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Assessing the relationship between total parasitaemia and gametocytaemia in field surveys can provide insight as to whether detection of low-density, asymptomatic\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      infections with sensitive molecular methods can adequately detect the majority of infected individuals who are potentially capable of onward transmission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a cross-sectional survey of 1354 healthy children and adults in three communities in western Kenya across a gradient of malaria transmission (Ajigo, Webuye, and Kapsisywa\u2013Kipsamoite), asymptomatic\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      infections were screened by rapid diagnostic tests, blood smear, and quantitative PCR of dried blood spots targeting the\n                      <jats:italic>varATS<\/jats:italic>\n                      gene in genomic DNA. A multiplex quantitative reverse-transcriptase PCR assay targeting female and male gametocyte genes (\n                      <jats:italic>pfs25<\/jats:italic>\n                      ,\n                      <jats:italic>pfs230p<\/jats:italic>\n                      ), a gene with a transcriptional pattern restricted to asexual blood stages (\n                      <jats:italic>piesp2<\/jats:italic>\n                      ), and human\n                      <jats:italic>GAPDH<\/jats:italic>\n                      was also developed to determine total parasite and gametocyte densities among parasitaemic individuals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of\n                      <jats:italic>varATS<\/jats:italic>\n                      -detectable asymptomatic infections was greatest in Ajigo (42%), followed by Webuye (10%). Only two infections were detected in Kapsisywa. No infections were detected in Kipsamoite. Across all communities, children aged 11\u201315\u00a0years account for the greatest proportion total and sub-microscopic asymptomatic infections. In younger age groups, the majority of infections were detectable by microscopy, while 68% of asymptomatically infected adults (&gt;\u200921\u00a0years old) had sub-microscopic parasitaemia.\n                      <jats:italic>Piesp2<\/jats:italic>\n                      -derived parasite densities correlated poorly with microscopy-determined parasite densities in patent infections relative to\n                      <jats:italic>varATS<\/jats:italic>\n                      -based detection. In general, both male and female gametocytaemia increased with increasing\n                      <jats:italic>varATS<\/jats:italic>\n                      -derived total parasitaemia. A substantial proportion (41.7%) of individuals with potential for onward transmission had qPCR-estimated parasite densities below the limit of microscopic detection, but above the detectable limit of\n                      <jats:italic>varATS<\/jats:italic>\n                      qPCR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This assessment of parasitaemia and gametocytaemia in three communities with different transmission intensities revealed evidence of a substantial sub-patent infectious reservoir among asymptomatic carriers of\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      . Experimental studies are needed to definitively determine whether the low-density infections in communities such as Ajigo and Webuye contribute significantly to malaria transmission.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-021-03905-w","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T05:06:09Z","timestamp":1631855169000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["The prevalence and density of asymptomatic Plasmodium falciparum infections among children and adults in three communities of western Kenya"],"prefix":"10.1186","volume":"20","author":[{"given":"Christina","family":"Salgado","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Ayodo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Macklin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meetha P.","family":"Gould","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivas","family":"Nallandhighal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliud O.","family":"Odhiambo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Obala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy Prudhomme","family":"O\u2019Meara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandy C.","family":"John","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1928-861X","authenticated-orcid":false,"given":"Tuan M.","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,17]]},"reference":[{"key":"3905_CR1","volume-title":"World malaria report 2020","author":"WHO","year":"2020","unstructured":"WHO. 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