Comparison of diagnostics for the detection of asymptomatic Plasmodium falciparum infections to inform control and elimination strategies

Lindsey Wu (), Lotus L. van den Hoogen, Hannah Slater, Patrick G. T. Walker, Azra C. Ghani, Chris J. Drakeley and Lucy C. Okell
Additional contact information
Lindsey Wu: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
Lotus L. van den Hoogen: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
Hannah Slater: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Patrick G. T. Walker: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Azra C. Ghani: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London
Chris J. Drakeley: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
Lucy C. Okell: MRC Centre for Outbreak Analysis and Modelling, Faculty of Medicine, Imperial College London

Nature, 2015, vol. 528, issue 7580, S86-S93

Abstract: Abstract The global burden of malaria has been substantially reduced over the past two decades. Future efforts to reduce malaria further will require moving beyond the treatment of clinical infections to targeting malaria transmission more broadly in the community. As such, the accurate identification of asymptomatic human infections, which can sustain a large proportion of transmission, is becoming a vital component of control and elimination programmes. We determined the relationship across common diagnostics used to measure malaria prevalence — polymerase chain reaction (PCR), rapid diagnostic test and microscopy — for the detection of Plasmodium falciparum infections in endemic populations based on a pooled analysis of cross-sectional data. We included data from more than 170,000 individuals comparing the detection by rapid diagnostic test and microscopy, and 30,000 for detection by rapid diagnostic test and PCR. The analysis showed that, on average, rapid diagnostic tests detected 41% (95% confidence interval = 26–66%) of PCR-positive infections. Data for the comparison of rapid diagnostic test to PCR detection at high transmission intensity and in adults were sparse. Prevalence measured by rapid diagnostic test and microscopy was comparable, although rapid diagnostic test detected slightly more infections than microscopy. On average, microscopy captured 87% (95% confidence interval = 74–102%) of rapid diagnostic test-positive infections. The extent to which higher rapid diagnostic test detection reflects increased sensitivity, lack of specificity or both, is unclear. Once the contribution of asymptomatic individuals to the infectious reservoir is better defined, future analyses should ideally establish optimal detection limits of new diagnostics for use in control and elimination strategies. This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.

Date: 2015
References: Add references at CitEc
Citations: View citations in EconPapers (3)

Downloads: (external link)
https://www.nature.com/articles/nature16039 Abstract (text/html)
Access to the full text of the articles in this series is restricted.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:nat:nature:v:528:y:2015:i:7580:d:10.1038_nature16039

Ordering information: This journal article can be ordered from
https://www.nature.com/

DOI: 10.1038/nature16039

Access Statistics for this article

Nature is currently edited by Magdalena Skipper

More articles in Nature from Nature
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().