Abstract
Many of malaria's signs and symptoms are indistinguishable from those of other febrile diseases. Detection of the presence of Plasmodium parasites is essential, therefore, to guide case management. Improved diagnostic tools are required to enable targeted treatment of infected individuals. In addition, field-ready diagnostic tools for mass screening and surveillance that can detect asymptomatic infections of very low parasite densities are needed to monitor transmission reduction and ensure elimination. Antibody-based tests for infection and novel methods based on biomarkers need further development and validation, as do methods for the detection and treatment of Plasmodium vivax. Current rapid diagnostic tests targeting P. vivax are generally less effective than those targeting Plasmodium falciparum. Moreover, because current drugs for radical cure may cause serious side effects in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, more information is needed on the distribution of G6PD-deficiency variants as well as tests to identify at-risk individuals. Finally, in an environment of very low or absent malaria transmission, sustaining interest in elimination and maintaining resources will become increasingly important. Thus, research is required into the context in which malaria diagnostic tests are used, into diagnostics for other febrile diseases, and into the integration of these tests into health systems.
Highlights
As malaria transmission declines across much of its range and the possibility of elimination is increasingly considered [1,2], accurate diagnosis and case identification through the demonstration of malaria parasites in sick patients presenting to health workers (‘‘passive case detection’’) is ever more important
The very low levels of transmission being attained in many countries present new challenges that will demand new diagnostic tools and strategies, in particular, a change from passive case detection to ‘‘active’’ case detection
As a result of our discussions, we propose a research and development agenda for diagnoses and diagnostics that should stimulate and facilitate the development, validation, and use of such tests
Summary
As malaria transmission declines across much of its range and the possibility of elimination (reduction of transmission to zero in a defined geographical area) is increasingly considered [1,2], accurate diagnosis and case identification through the demonstration of malaria parasites in sick patients presenting to health workers (‘‘passive case detection’’) is ever more important. During case management in all settings, all symptomatic patients with demonstrated parasitemia should be considered to be malaria cases, and all parasitemic patients should be given definitive antimalarial treatment. As the elimination agenda is increasingly followed [14], improvements in current field diagnostics (microscopy and rapid diagnostic tests [RDTs]) for case management and new diagnostics that can detect very low levels of Plasmodium in the blood of asymptomatic. Novel strategies will be needed to incorporate these new and improved diagnostics into routine health service activities
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