Hyper-diverse antigenic variation and resilience to transmission-reducing intervention in falciparum malaria

Qi Zhan, Qixin He, Kathryn E. Tiedje, Karen P. Day and Mercedes Pascual ()
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Qi Zhan: The University of Chicago
Qixin He: Purdue University
Kathryn E. Tiedje: The University of Melbourne
Karen P. Day: The University of Melbourne
Mercedes Pascual: New York University

Nature Communications, 2024, vol. 15, issue 1, 1-16

Abstract: Abstract Intervention efforts against falciparum malaria in high-transmission regions remain challenging, with rapid resurgence typically following their relaxation. Such resilience co-occurs with incomplete immunity and a large transmission reservoir from high asymptomatic prevalence. Incomplete immunity relates to the large antigenic variation of the parasite, with the major surface antigen of the blood stage of infection encoded by the multigene and recombinant family known as var. With a stochastic agent-based model, we investigate the existence of a sharp transition in resurgence ability with intervention intensity and identify molecular indicators informative of its proximity. Their application to survey data with deep sampling of var sequences from individual isolates in northern Ghana suggests that the transmission system was brought close to transition by intervention with indoor residual spraying. These results indicate that sustaining and intensifying intervention would have pushed malaria dynamics to a slow-rebound regime with an increased probability of local parasite extinction.

Date: 2024
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DOI: 10.1038/s41467-024-51468-6

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