plasmodium antigens. There were significant differences in the rates of antibody acquisition against P. falciparum and P. vivax, and age-related differences in species-specific immunodominance of response. Antibodies against Plasmodium increased along the ten-month study period. Febrile patients had stronger antibody responses than asymptomatic carriers. Conclusions: Despite a great decline in malaria prevalence, transmission is still ongoing at levels undetectable by traditional methods. As current surveillance methods focus on case management, malaria transmission in Thailand will not be interrupted if asymptomatic submicroscopic infections are not detected and treated.

Original languageEnglish (US)
Article number333
JournalMalaria journal
Volume15
Issue number1
DOIs
StatePublished - Jun 22 2016

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Thailand
Malaria
Plasmodium
Antibody Formation
Infection
Fever
Plasmodium falciparum
Coinfection
Microscopy
Plasmodium ovale
Plasmodium knowlesi
Plasmodium malariae
Vivax Malaria
Plasmodium vivax
Protein Array Analysis
Asymptomatic Infections
Parasitemia
Antibodies
Case Management
Diagnostic Errors

All Science Journal Classification (ASJC) codes

  • Parasitology
  • Infectious Diseases

Cite this

Baum, Elisabeth ; Sattabongkot, Jetsumon ; Sirichaisinthop, Jeeraphat ; Kiattibutr, Kirakorn ; Jain, Aarti ; Taghavian, Omid ; Lee, Ming Chieh ; Huw Davies, D. ; Cui, Liwang ; Felgner, Philip L. ; Yan, Guiyun. / Common asymptomatic and submicroscopic malaria infections in Western Thailand revealed in longitudinal molecular and serological studies : A challenge to malaria elimination. In: Malaria journal. 2016 ; Vol. 15, No. 1.
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title = "Common asymptomatic and submicroscopic malaria infections in Western Thailand revealed in longitudinal molecular and serological studies: A challenge to malaria elimination",
abstract = "Background: Despite largely successful control efforts, malaria remains a significant public health problem in Thailand. Based on microscopy, the northwestern province of Tak, once Thailand's highest burden area, is now considered a low-transmission region. However, microscopy is insensitive to detect low-level parasitaemia, causing gross underestimation of parasite prevalence in areas where most infections are subpatent. The objective of this study was to assess the current epidemiology of malaria prevalence using molecular and serological detection methods, and to profile the antibody responses against Plasmodium as it relates to age, seasonal changes and clinical manifestations during infection. Three comprehensive cross-sectional surveys were performed in a sentinel village and from febrile hospital patients, and whole blood samples were collected from infants to elderly adults. Genomic DNA isolated from cellular fraction was screened by quantitative-PCR for the presence of Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi. Plasma samples were probed on protein microarray to obtain antibody response profiles from the same individuals. Results: Within the studied community, 90.2 {\%} of Plasmodium infections were submicroscopic and asymptomatic, including a large number of mixed-species infections. Amongst febrile patients, mixed-species infections comprised 68 {\%} of positive cases, all of which went misdiagnosed and undertreated. All samples tested showed serological reactivity to Plasmodium antigens. There were significant differences in the rates of antibody acquisition against P. falciparum and P. vivax, and age-related differences in species-specific immunodominance of response. Antibodies against Plasmodium increased along the ten-month study period. Febrile patients had stronger antibody responses than asymptomatic carriers. Conclusions: Despite a great decline in malaria prevalence, transmission is still ongoing at levels undetectable by traditional methods. As current surveillance methods focus on case management, malaria transmission in Thailand will not be interrupted if asymptomatic submicroscopic infections are not detected and treated.",
author = "Elisabeth Baum and Jetsumon Sattabongkot and Jeeraphat Sirichaisinthop and Kirakorn Kiattibutr and Aarti Jain and Omid Taghavian and Lee, {Ming Chieh} and {Huw Davies}, D. and Liwang Cui and Felgner, {Philip L.} and Guiyun Yan",
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Baum, E, Sattabongkot, J, Sirichaisinthop, J, Kiattibutr, K, Jain, A, Taghavian, O, Lee, MC, Huw Davies, D, Cui, L, Felgner, PL & Yan, G 2016, 'Common asymptomatic and submicroscopic malaria infections in Western Thailand revealed in longitudinal molecular and serological studies: A challenge to malaria elimination', Malaria journal, vol. 15, no. 1, 333. https://doi.org/10.1186/s12936-016-1393-4

Common asymptomatic and submicroscopic malaria infections in Western Thailand revealed in longitudinal molecular and serological studies : A challenge to malaria elimination. / Baum, Elisabeth; Sattabongkot, Jetsumon; Sirichaisinthop, Jeeraphat; Kiattibutr, Kirakorn; Jain, Aarti; Taghavian, Omid; Lee, Ming Chieh; Huw Davies, D.; Cui, Liwang; Felgner, Philip L.; Yan, Guiyun.

In: Malaria journal, Vol. 15, No. 1, 333, 22.06.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Common asymptomatic and submicroscopic malaria infections in Western Thailand revealed in longitudinal molecular and serological studies

T2 - A challenge to malaria elimination

AU - Baum, Elisabeth

AU - Sattabongkot, Jetsumon

AU - Sirichaisinthop, Jeeraphat

AU - Kiattibutr, Kirakorn

AU - Jain, Aarti

AU - Taghavian, Omid

AU - Lee, Ming Chieh

AU - Huw Davies, D.

AU - Cui, Liwang

AU - Felgner, Philip L.

AU - Yan, Guiyun

PY - 2016/6/22

Y1 - 2016/6/22

N2 - Background: Despite largely successful control efforts, malaria remains a significant public health problem in Thailand. Based on microscopy, the northwestern province of Tak, once Thailand's highest burden area, is now considered a low-transmission region. However, microscopy is insensitive to detect low-level parasitaemia, causing gross underestimation of parasite prevalence in areas where most infections are subpatent. The objective of this study was to assess the current epidemiology of malaria prevalence using molecular and serological detection methods, and to profile the antibody responses against Plasmodium as it relates to age, seasonal changes and clinical manifestations during infection. Three comprehensive cross-sectional surveys were performed in a sentinel village and from febrile hospital patients, and whole blood samples were collected from infants to elderly adults. Genomic DNA isolated from cellular fraction was screened by quantitative-PCR for the presence of Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi. Plasma samples were probed on protein microarray to obtain antibody response profiles from the same individuals. Results: Within the studied community, 90.2 % of Plasmodium infections were submicroscopic and asymptomatic, including a large number of mixed-species infections. Amongst febrile patients, mixed-species infections comprised 68 % of positive cases, all of which went misdiagnosed and undertreated. All samples tested showed serological reactivity to Plasmodium antigens. There were significant differences in the rates of antibody acquisition against P. falciparum and P. vivax, and age-related differences in species-specific immunodominance of response. Antibodies against Plasmodium increased along the ten-month study period. Febrile patients had stronger antibody responses than asymptomatic carriers. Conclusions: Despite a great decline in malaria prevalence, transmission is still ongoing at levels undetectable by traditional methods. As current surveillance methods focus on case management, malaria transmission in Thailand will not be interrupted if asymptomatic submicroscopic infections are not detected and treated.

AB - Background: Despite largely successful control efforts, malaria remains a significant public health problem in Thailand. Based on microscopy, the northwestern province of Tak, once Thailand's highest burden area, is now considered a low-transmission region. However, microscopy is insensitive to detect low-level parasitaemia, causing gross underestimation of parasite prevalence in areas where most infections are subpatent. The objective of this study was to assess the current epidemiology of malaria prevalence using molecular and serological detection methods, and to profile the antibody responses against Plasmodium as it relates to age, seasonal changes and clinical manifestations during infection. Three comprehensive cross-sectional surveys were performed in a sentinel village and from febrile hospital patients, and whole blood samples were collected from infants to elderly adults. Genomic DNA isolated from cellular fraction was screened by quantitative-PCR for the presence of Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi. Plasma samples were probed on protein microarray to obtain antibody response profiles from the same individuals. Results: Within the studied community, 90.2 % of Plasmodium infections were submicroscopic and asymptomatic, including a large number of mixed-species infections. Amongst febrile patients, mixed-species infections comprised 68 % of positive cases, all of which went misdiagnosed and undertreated. All samples tested showed serological reactivity to Plasmodium antigens. There were significant differences in the rates of antibody acquisition against P. falciparum and P. vivax, and age-related differences in species-specific immunodominance of response. Antibodies against Plasmodium increased along the ten-month study period. Febrile patients had stronger antibody responses than asymptomatic carriers. Conclusions: Despite a great decline in malaria prevalence, transmission is still ongoing at levels undetectable by traditional methods. As current surveillance methods focus on case management, malaria transmission in Thailand will not be interrupted if asymptomatic submicroscopic infections are not detected and treated.

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U2 - 10.1186/s12936-016-1393-4

DO - 10.1186/s12936-016-1393-4

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AN - SCOPUS:84980019042

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JO - Malaria Journal

JF - Malaria Journal

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