{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:36:00Z","timestamp":1790948160202,"version":"4.1.0"},"reference-count":40,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2,6]]},"abstract":"<jats:p>To achieve and sustain malaria elimination, identification and treatment of the asymptomatic infectious reservoir is critical. Malaria rapid diagnostic tests (RDTs) are frequently used to identify asymptomatic, <jats:italic>Plasmodium<\/jats:italic>-infected individuals through test-and-treat strategies, but their sensitivity is low when used in low transmission settings. Characteristics of individuals with subpatent (RDT-negative but polymerase chain reaction [PCR]\u2013positive) <jats:italic>Plasmodium<\/jats:italic> parasitemia were evaluated in southern Zambia where malaria transmission has declined and efforts to achieve malaria elimination are underway. Simple random sampling based on satellite imagery was used to select households for participation in community-based, cross-sectional surveys between 2008 and 2013. Questionnaires were administered to collect information on age, gender, recent history of malaria symptoms, and recent antimalarial drug use. Blood samples were collected by finger prick for <jats:italic>Plasmodium falciparum<\/jats:italic> histidine-rich protein 2 RDT, blood smears for microscopy, and dried blood spots for molecular analysis to detect malaria parasites and their sexual stage. Of 3,863 participants with complete data, 102 (2.6%) were positive by microscopy, RDT, or PCR. Of these, 48 (47%) had subpatent parasitemia. Most individuals with subpatent parasitemia were asymptomatic (85%). Compared with individuals without parasitemia, individuals with subpatent parasitemia were significantly more likely to be aged 5\u201325 years. Approximately one quarter (27%) of those with subpatent parasitemia had detectable gametocytemia. These findings suggest that strategies based on active or reactive case detection can identify asymptomatic individuals positive by RDT, but more sensitive diagnostic tests or focal drug administration may be necessary to target individuals with subpatent parasitemia to achieve malaria elimination.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0399","type":"journal-article","created":{"date-parts":[[2018,12,11]],"date-time":"2018-12-11T07:01:04Z","timestamp":1544511664000},"page":"280-286","source":"Crossref","is-referenced-by-count":23,"title":["Characteristics of Subpatent Malaria in a Pre-Elimination Setting in Southern Zambia"],"prefix":"10.4269","volume":"100","author":[{"given":"Tamaki","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mufaro","family":"Kanyangarara","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha M.","family":"Laban","sequence":"additional","affiliation":[{"name":"Macha Research Trust, Choma, Zambia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masiliso","family":"Phiri","sequence":"additional","affiliation":[{"name":"Ministry of Fisheries and Livestock, Nchelenge, Zambia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Hamapumbu","sequence":"additional","affiliation":[{"name":"Macha Research Trust, Choma, Zambia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Searle","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer C.","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Macha Research Trust, Choma, Zambia;"},{"name":"W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip E.","family":"Thuma","sequence":"additional","affiliation":[{"name":"Macha Research Trust, Choma, Zambia;"},{"name":"W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Moss","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"},{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"},{"name":"W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"},{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"},{"name":"Macha Research Trust, Choma, Zambia;"},{"name":"Ministry of Fisheries and Livestock, Nchelenge, Zambia;"},{"name":"W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","author":"WHO","year":"2015"},{"key":"b2","author":"WHO","year":"2016"},{"key":"b3","series-title":"Malar J","first-page":"412","article-title":"Evaluation of the operational challenges in implementing reactive screen-and-treat and implications of reactive case detection strategies for malaria elimination in a region of low transmission in southern Zambia","volume":"15","author":"Searle","year":"2016"},{"key":"b4","series-title":"Expert Rev Anti Infect Ther","first-page":"623","article-title":"The silent threat: asymptomatic parasitemia and malaria transmission","volume":"11","author":"Lindblade","year":"2013"},{"key":"b5","series-title":"Malar J","first-page":"18","article-title":"Plasmodium falciparum gametocyte carriage in asymptomatic children in western Kenya","volume":"3","author":"Bousema","year":"2004"},{"key":"b6","series-title":"Trends Parasitol","first-page":"183","article-title":"The role of submicroscopic parasitemia in malaria transmission: what is the evidence?","volume":"30","author":"Lin","year":"2014"},{"key":"b7","series-title":"Nat Rev Microbiol","first-page":"833","article-title":"Asymptomatic malaria infections: detectability, transmissibility and public health relevance","volume":"12","author":"Bousema","year":"2014"},{"key":"b8","series-title":"J Infect","first-page":"587","article-title":"Is asymptomatic malaria really asymptomatic? Hematological, vascular and inflammatory effects of asymptomatic malaria parasitemia","volume":"71","author":"de Mast","year":"2015"},{"key":"b9","series-title":"Nat Commun","first-page":"1237","article-title":"Factors determining the occurrence of submicroscopic malaria infections and their relevance for control","volume":"3","author":"Okell","year":"2012"},{"key":"b10","series-title":"J Infect Dis","first-page":"1509","article-title":"Submicroscopic infection in Plasmodium falciparum-endemic populations: a systematic review and meta-analysis","volume":"200","author":"Okell","year":"2009"},{"key":"b11","series-title":"Acta Trop","first-page":"202","article-title":"Malaria epidemiology and control in southern Africa","volume":"121","author":"Mharakurwa","year":"2012"},{"key":"b12","series-title":"Malar J","first-page":"25","article-title":"Comparison of a PfHRP2-based rapid diagnostic test and PCR for malaria in a low prevalence setting in rural southern Zambia: implications for elimination","volume":"14","author":"Laban","year":"2015"},{"key":"b13","author":"PMI","year":"2018"},{"key":"b14","series-title":"Am J Trop Med Hyg","first-page":"316","article-title":"Spatial and temporal genetic structure of Anopheles arabiensis in southern Zambia over consecutive wet and drought years","volume":"77","author":"Kent","year":"2007"},{"key":"b15","author":"WHO","year":"2017"},{"key":"b16","series-title":"J Clin Microbiol","first-page":"1171","article-title":"Determination of genetic variation within Plasmodium falciparum by using enzymatically amplified DNA from filter paper disks impregnated with whole blood","volume":"29","author":"Kain","year":"1991"},{"key":"b17","series-title":"Malar J","first-page":"86","article-title":"Towards high-throughput molecular detection of Plasmodium: new approaches and molecular markers","volume":"8","author":"Steenkeste","year":"2009"},{"key":"b18","series-title":"Am J Trop Med Hyg","first-page":"114","article-title":"A filter paper method for the detection of Plasmodium falciparum gametocytes by reverse transcription polymerase chain reaction","volume":"78","author":"Mlambo","year":"2008"},{"key":"b19","series-title":"Trans R Soc Trop Med Hyg","first-page":"179","article-title":"Persistence of Plasmodium falciparum HRP-2 in successfully treated acute falciparum malaria","volume":"95","author":"Mayxay","year":"2001"},{"key":"b20","series-title":"Malar J","first-page":"74","article-title":"Modelling the dynamics of Plasmodium falciparum histidine-rich protein 2 in human malaria to better understand malaria rapid diagnostic test performance","volume":"11","author":"Marquart","year":"2012"},{"key":"b21","author":"CIA","year":"2017"},{"key":"b22","series-title":"PLoS One","first-page":"e15149","article-title":"Interrupting malaria transmission: quantifying the impact of interventions in regions of low to moderate transmission","volume":"5","author":"Gatton","year":"2010"},{"key":"b23","series-title":"Am J Trop Med Hyg","first-page":"1101","article-title":"High levels of asymptomatic and subpatent Plasmodium falciparum parasite carriage at health facilities in an area of heterogeneous malaria transmission intensity in the Kenyan highlands","volume":"91","author":"Stresman","year":"2014"},{"key":"b24","series-title":"Malar J","first-page":"418","article-title":"Use of different transmission metrics to describe malaria epidemiology in the highlands of western Kenya","volume":"14","author":"Stevenson","year":"2015"},{"key":"b25","author":"Wu","year":"2015"},{"key":"b26","series-title":"J Infect Dis","first-page":"90","article-title":"Dynamics of the human infectious reservoir for malaria determined by mosquito feeding assays and ultrasensitive malaria diagnosis in Burkina Faso","volume":"213","author":"Ouedraogo","year":"2016"},{"key":"b27","series-title":"Trop Med Int Health","first-page":"1294","article-title":"Malaria in school\u2010age children in Africa: an increasingly important challenge","volume":"19","author":"Nankabirwa","year":"2014"},{"key":"b28","series-title":"PLoS One","first-page":"e0134061","article-title":"School-age children are a reservoir of malaria infection in Malawi","volume":"10","author":"Walldorf","year":"2015"},{"key":"b29","series-title":"BMC Public Health","first-page":"369","article-title":"The use of insecticide treated nets by age: implications for universal coverage in Africa","volume":"9","author":"Noor","year":"2009"},{"key":"b30","series-title":"Am J Trop Med Hyg","first-page":"954","article-title":"Factors associated with sustained use of long-lasting insecticide-treated nets following a reduction in malaria transmission in southern Zambia","volume":"93","author":"Pinchoff","year":"2015"},{"key":"b31","series-title":"Malar J","first-page":"41","article-title":"Malaria knowledge and bed net use in three transmission settings in southern Africa","volume":"17","author":"Kanyangarara","year":"2018"},{"key":"b32","series-title":"Am J Trop Med Hyg","first-page":"830","article-title":"Continuing intense malaria transmission in northern Uganda","volume":"84","author":"Proietti","year":"2011"},{"key":"b33","series-title":"Am J Trop Med Hyg","first-page":"194","article-title":"False-negative rapid diagnostic tests for malaria and deletion of the histidine-rich repeat region of the hrp2 gene","volume":"86","author":"Koita","year":"2012"},{"key":"b34","series-title":"Malar J","first-page":"34","article-title":"Pfhrp2 and pfhrp3 polymorphisms in Plasmodium falciparum isolates from Dakar, Senegal: impact on rapid malaria diagnostic tests","volume":"12","author":"Wurtz","year":"2013"},{"key":"b35","series-title":"J Infect Dis","first-page":"36","article-title":"Pfhrp2-deleted Plasmodium falciparum parasites in the Democratic Republic of the Congo: a national cross-sectional survey","volume":"216","author":"Parr","year":"2017"},{"key":"b36","series-title":"Infect Genet Evol","first-page":"131","article-title":"Identification of Plasmodium falciparum isolates lacking histidine-rich protein 2 and 3 in Eritrea","volume":"55","author":"Menegon","year":"2017"},{"key":"b37","series-title":"Emerg Infect Dis","first-page":"462","article-title":"Major threat to malaria control programs by Plasmodium falciparum lacking histidine-rich protein 2, Eritrea","volume":"24","author":"Berhane","year":"2018"},{"key":"b38","series-title":"Malar J","first-page":"123","article-title":"False-negative malaria rapid diagnostic tests in Rwanda: impact of Plasmodium falciparum isolates lacking hrp2 and declining malaria transmission","volume":"16","author":"Kozycki","year":"2017"},{"key":"b39","series-title":"PLoS One","first-page":"e76316","article-title":"Strategies for detection of Plasmodium species gametocytes","volume":"8","author":"Wampfler","year":"2013"},{"key":"b40","series-title":"Clin Microbiol Rev","first-page":"377","article-title":"Epidemiology and infectivity of Plasmodium falciparum and Plasmodium vivax gametocytes in relation to malaria control and elimination","volume":"24","author":"Bousema","year":"2011"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/100\/2\/article-p280.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/100\/2\/article-p280.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/100\/2\/article-p280.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T12:48:33Z","timestamp":1722430113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/100\/2\/article-p280.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,6]]},"references-count":40,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.18-0399","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,6]]}}}