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The complex relationship of exposure to new Plasmodium infections and incidence of clinical malaria in Papua New Guinea
Hofmann, Natalie E.; Karl, Stephan; Wampfler, Rahel; Kiniboro, Benson; Teliki, Albina; Iga, Jonah; Waltmann, Andreea; Betuela, Inoni; Felger, Ingrid; Robinson, Leanne J.; Mueller, Ivo
The molecular force of blood-stage infection (molFOB) is a quantitative surrogate metric for malaria transmission at population level and for exposure at individual level. Relationships between molFOB, parasite prevalence and clinical incidence were assessed in a treatment-to-reinfection cohort, where P.vivax (Pv) hypnozoites were eliminated in half the children by primaquine (PQ). Discounting relapses, children acquired equal numbers of new P. falciparum (Pf) and Pv blood-stage infections/year (Pf-molFOB = 0-18, Pv-molFOB = 0-23) resulting in comparable spatial and temporal patterns in incidence and prevalence of infections. Including relapses, Pv-molFOB increased >3 fold (relative to PQ-treated children) showing greater heterogeneity at individual (Pv-molFOB = 0-36) and village levels. Pf- and Pv-molFOB were strongly associated with clinical episode risk. Yearly Pf clinical incidence rate (IR = 0.28) was higher than for Pv (IR = 0.12) despite lower Pf-molFOB. These relationships between molFOB, clinical incidence and parasite prevalence reveal a comparable decline in Pf and Pv transmission that is normally hidden by the high burden of Pv relapses. CLINICAL TRIAL REGISTRATION: NCT02143934.
Papua Nova Guinea
Plasmodium vivax
Papua New Guinea
Plasmodium vivax
cc by (c) Hofmann et al., 2017
eLife Sciences Publications

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