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Kartal L, Mueller I, Longley RJ. Using Serological Markers for the Surveillance of Plasmodium vivax Malaria: A Scoping Review. Pathogens 2023; 12:791. [PMID: 37375481 DOI: 10.3390/pathogens12060791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
The utilisation of serological surveillance methods for malaria has the potential to identify individuals exposed to Plasmodium vivax, including asymptomatic carriers. However, the application of serosurveillance varies globally, including variations in methodology and transmission context. No systematic review exists describing the advantages and disadvantages of utilising serosurveillance in various settings. Collation and comparison of these results is a necessary first step to standardise and validate the use of serology for the surveillance of P. vivax in specific transmission contexts. A scoping review was performed of P. vivax serosurveillance applications globally. Ninety-four studies were found that met predefined inclusion and exclusion criteria. These studies were examined to determine the advantages and disadvantages of serosurveillance experienced in each study. If studies reported seroprevalence results, this information was also captured. Measurement of antibodies serves as a proxy by which individuals exposed to P. vivax may be indirectly identified, including those with asymptomatic infections, which may be missed by other technologies. Other thematic advantages identified included the ease and simplicity of serological assays compared to both microscopy and molecular diagnostics. Seroprevalence rates varied widely from 0-93%. Methodologies must be validated across various transmission contexts to ensure the applicability and comparability of results. Other thematic disadvantages identified included challenges with species cross-reactivity and determining changes in transmission patterns in both the short- and long-term. Serosurveillance requires further refinement to be fully realised as an actionable tool. Some work has begun in this area, but more is required.
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Affiliation(s)
- Lejla Kartal
- School of Population and Global Health, The University of Melbourne, Parkville 3010, Australia
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
| | - Ivo Mueller
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Rhea J Longley
- Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
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Rosas-Aguirre A, Patra KP, Calderón M, Torres K, Gamboa D, Arocutipa E, Málaga E, Garro K, Fernández C, Trompeter G, Alnasser Y, Llanos-Cuentas A, Gilman RH, Vinetz JM. Anti-MSP-10 IgG indicates recent exposure to Plasmodium vivax infection in the Peruvian Amazon. JCI Insight 2020; 5:130769. [PMID: 31770108 DOI: 10.1172/jci.insight.130769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDSerological tools for the accurate detection of recent malaria exposure are needed to guide and monitor malaria control efforts. IgG responses against Plasmodium vivax and P. falciparum merozoite surface protein-10 (MSP10) were measured as a potential way to identify recent malaria exposure in the Peruvian Amazon.METHODSA field-based study included 470 participants in a longitudinal cohort who completed a comprehensive evaluation: light microscopy and PCR on enrollment, at least 1 monthly follow-up by light microscopy, a second PCR, and serum and dried blood spots for serological analysis at the end of the follow-up. IgG titers against novel mammalian cell-produced recombinant PvMSP10 and PfMSP10 were determined by ELISA.RESULTSDuring the follow-up period, 205 participants were infected, including 171 with P. vivax, 26 with P. falciparum, 6 with infections by both species but at different times, and 2 with mixed infections. Exposure to P. vivax was more accurately identified when serological responses to PvMSP10 were obtained from serum (sensitivity, 58.1%; specificity, 81.8%; AUC: 0.76) than from dried blood spots (sensitivity, 35.2; specificity, 83.5%; AUC: 0.64) (PAUC < 0.001). Sensitivity was highest (serum, 82.9%; dried blood spot, 45.7%) with confirmed P. vivax infections occurring 7-30 days before sample collection; sensitivity decreased significantly in relation to time since last documented infection. PvMSP10 serological data did not show evidence of interspecies cross-reactivity. Anti-PfMSP10 responses poorly discriminated between P. falciparum-exposed and nonexposed individuals (AUC = 0.59; P > 0.05).CONCLUSIONAnti-PvMSP10 IgG indicates recent exposure to P. vivax at the population level in the Amazon region. Serum, not dried blood spots, should be used for such serological tests.FUNDINGCooperative agreement U19AI089681 from the United States Public Health Service, NIH/National Institute of Allergy and Infectious Diseases, as the Amazonian International Center of Excellence in Malaria Research.
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Affiliation(s)
- Angel Rosas-Aguirre
- Fund for Scientific Research FNRS, Brussels, Belgium.,Research Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.,Instituto de Medicina, Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kailash P Patra
- Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Maritza Calderón
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, and
| | - Katherine Torres
- Instituto de Medicina, Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru.,Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Dionicia Gamboa
- Instituto de Medicina, Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru.,Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, and.,Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edith Arocutipa
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, and.,Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edith Málaga
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, and.,Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katherine Garro
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Fernández
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Grace Trompeter
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yossef Alnasser
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina, Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, and.,Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru.,Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joseph M Vinetz
- Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA.,Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, and.,Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
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Kim J, Jang JW, Kim JY, Oh DJ, Lim CS. Combined Use of Malaria Antigen and Antibody Enzyme-Linked Immunosorbent Assay for Blood Screening of Plasmodium vivax in the Republic of Korea. Med Princ Pract 2016; 25:212-8. [PMID: 26794404 PMCID: PMC5588392 DOI: 10.1159/000444144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 01/20/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the clinical sensitivity and specificity of the newly developed Genedia malaria antigen enzyme-linked immunosorbent assay (ELISA) test and to evaluate the diagnostic efficiency of the combined use of the Genedia malaria antigen and antibody ELISA tests to detect Plasmodium vivax in blood samples. MATERIALS AND METHODS In all, 1,070 samples were analyzed: 300 P. vivax-infected patients, 41 samples from posttreatment patients upon follow-up and 729 healthy volunteers. The Genedia malaria antigen ELISA test and the Genedia malaria antibody ELISA 2.0 test were evaluated and compared to polymerase chain reaction and microscopy. RESULTS The Genedia malaria antigen ELISA test had a clinical sensitivity of 94.7% (284/300) and a clinical specificity of 99.3% (724/729). The Genedia malaria antibody ELISA 2.0 test had a clinical sensitivity of 94.0% (282/300) and a clinical specificity of 98.4% (717/729). The Genedia malaria antigen ELISA test was able to detect 13 confirmed P. vivax cases without antibodies against P. vivax, whereas the Genedia malaria antibody ELISA 2.0 test detected 11 confirmed P. vivax cases nonreactive to the Genedia malaria antigen ELISA test, and 25 cases from 41 follow-up samples nonreactive in the Genedia malaria antigen ELISA test. The combined Genedia malaria antigen and antibody ELISA 2.0 tests had a clinical sensitivity of 98.3% (295/300) and a clinical specificity of 97.9% (714/729). CONCLUSION The combination of antigen and antibody ELISAs improved the diagnostic sensitivity in P. vivax-confirmed cases in the Republic of Korea.
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Affiliation(s)
- Jeeyong Kim
- Department of Laboratory Medicine, Brain Korea 21 Graduate School of Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jin Woo Jang
- Department of Laboratory Medicine, Brain Korea 21 Graduate School of Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ju Yeon Kim
- Department of Laboratory Medicine, Brain Korea 21 Graduate School of Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Deok Ja Oh
- Central Blood Laboratory Center, Korean Red Cross, Seoul, Republic of Korea
| | - Chae Seung Lim
- Department of Laboratory Medicine, Brain Korea 21 Graduate School of Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
- *Chae Seung Lim, Department of Laboratory Medicine, College of Medicine, Korea University Guro Hospital, Guro 2 Dong, Guro Gu, Seoul 152-703 (Republic of Korea), E-Mail
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Wong J, Hamel MJ, Drakeley CJ, Kariuki S, Shi YP, Lal AA, Nahlen BL, Bloland PB, Lindblade KA, Were V, Otieno K, Otieno P, Odero C, Slutsker L, Vulule JM, Gimnig JE. Serological markers for monitoring historical changes in malaria transmission intensity in a highly endemic region of Western Kenya, 1994-2009. Malar J 2014; 13:451. [PMID: 25416454 PMCID: PMC4258276 DOI: 10.1186/1475-2875-13-451] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 11/11/2014] [Indexed: 11/25/2022] Open
Abstract
Background Monitoring local malaria transmission intensity is essential for planning evidence-based control strategies and evaluating their impact over time. Anti-malarial antibodies provide information on cumulative exposure and have proven useful, in areas where transmission has dropped to low sustained levels, for retrospectively reconstructing the timing and magnitude of transmission reduction. It is unclear whether serological markers are also informative in high transmission settings, where interventions may reduce transmission, but to a level where considerable exposure continues. Methods This study was conducted through ongoing KEMRI and CDC collaboration. Asembo, in Western Kenya, is an area where intense malaria transmission was drastically reduced during a 1997–1999 community-randomized, controlled insecticide-treated net (ITN) trial. Two approaches were taken to reconstruct malaria transmission history during the period from 1994 to 2009. First, point measurements were calculated for seroprevalence, mean antibody titre, and seroconversion rate (SCR) against three Plasmodium falciparum antigens (AMA-1, MSP-119, and CSP) at five time points for comparison against traditional malaria indices (parasite prevalence and entomological inoculation rate). Second, within individual post-ITN years, age-stratified seroprevalence data were analysed retrospectively for an abrupt drop in SCR by fitting alternative reversible catalytic conversion models that allowed for change in SCR. Results Generally, point measurements of seroprevalence, antibody titres and SCR produced consistent patterns indicating that a gradual but substantial drop in malaria transmission (46-70%) occurred from 1994 to 2007, followed by a marginal increase beginning in 2008 or 2009. In particular, proportionate changes in seroprevalence and SCR point estimates (relative to 1994 baseline values) for AMA-1 and CSP, but not MSP-119, correlated closely with trends in parasite prevalence throughout the entire 15-year study period. However, retrospective analyses using datasets from 2007, 2008 and 2009 failed to detect any abrupt drop in transmission coinciding with the timing of the 1997–1999 ITN trial. Conclusions In this highly endemic area, serological markers were useful for generating accurate point estimates of malaria transmission intensity, but not for retrospective analysis of historical changes. Further investigation, including exploration of different malaria antigens and/or alternative models of population seroconversion, may yield serological tools that are more informative in high transmission settings. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-451) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jacklyn Wong
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Elliott SR, Fowkes FJ, Richards JS, Reiling L, Drew DR, Beeson JG. Research priorities for the development and implementation of serological tools for malaria surveillance. F1000PRIME REPORTS 2014; 6:100. [PMID: 25580254 PMCID: PMC4229730 DOI: 10.12703/p6-100] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Surveillance is a key component of control and elimination programs. Malaria surveillance has been typically reliant on case reporting by health services, entomological estimates and parasitemia (Plasmodium species) point prevalence. However, these techniques become less sensitive and relatively costly as transmission declines. There is great potential for the development and application of serological biomarkers of malaria exposure as sero-surveillance tools to strengthen malaria control and elimination. Antibodies to malaria antigens are sensitive biomarkers of population-level malaria exposure and can be used to identify hotspots of malaria transmission, estimate transmission levels, monitor changes over time or the impact of interventions on transmission, confirm malaria elimination, and monitor re-emergence of malaria. Sero-surveillance tools could be used in reference laboratories or developed as simple point-of-care tests for community-based surveillance, and different applications and target populations dictate the technical performance required from assays that are determined by properties of antigens and antibody responses. To advance the development of sero-surveillance tools for malaria elimination, major gaps in our knowledge need to be addressed through further research. These include greater knowledge of potential antigens, the sensitivity and specificity of antibody responses, and the longevity of these responses and defining antigens and antibodies that differentiate between exposure to Plasmodium falciparum and P. vivax. Additionally, a better understanding of the influence of host factors, such as age, genetics, and comorbidities on antibody responses in different populations is needed.
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Affiliation(s)
| | - Freya J.I. Fowkes
- Burnet Institute85 Commercial Road, Melbourne, Victoria 3004Australia
- School of Epidemiology and Preventive Medicine, Monash University99 Commercial Road, Victoria 3004Australia
- School of Population Health and Department of Medicine (RMH), University of MelbourneVictoria 3010Australia
| | - Jack S. Richards
- Burnet Institute85 Commercial Road, Melbourne, Victoria 3004Australia
- School of Population Health and Department of Medicine (RMH), University of MelbourneVictoria 3010Australia
- Department of Microbiology, Monash UniversityVictoria 3800Australia
| | - Linda Reiling
- Burnet Institute85 Commercial Road, Melbourne, Victoria 3004Australia
| | - Damien R. Drew
- Burnet Institute85 Commercial Road, Melbourne, Victoria 3004Australia
| | - James G. Beeson
- Burnet Institute85 Commercial Road, Melbourne, Victoria 3004Australia
- School of Population Health and Department of Medicine (RMH), University of MelbourneVictoria 3010Australia
- Department of Microbiology, Monash UniversityVictoria 3800Australia
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Van den Eede P, Soto-Calle VE, Delgado C, Gamboa D, Grande T, Rodriguez H, Llanos-Cuentas A, Anné J, D'Alessandro U, Erhart A. Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study. PLoS One 2011; 6:e16257. [PMID: 21297986 PMCID: PMC3030575 DOI: 10.1371/journal.pone.0016257] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 12/20/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is an increasing body of literature reporting treatment failure of the currently recommended radical treatment of Plasmodium vivax infections. As P. vivax is the main malaria species outside the African continent, emerging tolerance to its radical treatment regime could have major consequences in countries like Peru, where 80% of malaria cases are due to P. vivax. Here we describe the results of a 1-year longitudinal follow up of 51 confirmed P. vivax patients living around Iquitos, Peruvian Amazon, and treated according to the Peruvian national guidelines. METHODOLOGY Each month a blood sample for microscopy and later genotyping was systematically collected. Recent exposure to infection was estimated by detecting antibodies against the P. vivax circumsporozoite protein (CSP) and all PCR confirmed P. vivax infections were genotyped with 16 polymorphic microsatellites. RESULTS During a 1-year period, 84 recurrent infections, 22 positive also by microscopy, were identified, with a median survival time to first recurrent infection of 203 days. Most of them (71%) were asymptomatic; in 13 patients the infection persisted undetected by microscopy for several consecutive months. The genotype of mostly recurrent infections differed from that at day 0 while fewer differences were seen between the recurrent infections. The average expected heterozygosity was 0.56. There was strong linkage disequilibrium (I(A)(s) = 0.29, p<1.10(-4)) that remained also when analyzing only the unique haplotypes, suggesting common inbreeding. CONCLUSION In Peru, the P. vivax recurrent infections were common and displayed a high turnover of parasite genotypes compared to day 0. Plasmodium vivax patients, even when treated according to the national guidelines, may still represent an important parasite reservoir that can maintain transmission. Any elimination effort should consider such a hidden reservoir.
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Affiliation(s)
- Peter Van den Eede
- Department of Parasitology, Institute of Tropical Medicine, Antwerp, Belgium.
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Drakeley C, Cook J. Chapter 5. Potential contribution of sero-epidemiological analysis for monitoring malaria control and elimination: historical and current perspectives. ADVANCES IN PARASITOLOGY 2009; 69:299-352. [PMID: 19622411 DOI: 10.1016/s0065-308x(09)69005-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Anti-malarial antibody responses represent an individual's history of exposure to the disease and, as age sero-conversion rates, reflect cumulative malaria exposure in a population. As such these antibody responses are an alternate measure of malaria transmission intensity and have potential in evaluating changes in exposure. This approach was used in the 1970s to evaluate malaria control and eradication attempts in a variety of different ecological settings. These historical studies provided a wealth of information on how serological data might be used to interpret control measures. However they were limited by a lack of standardized antigens and reproducible high-throughput assays. Current techniques using recombinant antigens with a range of immunogenicities, high-throughput enzyme-linked immunosorbent assays (ELISA) and statistical analysis allow a more robust examination of how serological parameters can be used to evaluate factors affecting malaria transmission. Here we present a review of the historical data and use it to assess the serological contribution to monitoring malaria elimination.
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Affiliation(s)
- Chris Drakeley
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Corran P, Coleman P, Riley E, Drakeley C. Serology: a robust indicator of malaria transmission intensity? Trends Parasitol 2007; 23:575-82. [PMID: 17988945 DOI: 10.1016/j.pt.2007.08.023] [Citation(s) in RCA: 208] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 08/21/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
Abstract
To estimate the burden of malarial disease, and evaluate the likely effects of control strategies, requires reliable predictions of malaria transmission intensity. It has long been suggested that antimalarial antibody prevalences could provide a more accurate estimate of transmission intensity than traditional measures such as parasite prevalence or entomological inoculation rates, but there has been no systematic evaluation of this approach. Now, the availability of well characterized malarial antigens allows us to test whether serological measurements provide a practical method for estimating transmission. Here we present a suggested methodology, highlight the advantages and shortcomings of serological measurements of malaria transmission and identify areas in which further work is desirable.
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Affiliation(s)
- Patrick Corran
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel St, London, WC1E 7HT, UK
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