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Integration of more sensitive diagnostic molecular and serological measures into the VHV network may improve surveillance of residual malaria transmission in hard-to-reach areas in the region and inform targeted interventions and elimination responses. However, data on residual malaria transmission that would be captured by these measures in the VHV-led testing and treatment surveillance network in the GMS is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 114 VHVs were trained to collect dried blood spots from villagers undergoing routine RDTs as part of VHV-led active and passive case detection from April 2015 to June 2016. Samples were subjected to molecular testing (quantitative polymerase chain reaction [qPCR]) to determine\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      and\n                      <jats:italic>P. vivax<\/jats:italic>\n                      infection and serological testing (against\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      and\n                      <jats:italic>P. vivax<\/jats:italic>\n                      antigens) to determine exposure to\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      and\n                      <jats:italic>P. vivax<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over 15 months, 114 VHVs performed 32,194 RDTs and collected samples for molecular (\n                      <jats:italic>n<\/jats:italic>\n                      = 13,157) and serological (\n                      <jats:italic>n<\/jats:italic>\n                      = 14,128) testing. The prevalence of molecular-detectable\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      and\n                      <jats:italic>P. vivax<\/jats:italic>\n                      infection was 3.2% compared to the 0.16% prevalence of\n                      <jats:italic>Plasmodium<\/jats:italic>\n                      spp. by RDT, highlighting the large burden of infections undetected by standard surveillance. Peaks in anti-\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      , but not\n                      <jats:italic>P. vivax<\/jats:italic>\n                      , merozoite IgG seroprevalence coincided with seasonal\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      transmission peaks, even in those with no molecularly detectable parasites. At the individual level, antibody seropositivity was associated with reduced odds of contemporaneous\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      (OR for\n                      <jats:italic>Pf<\/jats:italic>\n                      CSP 0.51 [95%CI 0.35, 0.76],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001,\n                      <jats:italic>Pf<\/jats:italic>\n                      AMA1 0.70 [95%CI 0.52, 0.93],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01, and\n                      <jats:italic>Pf<\/jats:italic>\n                      MSP2 0.81 [95%CI 0.61, 1.08],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.15), but not\n                      <jats:italic>P. vivax<\/jats:italic>\n                      infection (OR\n                      <jats:italic>Pv<\/jats:italic>\n                      AMA1 1.02 [95%CI 0.73, 1.43],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.89) indicating a potential role of immunity in protection against molecular-detectable\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      parasitaemia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We demonstrated that integration and implementation of sample collection for molecular and serological surveillance into networks of VHV servicing hard-to-reach populations in the GMS is feasible, can capture significant levels of ongoing undetected seasonal malaria transmission and has the potential to supplement current routine RDT testing. Improving malaria surveillance by advancing the integration of molecular and serological techniques, through centralised testing approaches or novel point-of-contact tests, will advance progress, and tracking, towards malaria elimination goals in the GMS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-021-01993-8","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T21:02:58Z","timestamp":1622149378000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Community-based molecular and serological surveillance of subclinical malaria in Myanmar"],"prefix":"10.1186","volume":"19","author":[{"given":"Katherine","family":"O\u2019Flaherty","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Win Han","family":"Oo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie G.","family":"Zaloumis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia C.","family":"Cutts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyaw Zayar","family":"Aung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myat Mon","family":"Thein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien R.","family":"Drew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Razook","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa E.","family":"Barry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naanki","family":"Parischa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyi Nyi","family":"Zaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Htin Kyaw","family":"Thu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aung","family":"Thi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Yan Min","family":"Htay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aung Paing","family":"Soe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Simpson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James G.","family":"Beeson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Agius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freya J. 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The ethics review committee of the Department of Medical Research, Ministry of Health and Sports, requested that there be no commercial advantage for the product during the trial. Consequently, the repellent was provided in plain unbranded tubes, and the investigators registered the trial after completion of fieldwork (but prior to the commencement of data analysis) to minimise public disclosure. The study protocol has been published previously [\n                      \n                      ], and the study is reported according to the CONSORT guidelines of reporting a stepped-wedge cluster randomised trial [\n                      \n                      ].","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"121"}}