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Most cases are asymptomatic and escape routine malaria surveillance based on light microscopy (LM). Following the implementation of control programs in this region, new approaches to stratify transmission and direct efforts at an individual and community level are needed. Antibody responses to serological exposure markers (SEM) to <jats:italic>Plasmodium vivax<\/jats:italic> have proven diagnostic performance to identify people exposed in the previous 9 months.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>We measured antibody responses against 8 SEM to identify recently exposed people and determine the transmission dynamics of <jats:italic>P<\/jats:italic>. <jats:italic>vivax<\/jats:italic> in peri-urban (Iquitos) and riverine (Maz\u00e1n) communities of Loreto, communities that have seen significant recent reductions in malaria transmission. Socio-demographic, geo-reference, LM and qPCR diagnosis data were collected from two cross-sectional surveys. Spatial and multilevel analyses were implemented to describe the distribution of seropositive cases and the risk factors associated with exposure to <jats:italic>P<\/jats:italic>. <jats:italic>vivax<\/jats:italic>.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Principal findings<\/jats:title>\n<jats:p>Low local transmission was detected by qPCR in both Iquitos (5.3%) and Maz\u00e1n (2.7%); however, seroprevalence indicated a higher level of (past) exposure to <jats:italic>P<\/jats:italic>. <jats:italic>vivax<\/jats:italic> in Maz\u00e1n (56.5%) than Iquitos (38.2%). Age and being male were factors associated with high odds of being seropositive in both sites. Higher antibody levels were found in individuals &gt;15 years old. The persistence of long-lived antibodies in these individuals could overestimate the detection of recent exposure. Antibody levels in younger populations (&lt;15 years old) could be a better indicator of recent exposure to <jats:italic>P<\/jats:italic>. <jats:italic>vivax<\/jats:italic>.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The large number of current and past infections detected by SEMs allows for detailed local epidemiological analyses, in contrast to data from qPCR prevalence surveys which did not produce statistically significant associations. Serological surveillance will be increasingly important in the Peruvian Amazon as malaria transmission is reduced by continued control and elimination efforts.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010415","type":"journal-article","created":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T17:40:11Z","timestamp":1652118011000},"page":"e0010415","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Malaria transmission structure in the Peruvian Amazon through antibody signatures to Plasmodium 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