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Abstract
Hispaniola, comprising Haiti and the Dominican Republic, has been identified as a candidate for malaria elimination. However, incomplete surveillance data in Haiti hamper efforts to assess the impact of ongoing malaria control interventions. Characteristics of the genetic diversity of Plasmodium falciparum populations can be used to assess parasite transmission, which is information vital to evaluating malaria elimination efforts. Here we characterize the genetic diversity of P. falciparum samples collected from patients at seven sites in Haiti using 12 microsatellite markers previously employed in population genetic analyses of global P. falciparum populations. We measured multiplicity of infections, level of genetic diversity, degree of population geographic substructure, and linkage disequilibrium (defined as non-random association of alleles from different loci). For low transmission populations like Haiti, we expect to see few multiple infections, low levels of genetic diversity, high degree of population structure, and high linkage disequilibrium. In Haiti, we found low levels of multiple infections (12.9%), moderate to high levels of genetic diversity (mean number of alleles per locus = 4.9, heterozygosity = 0.61), low levels of population structure (highest pairwise Fst = 0.09 and no clustering in principal components analysis), and moderate linkage disequilibrium (ISA = 0.05, P<0.0001). In addition, population bottleneck analysis revealed no evidence for a reduction in the P. falciparum population size in Haiti. We conclude that the high level of genetic diversity and lack of evidence for a population bottleneck may suggest that Haiti’s P. falciparum population has been stable and discuss the implications of our results for understanding the impact of malaria control interventions. We also discuss the relevance of parasite population history and other host and vector factors when assessing transmission intensity from genetic diversity data.
Highlights
Malaria remains a leading global health threat, accounting for 627,000 deaths in 2012
The island has been identified as an ideal candidate for malaria elimination interventions [3,4,5] because Hispaniola: 1) has relatively low transmission of the malaria parasite [6,7,8], 2) has only one primary parasite species (Plasmodium falciparum) [9], 3) little to no antimalarial resistance exists as evidenced by drug efficacy studies and molecular studies [10,11,12,13,14,15,16,17,18] despite decades of chloroquine first-line treatment policy in Haiti, and 4) has a low risk of re-importation, a benefit of being an island surrounded by non-malaria endemic islands
We examined evidence of linkage disequilibrium (LD) between microsatellite markers for the P. falciparum samples from Haiti using a Monte Carlo simulation method to calculate the standard index of association
Summary
Malaria remains a leading global health threat, accounting for 627,000 deaths in 2012. The island has been identified as an ideal candidate for malaria elimination interventions [3,4,5] because Hispaniola: 1) has relatively low transmission of the malaria parasite [6,7,8], 2) has only one primary parasite species (Plasmodium falciparum) [9], 3) little to no antimalarial resistance exists as evidenced by drug efficacy studies and molecular studies [10,11,12,13,14,15,16,17,18] despite decades of chloroquine first-line treatment policy in Haiti, and 4) has a low risk of re-importation, a benefit of being an island surrounded by non-malaria endemic islands. Haiti is a strong candidate for malaria elimination, the 2014 World Malaria Report lists Haiti’s malaria program phase as “control” with the note “insufficiently consistent data to assess trends” [1]. More cases of malaria infection were reported after the 2010 earthquake than before the earthquake, though it is unclear whether this increase was the result of increased exposure to P. falciparum or the result of increased surveillance by visiting aid groups in Haiti [6]
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