Abstract
BackgroundWith low and markedly seasonal malaria transmission, increasingly sensitive tools for better stratifying the risk of infection and targeting control interventions are needed. A cross-sectional survey to characterize the current malaria transmission patterns, identify hotspots, and detect recent changes using parasitological and serological measures was conducted in three sites of the Peruvian Amazon.Material and MethodsAfter full census of the study population, 651 participants were interviewed, clinically examined and had a blood sample taken for the detection of malaria parasites (microscopy and PCR) and antibodies against P. vivax (PvMSP119, PvAMA1) and P. falciparum (PfGLURP, PfAMA1) antigens by ELISA. Risk factors for malaria infection (positive PCR) and malaria exposure (seropositivity) were assessed by multivariate survey logistic regression models. Age-specific seroprevalence was analyzed using a reversible catalytic conversion model based on maximum likelihood for generating seroconversion rates (SCR, λ). SaTScan was used to detect spatial clusters of serology-positive individuals within each site.ResultsThe overall parasite prevalence by PCR was low, i.e. 3.9% for P. vivax and 6.7% for P. falciparum, while the seroprevalence was substantially higher, 33.6% for P. vivax and 22.0% for P. falciparum, with major differences between study sites. Age and location (site) were significantly associated with P. vivax exposure; while location, age and outdoor occupation were associated with P. falciparum exposure. P. falciparum seroprevalence curves showed a stable transmission throughout time, while for P. vivax transmission was better described by a model with two SCRs. The spatial analysis identified well-defined clusters of P. falciparum seropositive individuals in two sites, while it detected only a very small cluster of P. vivax exposure.ConclusionThe use of a single parasitological and serological malaria survey has proven to be an efficient and accurate method to characterize the species specific heterogeneity in malaria transmission at micro-geographical level as well as to identify recent changes in transmission.
Highlights
Despite several decades of intense control efforts, malaria remains an important public health problem in Peru [1], mainly in the Department of Loreto in the Amazon region, which has historically accounted for most of the malaria burden within the country [2]
After full census of the study population, 651 participants were interviewed, clinically examined and had a blood sample taken for the detection of malaria parasites and antibodies against P. vivax (PvMSP119, PvAMA1) and P. falciparum (PfGLURP, PfAMA1) antigens by ELISA
Hotspots of Malaria Transmission in the Peruvian Amazon funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Summary
Between October 2005 and September 2010, increased support from international donors, e.g. the Global Fund-PAMAFRO Project [4], allowed the scale-up of comprehensive malaria control strategies in the Peruvian Amazon [5,6]. During this period, malaria declined drastically in Loreto from 54,291 reported clinical cases (25% due to P. falciparum) in 2005 to 11,604 cases (20% due to P. falciparum) in 2010, [2]. Since October 2010, malaria control activities are mainly supported by the Ministry of Health (MoH) budget, prioritizing passive and reactive case detection using standard light microscopy (LM) and treatment of confirmed infections. A cross-sectional survey to characterize the current malaria transmission patterns, identify hotspots, and detect recent changes using parasitological and serological measures was conducted in three sites of the Peruvian Amazon
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