Abstract

BackgroundSri Lanka was certified as a malaria-free nation in 2016; however, imported malaria cases continue to be reported. Evidence-based information on the genetic structure/diversity of the parasite populations is useful to understand the population history, assess the trends in transmission patterns, as well as to predict threatening phenotypes that may be introduced and spread in parasite populations disrupting elimination programmes. This study used a previously developed Plasmodium vivax single nucleotide polymorphism (SNP) barcode to evaluate the population dynamics of P. vivax parasite isolates from Sri Lanka and to assess the ability of the SNP barcode for tracking the parasites to its origin.MethodsA total of 51 P. vivax samples collected during 2005–2011, mainly from three provinces of the country, were genotyped for 40 previously identified P. vivax SNPs using a high-resolution melting (HRM), single-nucleotide barcode method. Minor allele frequencies, linkage disequilibrium, pair-wise FST values, and complexity of infection (COI) were evaluated to determine the genetic diversity. Structure analysis was carried out using STRUCTURE software (Version 2.3.4) and SNP barcode was used to identify the genetic diversity of the local parasite populations collected from different years. Principal component analysis (PCA) was used to determine the clustering according to global geographic regions.ResultsThe proportion of multi-clone infections was significantly higher in isolates collected during an infection outbreak in year 2007. The minor allele frequencies of the SNPs changed dramatically from year to year. Significant linkage was observed in sample sub-sets from years 2005 and 2007. The majority of the isolates from 2007 consisted of at least two genetically distinct parasite strains. The overall percentage of multi-clone infections for the entire parasite sample was 39.21%. Analysis using STRUCTURE software (Version 2.3.4) revealed the high genetic diversity of the sample sub-set from year 2007. In-silico analysis of these data with those available from other global geographical regions using PCA showed distinct clustering of parasite isolates according to geography, demonstrating the usefulness of the barcode in determining an isolate to be indigenous.ConclusionsPlasmodium vivax parasite isolates collected during a disease outbreak in year 2007 were more genetically diverse compared to those collected from other years. In-silico analysis using the 40 SNP barcode is a useful tool to track the origin of an isolate of uncertain origin, especially to differentiate indigenous from imported cases. However, an extended barcode with more SNPs may be needed to distinguish highly clonal populations within the country.

Highlights

  • Sri Lanka was certified as a malaria-free nation in 2016; imported malaria cases continue to be reported

  • It was obvious that the isolates from the Eastern province and the Southern province exhibited a higher genetic diversity with more multi-clone infections compared to the isolates from the North-Western province

  • The local P. vivax parasite population showed an overall high level of genetic diversity based on the 40-single nucleotide polymorphism (SNP) barcode, complexity of infection (COI) and structure analysis, which was viewed in the context of low malaria transmission that prevailed during the study period

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Summary

Introduction

Sri Lanka was certified as a malaria-free nation in 2016; imported malaria cases continue to be reported. Suppression of control efforts, upon approaching near elimination, often leads to malaria resurgence [4, 5], which is clearly evident from past experiences of many countries that include Sri Lanka [1, 2], India [6] and Madagascar [7]. In 2016, the World Health Organization (WHO) certified Sri Lanka as malaria-free. The last indigenous case of malaria in Sri Lanka was reported in October 2012; imported malaria cases continue to be recorded in notable numbers (95, 49, 36, 41, 47, and 48 cases reported during successive years between 2013 and 2018) [5, 8]. Accurate identification of the parasite is critically important in this process in order to make proper patient management decisions especially regarding chemotherapy [9]

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