{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:27:32Z","timestamp":1788956852219,"version":"build-2803163510"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T00:00:00Z","timestamp":1656460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Malaria Vaccine Branch of the Walter Reed Army Institute of Research"},{"name":"Rhodes Trust"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,18]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Assessing the infectious reservoir is critical in malaria control and elimination strategies. We conducted a longitudinal epidemiological study in a high-malaria-burden region in Kenya to characterize transmission in an asymptomatic population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>488 study participants encompassing all ages in 120 households within 30 clusters were followed for 1 year with monthly sampling. Malaria was diagnosed by microscopy and molecular methods. Transmission potential in gametocytemic participants was assessed using direct skin and\/or membrane mosquito feeding assays, then treated with artemether-lumefantrine. Study variables were assessed using mixed-effects generalized linear models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Asexual and sexual parasite data were collected from 3792 participant visits, with 903 linked with feeding assays. Univariate analysis revealed that the 6\u201311-year-old age group was at higher risk of harboring asexual and sexual infections than those &amp;lt;6 years old (odds ratio [OR] 1.68, P &amp;lt; .001; and OR 1.81, P &amp;lt; .001), respectively. Participants with submicroscopic parasitemia were at a lower risk of gametocytemia compared with microscopic parasitemia (OR 0.04, P &amp;lt; .001), but they transmitted at a significantly higher rate (OR 2.00, P = .002). A large proportion of the study population who were infected at least once remained infected (despite treatment) with asexual (71.7%, 291\/406) or sexual (37.4%, 152\/406) parasites. 88.6% (365\/412) of feeding assays conducted in individuals who failed treatment the previous month resulted in transmissions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Individuals with asymptomatic infection sustain the transmission cycle, with the 6\u201311-year age group serving as an important reservoir. The high rates of artemether-lumefantrine treatment failures suggest surveillance programs using molecular methods need to be expanded for accurate monitoring and evaluation of treatment outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciac527","type":"journal-article","created":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T15:31:30Z","timestamp":1656516690000},"page":"704-712","source":"Crossref","is-referenced-by-count":16,"title":["Malaria Transmission Dynamics in a High-Transmission Setting of Western Kenya and the Inadequate Treatment Response to Artemether-Lumefantrine in an Asymptomatic Population"],"prefix":"10.1093","volume":"76","author":[{"given":"Ben","family":"Andagalu","sequence":"first","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver J","family":"Watson","sequence":"additional","affiliation":[{"name":"Medical Research Council, Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London , London , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Onyango","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Opot","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Okoth","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gladys","family":"Chemwor","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Sifuna","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Juma","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Cheruiyot","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Redemptah","family":"Yeda","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Okudo","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackline","family":"Wafubwa","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santos","family":"Yalwala","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Abuom","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhards","family":"Ogutu","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI) , Nairobi , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Cowden","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoseah M","family":"Akala","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5761-7883","authenticated-orcid":false,"given":"Edwin","family":"Kamau","sequence":"additional","affiliation":[{"name":"Department of Emerging and Infectious Diseases (DEID), US Army Medical Research Directorate-Africa (USAMRD-A), Kenya Medical Research Institute (KEMRI)\/Walter Reed Project , Kisumu , Kenya"},{"name":"US Military HIV Research Program, Walter Reed Army Institute of Research , Silver Spring, Maryland , USA"},{"name":"Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles , Los Angeles, California , 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