Taking Sharper Pictures of Malaria with CAMERAs: Combined Antibodies to Measure Exposure Recency Assays

Bryan Greenhouse,Isabel Rodríguez-Barraquer,Ivo Mueller,David L Smith,Chris J Drakeley

doi:10.4269/ajtmh.18-0303

Abstract

.Antibodies directed against malaria parasites are easy and inexpensive to measure but remain an underused surveillance tool because of a lack of consensus on what to measure and how to interpret results. High-throughput screening of antibodies from well-characterized cohorts offers a means to substantially improve existing assays by rationally choosing the most informative sets of responses and analytical methods. Recent data suggest that high-resolution information on malaria exposure can be obtained from a small number of samples by measuring a handful of properly chosen antibody responses. In this review, we discuss how standardized multi-antibody assays can be developed and efficiently integrated into existing surveillance activities, with potential to greatly augment the breadth and quality of information available to direct and monitor malaria control and elimination efforts.

Highlights

Elimination of malaria or effective and sustainable control requires deployment of interventions updated using surveillance data
Prevalence data, useful, are limited in the ability to detect changes in malaria transmission where transmission is so high that parasite rate (PR) remains high even if exposure decreases considerably, or where it is so low that infeasibly large sample sizes are required to accurately measure changes over time or at fine enough spatial scales to be programmatically useful.[4]
Obtaining antibody data is quite practical: enzyme-linked immunosorbent assay (ELISA) and some multiplexed assays are inexpensive and can be performed on material extracted from dried blood spots which are simple to collect and transport; point-of-contact tests such as lateral flow and microfluidic assays are options

Summary

Recency Assays

Smith,[3] Isabel Rodrıguez-Barraquer,[1] Ivo Mueller,[4,5] and Chris J. Drakeley6 1Department of Medicine, University of California, San Francisco, San Francisco, California; 2Chan Zuckerberg Biohub, San Francisco, California; 3Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; 4Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; 5Institute Pasteur, Paris, France; 6London School of Hygiene & Tropical Medicine, London, United Kingdom

EFFECTIVE MALARIA STRATEGIES REQUIRE GOOD DATA

THE CURRENT FOCUS OF MALARIA SURVEILLANCE

USING ANTIBODIES TO SHARPEN SURVEILLANCE DATA

What are the biomarkers and mechanisms of immunity to malaria?

PRACTICAL CONSIDERATIONS FOR INCORPORATING CAMERAS INTO ROUTINE SURVEILLANCE