{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:57:12Z","timestamp":1791385032320,"version":"4.3.3"},"reference-count":31,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Despite malaria remaining a major public health threat, several countries have made significant progress toward elimination. Timor-Leste has reduced the number of malaria cases from more than 200,000 to zero, with no indigenous cases reported since 2022, and has recently been certified as malaria-free by the WHO. At low transmission levels, serological surveys, which detect antibodies to malaria parasites, can augment conventional surveillance by revealing the absence of antibodies and, therefore, of exposure in previously endemic populations. Exposure to malaria, as determined using antibody responses to antigens from\n                    <jats:italic>Plasmodium falciparum<\/jats:italic>\n                    (\n                    <jats:italic>P. falciparum<\/jats:italic>\n                    ) and\n                    <jats:italic>Plasmodium vivax<\/jats:italic>\n                    (\n                    <jats:italic>P. vivax<\/jats:italic>\n                    ), was assessed in 4,631 participants recruited from all municipalities in Timor-Leste. These antigens are associated with recent and cumulative exposure to each species. Age-specific seroprevalence was assessed, and seroconversion was estimated using reverse catalytic models. Risk analysis for individual and geographical exposure was also conducted. Seroprevalence to recent exposure to\n                    <jats:italic>P. falciparum<\/jats:italic>\n                    antigens was uniformly low across age groups (1.4% [95% CI: 1%\u20132%]) and consistent with the absence of ongoing transmission. The recent seroprevalence of\n                    <jats:italic>P. vivax<\/jats:italic>\n                    was similarly low (0.2% [95% CI: 0.1%\u20130.3%]). The time of change in the force of infection was consistent with the country\u2019s scale-up for elimination. Areas at lower altitudes and those with higher historical tree cover had evidence of the highest co-endemic historical exposure. The serological analysis supports passive and active surveillance malaria data in confirming the near-absence of ongoing transmission in Timor-Leste. In low-transmission settings, sero-epidemiological surveillance can provide key information on transmission that will benefit control programs.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0700","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:50:49Z","timestamp":1787849449000},"page":"785-794","source":"Crossref","is-referenced-by-count":0,"title":["Serology Confirms Near-Absence of Malaria Transmission in Timor-Leste"],"prefix":"10.4269","volume":"115","author":[{"given":"Elfiana De Fatima","family":"Amaral","sequence":"first","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste;"},{"name":"Associa\u00e7\u00e3o Maluk Timor, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Byrne","sequence":"additional","affiliation":[{"name":"Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Brazal Monzo","sequence":"additional","affiliation":[{"name":"Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul","family":"Sarmento","sequence":"additional","affiliation":[{"name":"Communicable Disease Control Department, Ministry of Health, National Directorate of Public Health, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Do Rosario De Fatima Mota","sequence":"additional","affiliation":[{"name":"Communicable Disease Control Department, Ministry of Health, National Directorate of Public Health, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregorio","family":"Rangel","sequence":"additional","affiliation":[{"name":"Ossomali Research and Development, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Tanesi","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Salles de Sousa","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Martins","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Oakley","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucsendar","family":"Alves","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Yan","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Arkell","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua R.","family":"Francis","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Drakeley","sequence":"additional","affiliation":[{"name":"Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","article-title":"World Malaria Report 2023.","year":"2023"},{"key":"b2","article-title":"Malaria Elimination Certification Process.","year":"2026"},{"key":"b3","series-title":"Malar J","first-page":"40","article-title":"Malaria vectors of Timor-Leste","volume":"9","author":"Cooper","year":"2010"},{"key":"b4","article-title":"Timor-Leste Population and Housing Census 2022.","year":"2023"},{"key":"b5","series-title":"Malar J","first-page":"109","article-title":"Evidence-based malaria control in Timor Leste from 2006 to 2012","volume":"14","author":"Yapabandara","year":"2015"},{"issue":"1","key":"b6","series-title":"Malar 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