The temporal dynamics and infectiousness of subpatent Plasmodium falciparum infections in relation to parasite density

• Main Authors: Hannah C. Slater, Amanda Ross, Ingrid Felger, Natalie E. Hofmann, Leanne Robinson, Jackie Cook, Bronner P. Gonçalves, Anders Björkman, Andre Lin Ouedraogo, Ulrika Morris, Mwinyi Msellem, Cristian Koepfli, Ivo Mueller, Fitsum Tadesse, Endalamaw Gadisa, Smita Das, Gonzalo Domingo, Melissa Kapulu, Janet Midega, Seth Owusu-Agyei, Cécile Nabet, Renaud Piarroux, Ogobara Doumbo, Safiatou Niare Doumbo, Kwadwo Koram, Naomi Lucchi, Venkatachalam Udhayakumar, Jacklin Mosha, Alfred Tiono, Daniel Chandramohan, Roly Gosling, Felista Mwingira, Robert Sauerwein, Eleanor M. Riley, Nicholas J. White, Francois Nosten, Mallika Imwong, Teun Bousema, Chris Drakeley, Lucy C. Okell
• Other Authors: University of Health and Allied Sciences, Ghana
• Format: Article
• Published: 2020
• Subjects: Biochemistry, Genetics and Molecular Biology; Chemistry
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/50028
• Institution: Mahidol University

© 2019, The Author(s). Malaria infections occurring below the limit of detection of standard diagnostics are common in all endemic settings. However, key questions remain surrounding their contribution to sustaining transmission and whether they need to be detected and targeted to achieve malaria elimination. In this study we analyse a range of malaria datasets to quantify the density, detectability, course of infection and infectiousness of subpatent infections. Asymptomatically infected individuals have lower parasite densities on average in low transmission settings compared to individuals in higher transmission settings. In cohort studies, subpatent infections are found to be predictive of future periods of patent infection and in membrane feeding studies, individuals infected with subpatent asexual parasite densities are found to be approximately a third as infectious to mosquitoes as individuals with patent (asexual parasite) infection. These results indicate that subpatent infections contribute to the infectious reservoir, may be long lasting, and require more sensitive diagnostics to detect them in lower transmission settings.