Asymptomatic School-Aged Children Are Important Drivers of Malaria Transmission in a High Endemicity Setting in Uganda
John Rek, Sara Lynn Blanken, Joseph Okoth, Daniel Ayo, Ismail Onyige, Eric Musasizi, Jordache Ramjith, Chiara Andolina, Kjerstin Lanke, Emmanuel Arinaitwe, Peter Olwoch, Katharine A. Collins, Moses R. Kamya, Grant Dorsey, Chris Drakeley, Sarah G. Staedke, Teun Bousema, Melissa D. Conrad
Abstract
Achieving malaria elimination requires a better understanding of the transmissibility of human infections in different transmission settings. This study aimed to characterize the human infectious reservoir in a high endemicity setting in eastern Uganda, using gametocyte quantification and mosquito feeding assays. In asymptomatic infections, gametocyte densities were positively associated with the proportion of infected mosquitoes (β = 1.60; 95% CI, 1.32-1.92; P < .0001). Combining transmissibility and abundance in the population, symptomatic and asymptomatic infections were estimated to contribute to 5.3% and 94.7% of the infectious reservoir, respectively. School-aged children (5-15 years old) contributed to 50.4% of transmission events and were important drivers of malaria transmission.