Relative contribution of low-density and asymptomatic infections to Plasmodium vivax transmission in the Amazon: pooled analysis of individual participant data from population-based cross-sectional surveys
Marcelo U. Ferreira, Rodrigo M. Corder, Igor Cavallini Johansen, Johanna Helena Kattenberg, Marta Moreno, Ángel Rosas-Aguirre, Simone Ladeia-Andrade, Jan E. Conn, Alejandro Llanos‐Cuentas, Dionicia Gamboa, Anna Rosanas‐Urgell, Joseph M. Vinetz
Abstract
Background: infections remain largely undetected and untreated and may contribute significantly to malaria transmission in the Amazon. Methods: infections and examined how parasite density relates to clinical manifestations and mosquito infection in Amazonian settings. Findings: transmission, while asymptomatic carriers are the source of 28·2% to 79·2% of mosquito infections. Interpretation: carriers constitute a vast infectious reservoir that, if targeted by malaria elimination strategies, could substantially reduce malaria transmission in the Amazon. Infected children may remain asymptomatic despite high parasite densities that elicit clinical manifestations in adults. Funding: US National Institutes of Health, Fundação de Amparo à Pesquisa do Estado de São Paulo, and Belgium Development Cooperation.