Characterising temporal trends in asymptomatic Plasmodium infections and transporter polymorphisms during transition from high to low transmission in Zanzibar, 2005–2013

• Published in: Infection, genetics and evolution Vol. 33; pp. 110 - 117
• Main Authors: Morris, Ulrika, Xu, Weiping, Msellem, Mwinyi I., Schwartz, Alanna, Abass, Ali, Shakely, Delér, Cook, Jackie, Bhattarai, Achuyt, Petzold, Max, Greenhouse, Bryan, Ali, Abdullah S., Björkman, Anders, Fröberg, Gabrielle, Mårtensson, Andreas
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-07-2015
• Subjects: Adolescent; Adult; Antimalarial drug resistance; Antimalarial drug resistance markers; ARTEMETHER-LUMEFANTRINE; ARTESUNATE-AMODIAQUINE; Asymptomatic; Asymptomatic Infections; CARRIAGE; Child; Child, Preschool; COMBINATION THERAPY; Cross-Sectional Studies; FALCIPARUM DRUG-RESISTANCE; Female; Genotype; Humans; IN-VITRO; Infant; Infectious Diseases; Infectious Medicine; Infektionsmedicin; Low transmission; MALARIA PARASITE; Malaria, Falciparum - epidemiology; Malaria, Falciparum - parasitology; Male; Medicin och hälsovetenskap; Membrane Transport Proteins - genetics; Middle Aged; Molecular surveillance; Parasite Load; PFMDR1 GENES; Plasmodium; Plasmodium falciparum - classification; Plasmodium falciparum - genetics; POLYMERASE-CHAIN-REACTION; Polymorphism, Single Nucleotide; Prevalence; Protozoan Proteins - genetics; RAPID DIAGNOSTIC-TESTS; Tanzania - epidemiology; Young Adult; Tanzania; Plasmodium; Low transmission; Molecular surveillance; Asymptomatic; Antimalarial drug resistance markers
• ISSN: 1567-1348; 1567-7257; 1567-7257
• DOI: 10.1016/j.meegid.2015.04.018

•Declining, but persistent, reservoir of low-density malaria in Zanzibar between 2005 and 2013.•Decreasing MOI after 2005, but genetic diversity of P. falciparum remained high.•Declining prevalence of AQ resistance associated pfcrt 76T and pfmdr1 86Y despite wide scale use of ASAQ.•AQ resistance associated pfmdr1 (a.a.86,184,1246) YYY/YYD haplotypes more frequent in asymptomatic than symptomatic infections.
Improved understanding of the asymptomatic malaria parasite reservoir is a prerequisite to pursue malaria elimination efforts. We therefore characterised temporal trends and transporter polymorphisms in asymptomatic Plasmodium infections during the transition from high to low transmission in Zanzibar.
Healthy individuals participating in cross-sectional surveys conducted 2005–2013 were screened for asymptomatic malaria by PCR. Complexity/diversity of infection and transporter polymorphisms were assessed in Plasmodium falciparum positive samples. Symptomatic samples were included for comparison of polymorphisms in 2013.
PCR-determined parasite prevalence declined from 21.1% (CI95% 17.4–24.9) to 2.3% (CI95% 1.7–2.9) from 2005 to 2013. P. falciparum remained the predominant species; prevalence was highest in children and young adults aged 5–25years. Parasite densities and complexity of infection, but not population genetic diversity of P. falciparum, decreased from 2005–2009. pfcrt 76T (99.2–64.7%, p<0.001) and pfmdr1 86Y frequencies (89.4–66.7%, p=0.03) decreased over time. Pfmdr1 (a.a.86,184,1246) YYY and YYD haplotypes were more frequent in asymptomatic than symptomatic infections in 2013 (p<0.001).
There is a declining, albeit persistent, reservoir of parasites present at low-densities in asymptomatic individuals in Zanzibar. This study revealed important characteristics of the remaining parasite population, including intriguing temporal trends in molecular markers associated with antimalarial resistance, which need to be further investigated.