Abstract
To achieve malaria elimination, new tools are required to explicitly target Plasmodium vivax. Recently, a novel panel of P. vivax proteins were identified and validated as serological markers for detecting recent exposure to P. vivax within the last 9 months. In order to improve the sensitivity and specificity of these markers, immunoglobulin M (IgM) in addition to immunoglobulin G (IgG) antibody responses were compared with a down-selected panel of 20 P. vivax proteins. IgM was tested using archival plasma samples from observational cohort studies conducted in malaria-endemic regions of Thailand and Brazil. IgM responses to these proteins generally had poorer classification performance than IgG.
Highlights
Infections due to Plasmodium vivax are a major challenge for malaria elimination
Serological markers of recent exposure to P. vivax infections could play an important role in malaria elimination by delineating areas of ongoing transmission and identifying individuals with a high chance of carrying hypnozoites in their livers
They have similar accuracy as compared with these same antigens using immunoglobulin G (IgG) (RAMA performs slightly better with IgG; TRAP performs slightly better with Immunoglobulin M (IgM))
Summary
Infections due to Plasmodium vivax are a major challenge for malaria elimination. This is due to unique biological features of P. vivax parasites, including an arrested stage in the liver (hypnozoites) that can reactivate weeks to months later, causing relapses of clinical disease. Individuals with hypnozoites are major reservoirs of transmission and are responsible for >80% of blood-stage P. vivax infections [1] We have recently identified and validated a novel panel of P. vivax proteins that induce immunoglobulin G (IgG) antibody responses reflective of recent exposure to P. vivax blood-stage infections [3]. Combinations of IgG antibody responses to 5–8 P. vivax proteins can accurately classify (with 80% sensitivity and specificity) whether an individual has had a P. vivax infection within the last 9 months. Our novel serological exposure markers represent the first test that can, indirectly, identify hypnozoite carriers This tool could play an important role in malaria elimination by offering an alternative to mass drug administration (MDA) strategies (where everyone is treated) or mass screening and treatment (MSAT) strategies performed using currently available diagnostics for blood-stage parasites. We hypothesized that IgM antibody responses to our panel of P. vivax proteins could be used to improve the classification accuracy by providing additional information to the algorithm
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