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Abstract
BackgroundAsymptomatic carriage of Plasmodium falciparum and Plasmodium vivax is common in both low-and high-transmission settings and represents an important reservoir of infection that needs to be targeted if malaria elimination is to succeed.MethodsMass blood examinations (475 individuals) were conducted in two villages in Mae Hong Son, an area of endemic but low-transmission malaria in the north-west of Thailand. The microscopist at the local malaria clinic did not detect any infections. Pools of four samples were screened by real-time PCR; individual members of all of the positive pools were then re-examined by expert microscopy and by a second species-specific PCR reaction.ResultsEight subjects were found to be positive by both PCR and expert microscopy and one was found to be positive by PCR alone. The slides contained asexual stage parasites of P. vivax, P. falciparum and Plasmodium malariae, but no gametocytes. The local clinic was notified within two to eight days of the survey.ConclusionA combination of pooling, real-time PCR and expert microscopy provides a feasible approach to identifying and treating asymptomatic malaria infections in a timely manner.
Highlights
Asymptomatic carriage of Plasmodium falciparum and Plasmodium vivax is common in both low-and high-transmission settings and represents an important reservoir of infection that needs to be targeted if malaria elimination is to succeed
Active case detection (ACD) may have an even greater impact using PCR, which detect large numbers of infections that were previously undetected by microscopy (“submicroscopic infections”) [2,3,4,5,6,7,8,9,10]
The current paper shows that pooled real-time PCR coupled with expert microscopy enhances sensitivity of detection in mass blood examinations
Summary
Asymptomatic carriage of Plasmodium falciparum and Plasmodium vivax is common in both low-and high-transmission settings and represents an important reservoir of infection that needs to be targeted if malaria elimination is to succeed. Active case detection (ACD) is a key component of malaria surveillance programmes. ACD may have an even greater impact using PCR, which detect large numbers of infections that were previously undetected by microscopy (“submicroscopic infections”) [2,3,4,5,6,7,8,9,10]. Asymptomatic carriers could represent an important reservoir [3,9,11] and be of particular relevance to elimination efforts [12].
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