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

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, Richard Paul, Eleanor M Riley, Nicholas J White, Francois Nosten, Mallika Imwong, Teun Bousema, Chris Drakeley and Lucy C Okell
Additional contact information
Hannah C. Slater: Imperial College London
Amanda Ross: Swiss Tropical and Public Health Institute
Ingrid Felger: University of Basel
Natalie E. Hofmann: University of Basel
Leanne Robinson: Papua New Guinea Institute for Medical Research
Jackie Cook: London School of Hygiene and Tropical Medicine
Bronner P. Gonçalves: Department of Immunology and Infection, London School of Hygiene and Tropical Medicine
Anders Björkman: Malaria Research, Department of Microbiology, Tumor and Cell Biology
Andre Lin Ouedraogo: Centre National de Recherche et de Formation sur le Paludisme
Ulrika Morris: Malaria Research, Department of Microbiology, Tumor and Cell Biology
Mwinyi Msellem: Mnazi Mmoja Hospital
Cristian Koepfli: Walter and Eliza Hall Institute
Ivo Mueller: The Walter and Eliza Hall Institute of Medical Research
Fitsum Tadesse: Radboud University Medical Centre
Endalamaw Gadisa: Armauer Hansen Research Institute
Smita Das: Diagnostics Program, PATH, Seattle
Gonzalo Domingo: Diagnostics Program, PATH, Seattle
Melissa Kapulu: University of Oxford
Janet Midega: University of Oxford
Seth Owusu-Agyei: University of Health and Allied Sciences
Cécile Nabet: Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie
Renaud Piarroux: Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie
Ogobara Doumbo: University of Sciences, Technique and Technology
Safiatou Niare Doumbo: University of Sciences, Technique and Technology
Kwadwo Koram: University of Ghana
Naomi Lucchi: Centers for Global Health, Centers for Disease Control and Prevention
Venkatachalam Udhayakumar: Centers for Global Health, Centers for Disease Control and Prevention
Jacklin Mosha: Mwanza Medical Research Centre
Alfred Tiono: Centre National de Recherche et de Formation sur le Paludisme
Daniel Chandramohan: London School of Hygiene and Tropical Medicine
Roly Gosling: University of California, San Francisco
Felista Mwingira: Dar es Salaam University College of Education
Robert Sauerwein: Radboud University Medical Centre
Richard Paul: Laboratoire d‘Entomologie Médicale
Eleanor M Riley: Department of Immunology and Infection, London School of Hygiene and Tropical Medicine
Nicholas J White: Nuffield Department of Clinical Medicine, University of Oxford
Francois Nosten: Nuffield Department of Clinical Medicine, University of Oxford
Mallika Imwong: Faculty of Tropical Medicine, Mahidol University
Teun Bousema: Department of Immunology and Infection, London School of Hygiene and Tropical Medicine
Chris Drakeley: Department of Immunology and Infection, London School of Hygiene and Tropical Medicine
Lucy C Okell: Imperial College London

Nature Communications, 2019, vol. 10, issue 1, 1-16

Abstract: Abstract 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.

Date: 2019
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DOI: 10.1038/s41467-019-09441-1

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