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A cross-sectional survey was conducted during 2019 enrolling symptomatic malaria patients from nine health facilities across three zones consecutively to investigate the epidemiology of\n                    <jats:italic>P. falciparum<\/jats:italic>\n                    lacking\n                    <jats:italic>hrp2\/3<\/jats:italic>\n                    after the RDT switch. Molecular analyses of 715 samples revealed the overall prevalence of\n                    <jats:italic>hrp2-, hrp3<\/jats:italic>\n                    -, and dual\n                    <jats:italic>hrp2\/3<\/jats:italic>\n                    -deleted parasites as 9.4% (95%CI 7.4\u201311.7%), 41.7% (95% CI 38.1\u201345.3%) and 7.6% (95% CI 5.8\u20139.7%), respectively. The prevalence of\n                    <jats:italic>hrp2-<\/jats:italic>\n                    and\n                    <jats:italic>hrp3-<\/jats:italic>\n                    deletion is heterogeneous within and between zones: highest in Anseba (27.1% and 57.9%), followed by Gash Barka (6.4% and 37.9%) and Debub zone (5.2% and 43.8%).\n                    <jats:italic>hrp2\/3<\/jats:italic>\n                    -deleted parasites have multiple diverse haplotypes, with many shared or connected among parasites of different\n                    <jats:italic>hrp2\/3<\/jats:italic>\n                    status, indicating mutant parasites have likely evolved from multiple and local parasite genetic backgrounds. The findings show although prevalence of\n                    <jats:italic>hrp2\/3<\/jats:italic>\n                    -deleted parasites is lower 2 years after RDT switching, HRP2-based RDTs remain unsuitable for malaria diagnosis in Eritrea. Continued surveillance of\n                    <jats:italic>hrp2\/3<\/jats:italic>\n                    -deleted parasites in Eritrea and neighbouring countries is required to monitor the trend.\n                  <\/jats:p>","DOI":"10.1038\/s41598-021-00714-8","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T06:02:49Z","timestamp":1635228169000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Epidemiology of mutant Plasmodium falciparum parasites lacking histidine-rich protein 2\/3 genes in Eritrea 2 years after switching from HRP2-based RDTs"],"prefix":"10.1038","volume":"11","author":[{"given":"Selam","family":"Mihreteab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cielo","family":"Pasay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle L.","family":"Gatton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Cunningham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Araia","family":"Berhane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,26]]},"reference":[{"key":"714_CR1","unstructured":"Ministry of Health. 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