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Hailemeskel E, Tebeje SK, Ramjith J, Ashine T, Lanke K, Behaksra SW, Emiru T, Tsegaye T, Gashaw A, Kedir S, Chali W, Esayas E, Tafesse T, Abera H, Bulto MG, Shumie G, Petros B, Mamo H, Drakeley C, Gadisa E, Bousema T, Tadesse FG. Dynamics of asymptomatic Plasmodium falciparum and Plasmodium vivax infections and their infectiousness to mosquitoes in a low transmission setting of Ethiopia: a longitudinal observational study. Int J Infect Dis 2024; 143:107010. [PMID: 38490637 DOI: 10.1016/j.ijid.2024.107010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE A 15-month longitudinal study was conducted to determine the duration and infectivity of asymptomatic qPCR-detected Plasmodium falciparum and Plasmodium vivax infections in Ethiopia. METHOD Total parasite and gametocyte kinetics were determined by molecular methods; infectivity to Anopheles arabiensis mosquitoes by repeated membrane feeding assays. Infectivity results were contrasted with passively recruited symptomatic malaria cases. RESULTS For P. falciparum and P. vivax infections detected at enrolment, median durations of infection were 37 days (95% confidence interval [CI], 15-93) and 60 days (95% CI, 18-213), respectively. P. falciparum and P. vivax parasite densities declined over the course of infections. From 47 feeding assays on 22 asymptomatic P. falciparum infections, 6.4% (3/47) were infectious and these infected 1.8% (29/1579) of mosquitoes. No transmission was observed in feeding assays on asymptomatic P. vivax mono-infections (0/56); one mixed-species infection was highly infectious. Among the symptomatic cases, 4.3% (2/47) of P. falciparum and 73.3% (53/86) of P. vivax patients were infectious to mosquitoes. CONCLUSION The majority of asymptomatic infections were of short duration and low parasite density. Only a minority of asymptomatic individuals were infectious to mosquitoes. This contrasts with earlier findings and is plausibly due to the low parasite densities in this population.
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Affiliation(s)
- Elifaged Hailemeskel
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia; Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands; Department of Biology, College of Natural and Computational Sciences, Wollo university, Dessie, Ethiopia; Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Surafel K Tebeje
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia; Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jordache Ramjith
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Kjerstin Lanke
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Tadele Emiru
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tizita Tsegaye
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abrham Gashaw
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Soria Kedir
- Adama Regional Laboratory, Oromia Region Health Bureau, Adama, Ethiopia
| | - Wakweya Chali
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | - Haile Abera
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Girma Shumie
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Beyene Petros
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Chris Drakeley
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Teun Bousema
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fitsum G Tadesse
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia; Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands; London School of Hygiene & Tropical Medicine, London, United Kingdom.
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Tadesse FG, Ashine T, Teka H, Esayas E, Messenger LA, Chali W, Meerstein-Kessel L, Walker T, Wolde Behaksra S, Lanke K, Heutink R, Jeffries CL, Mekonnen DA, Hailemeskel E, Tebeje SK, Tafesse T, Gashaw A, Tsegaye T, Emiru T, Simon K, Bogale EA, Yohannes G, Kedir S, Shumie G, Sabir SA, Mumba P, Dengela D, Kolaczinski JH, Wilson A, Churcher TS, Chibsa S, Murphy M, Balkew M, Irish S, Drakeley C, Gadisa E, Bousema T. Anopheles stephensi Mosquitoes as Vectors of Plasmodium vivax and falciparum, Horn of Africa, 2019. Emerg Infect Dis 2021; 27:603-607. [PMID: 33496217 PMCID: PMC7853561 DOI: 10.3201/eid2702.200019] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Anopheles stephensi mosquitoes, efficient vectors in parts of Asia and Africa, were found in 75.3% of water sources surveyed and contributed to 80.9% of wild-caught Anopheles mosquitoes in Awash Sebat Kilo, Ethiopia. High susceptibility of these mosquitoes to Plasmodium falciparum and vivax infection presents a challenge for malaria control in the Horn of Africa.
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Hailemeskel E, Tebeje SK, Behaksra SW, Shumie G, Shitaye G, Keffale M, Chali W, Gashaw A, Ashine T, Drakeley C, Bousema T, Gadisa E, Tadesse FG. The epidemiology and detectability of asymptomatic plasmodium vivax and plasmodium falciparum infections in low, moderate and high transmission settings in Ethiopia. Malar J 2021; 20:59. [PMID: 33482841 PMCID: PMC7821398 DOI: 10.1186/s12936-021-03587-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND As countries move to malaria elimination, detecting and targeting asymptomatic malaria infections might be needed. Here, the epidemiology and detectability of asymptomatic Plasmodium falciparum and Plasmodium vivax infections were investigated in different transmission settings in Ethiopia. METHOD A total of 1093 dried blood spot (DBS) samples were collected from afebrile and apparently healthy individuals across ten study sites in Ethiopia from 2016 to 2020. Of these, 862 were from community and 231 from school based cross-sectional surveys. Malaria infection status was determined by microscopy or rapid diagnostics tests (RDT) and 18S rRNA-based nested PCR (nPCR). The annual parasite index (API) was used to classify endemicity as low (API > 0 and < 5), moderate (API ≥ 5 and < 100) and high transmission (API ≥ 100) and detectability of infections was assessed in these settings. RESULTS In community surveys, the overall prevalence of asymptomatic Plasmodium infections by microscopy/RDT, nPCR and all methods combined was 12.2% (105/860), 21.6% (183/846) and 24.1% (208/862), respectively. The proportion of nPCR positive infections that was detectable by microscopy/RDT was 48.7% (73/150) for P. falciparum and 4.6% (2/44) for P. vivax. Compared to low transmission settings, the likelihood of detecting infections by microscopy/RDT was increased in moderate (Adjusted odds ratio [AOR]: 3.4; 95% confidence interval [95% CI] 1.6-7.2, P = 0.002) and high endemic settings (AOR = 5.1; 95% CI 2.6-9.9, P < 0.001). After adjustment for site and correlation between observations from the same survey, the likelihood of detecting asymptomatic infections by microscopy/RDT (AOR per year increase = 0.95, 95% CI 0.9-1.0, P = 0.013) declined with age. CONCLUSIONS Conventional diagnostics missed nearly half of the asymptomatic Plasmodium reservoir detected by nPCR. The detectability of infections was particularly low in older age groups and low transmission settings. These findings highlight the need for sensitive diagnostic tools to detect the entire parasite reservoir and potential infection transmitters.
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Affiliation(s)
- Elifaged Hailemeskel
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
- Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia
- Department of Biology, College of Natural and Computational Sciences, Wollo University, PO Box, 1145, Dessie, Ethiopia
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Surafel K Tebeje
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Sinknesh W Behaksra
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Girma Shumie
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Getasew Shitaye
- Department of Biomedical Sciences, School of Medical Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Migbaru Keffale
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Wakweya Chali
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Abrham Gashaw
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Temesgen Ashine
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Endalamaw Gadisa
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Fitsum G Tadesse
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia.
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands.
- Institute of Biotechnology, Addis Ababa University, PO Box, 1176, Addis Ababa, Ethiopia.
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Bejano S, Shumie G, Kumar A, Asemahagn E, Damte D, Woldie S, Mulugeta A, Manaye N, Genetu A, Gadisa E, Mamo G. Prevalence of asymptomatic visceral leishmaniasis in human and dog, Benishangul Gumuz regional state, Western Ethiopia. Parasit Vectors 2021; 14:39. [PMID: 33430946 PMCID: PMC7798290 DOI: 10.1186/s13071-020-04542-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Benishangul-Gumuz region is an important development corridor in Ethiopia. Large-scale projects such as the Great Renaissance Dam, mining and agriculture have entailed huge environmental modifications and settlement pattern changes. There is no detailed epidemiological information on visceral leishmaniasis (VL) in the region. MATERIALS AND METHODS A cross-sectional study was carried out to assess the epidemiology and risk factors associated with Leishmania infection. A leishmanin skin test (LST) was done for 1342 participants, and for 253 of them rK39 and DAT were carried out. Thirty-six dogs owned by households with LST-positive member(s) were rK39 and DAT tested. A pretested questionnaire was used to capture individual and household characteristics. RESULTS Of the 89.2% (1197/1342) who availed themselves of the LST reading, 6.0% were positive. The rk39 and DAT positivity among the 253 tested were 3.2% and 5.9%, respectively. In dogs, positivity rates by rK39 and DAT were 13.9% and 5.6%, respectively. Of the household and individual risk factors, presence of a dog in the household (P = 0.005), male sex (0.003), residence woreda (0.000) and occupation (0.023) showed a strong positive association with LST positivity. Individuals who lived in households that had dogs were 2.6 times more likely to be LST positive (AOR = 2.6; 95% CI = 1.54, 4.40). Being female decreased the probability of being LST positive by 0.38 times (AOR = 0.38; 95% CI = 0.20, 0.72). People living in Guba and Kurmuk had 4.7 (AOR = 4.74, 95% CI 1.83, 12.31) and 5.9 (AOR = 5.85, 95% CI 2.27, 15.09) times more risk of being infected. CONCLUSIONS We demonstrated the presence of active VL transmission in the areas. Thus, we underline the need to establish the responsible vector(s) and reservoir(s) for comprehensive early containment plans to prevent potentially harmful public health and economic consequences.
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Affiliation(s)
- Shibabaw Bejano
- Armauer Hansen Research Institute, Neglected Tropical Disease and Malaria Research Directorate, Addis Ababa, Ethiopia.,Department of Veterinary Science, Assosa University College of Agriculture and Natural Resource, Assosa, Ethiopia.,Department of Veterinary Microbiology, Immunology and Public Health, Addis Ababa University College of Veterinary Medicine and Agriculture, Debre-Zeyit, Ethiopia
| | - Girma Shumie
- Armauer Hansen Research Institute, Neglected Tropical Disease and Malaria Research Directorate, Addis Ababa, Ethiopia
| | - Ashwani Kumar
- Department of Veterinary Microbiology, Immunology and Public Health, Addis Ababa University College of Veterinary Medicine and Agriculture, Debre-Zeyit, Ethiopia
| | - Eyuel Asemahagn
- Armauer Hansen Research Institute, Neglected Tropical Disease and Malaria Research Directorate, Addis Ababa, Ethiopia
| | - Demekech Damte
- Armauer Hansen Research Institute, Neglected Tropical Disease and Malaria Research Directorate, Addis Ababa, Ethiopia
| | - Sinkinesh Woldie
- Armauer Hansen Research Institute, Neglected Tropical Disease and Malaria Research Directorate, Addis Ababa, Ethiopia
| | - Abate Mulugeta
- World Health Organization-Regional Office for Africa, Brazzaville, Congo
| | - Nigus Manaye
- World Health Organization Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Abebe Genetu
- Armauer Hansen Research Institute, Neglected Tropical Disease and Malaria Research Directorate, Addis Ababa, Ethiopia
| | - Endalamaw Gadisa
- Armauer Hansen Research Institute, Neglected Tropical Disease and Malaria Research Directorate, Addis Ababa, Ethiopia.
| | - Gezahegn Mamo
- Department of Veterinary Microbiology, Immunology and Public Health, Addis Ababa University College of Veterinary Medicine and Agriculture, Debre-Zeyit, Ethiopia
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Eshetu D, Shimelis T, Nigussie E, Shumie G, Chali W, Yeshitela B, Assefa A, Gadisa E. Seropositivity to dengue and associated risk factors among non-malarias acute febrile patients in Arba Minch districts, southern Ethiopia. BMC Infect Dis 2020; 20:639. [PMID: 32867694 PMCID: PMC7460748 DOI: 10.1186/s12879-020-05370-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dengue fever is an arthropod vector-borne disease transmitted to humans by infected Aedes mosquitoes. Ethiopia has a favorable ecology for arthropods and report high burden of acute febrile illnesses. However, the contribution of arboviral infections to the burden of acute febrile illnesses is barely known. In this study the seropositivity to dengue virus infection and associated risk factors were assessed in Arba Minch districts, southern Ethiopia. METHODS An institution based cross-sectional study was conducted in a consecutive group of 529 acute febrile patients between May to August 2016. Socio-demographic data, residence place and clinical signs and symptoms were collected using structured questionnaires. Sera were tested for anti-dengue IgG and IgM using Euroimmune indirect immunofluorescent assay. Data analysis was done using SPSS V-20 (IBM Corp, 2012). P-value < 0.05 was taken as statistically significant. RESULT Seropositivity was 25.1% (133/529) and 8.1% (43/529) for anti- IgG and IgM respectively. CONCLUSION The high IgM prevalence detected indicate the probability of active transmission with a potential of public health significance that calls for a proactive follow up of the communities in the study area to forecast and avert the risk.
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Affiliation(s)
- Daniel Eshetu
- Department of Microbiology, Yirgalem Medical College, Yirgalem, Ethiopia. .,Malaria-NTD Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - Techalew Shimelis
- School of Medical Laboratory Science, Hawassa University, Hawassa, Ethiopia
| | - Eshetu Nigussie
- Malaria-NTD Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Department of Medical Laboratory Science, Madda Walabu University, Bale Goba, Ethiopia
| | - Girma Shumie
- Malaria-NTD Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Wakwoya Chali
- Malaria-NTD Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Biruck Yeshitela
- Malaria-NTD Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Assefa
- Malaria-NTD Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Endalamaw Gadisa
- Malaria-NTD Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Bisetegn H, Zeleke AJ, Gadisa E, Shumie G, Damte D, Fenta T, Behaksra S, Bayih AG. Clinical, parasitological and molecular profiles of Cutaneous Leishmaniasis and its associated factors among clinically suspected patients attending Borumeda Hospital, North-East Ethiopia. PLoS Negl Trop Dis 2020; 14:e0008507. [PMID: 32841279 PMCID: PMC7473553 DOI: 10.1371/journal.pntd.0008507] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 09/04/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis is one of the most neglected tropical diseases increasing in its public health importance. In Ethiopia over 28 million people are living at risk of infection. METHOD Institution based cross-sectional study was conducted at Borumeda Hospital from February to May 2019. A total 205 leishmaniasis suspected patients were included by systematic random sampling technique. Socio demographic characteristics were collected using pre-tested questionnaires. Parasitological investigation was done from skin slit sample by using Geimsa staining method. Species identification was done by PCR-RFLP. Data were entered in to EpiData version 3.1 and analyzed using SPSS version 20 software. P-value of ≤ 0.05 was considered as statistically significant. RESULT A total of 205 participants consisting 59% male and 41% female included in this study. The mean age (±SD) of the study participants was 31.9 (±14.29). The overall prevalence of cutaneous leishmaniasis was 22.4% (46/205). The prevalence in males (13.7%) was higher than in females (8.8%). It was more prevalent in the age group 16-45years old (15.6%). Clinically, 60% of patients' hade single lesion with 1.55 average number of lesions. About 30.7% of patients' had indurated plaque type of lesion. Most of the lesions were found on head and face (59%). House near to farmland, presence of hyrax in the village and presence of other cutaneous leishmaniasis cases in the neighborhood were independent predicator of cutaneous leishmaniasis prevalence. L.aethopica was found to be the etiologic agent of cutaneous leishmaniasis in the study participants. CONCLUSION The prevalence of cutaneous leishmaniasis was 22.4%, this alerts the need of intervention. It is statistically associated with house near to farm land, presence of other cutaneous leishmaniasis cases in the neighborhood and presence of hyrax in village. Head and face were the most common sites of lesion.
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Affiliation(s)
- Habtye Bisetegn
- Department of Medical Laboratory science, College of Medicine and Health Sciences, Wollo University,Dessie, Ethiopia
- * E-mail:
| | - Ayalew Jejaw Zeleke
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Girma Shumie
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Demekech Damte
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Tiruework Fenta
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | - Abebe Genetu Bayih
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
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Keffale M, Shumie G, Behaksra SW, Chali W, Hoogen LLVD, Hailemeskel E, Mekonnen D, Chanyalew M, Damte D, Fanta T, Ashine T, Chali S, Tetteh KKA, Birhanu DD, Balcha TT, Aseffa A, Drakeley C, Tessema TS, Adamu H, Bousema T, Gadisa E, Tadesse FG. Serological evidence for a decline in malaria transmission following major scale-up of control efforts in a setting selected for Plasmodium vivax and Plasmodium falciparum malaria elimination in Babile district, Oromia, Ethiopia. Trans R Soc Trop Med Hyg 2020; 113:305-311. [PMID: 30927007 PMCID: PMC6580689 DOI: 10.1093/trstmh/trz005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/06/2019] [Accepted: 03/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Following successful malaria control during the last decade, Ethiopia instituted a stepwise malaria elimination strategy in selected low-transmission areas. METHODS Cross-sectional surveys were conducted in Babile district, Oromia, Ethiopia from July to November 2017 to evaluate malaria infection status using microscopy and nested polymerase chain reaction (nPCR) and serological markers of exposure targeting Plasmodium falciparum and Plasmodium vivax apical membrane antigen-1 (AMA-1). RESULTS Parasite prevalence was 1.2% (14/1135) and 5.1% (58/1143) for P. falciparum and 0.4% (5/1135) and 3.6% (41/1143) for P. vivax by microscopy and nPCR, respectively. Antibody prevalence was associated with current infection by nPCR for both P. falciparum (p<0.001) and P. vivax (p=0.014) and showed an age-dependent increase (p<0.001, for both species). Seroconversion curves indicated a decline in malaria exposure 15 y prior to sampling for P. falciparum and 11.5 y prior to sampling for P. vivax, broadly following malaria incidence data from district health offices, with higher antibody titres in adults than children for both species. CONCLUSIONS Malaria transmission declined substantially in the region with continuing heterogeneous but measurable local transmission, arguing in favour of continued and tailored control efforts to accelerate the progress towards elimination efforts.
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Affiliation(s)
- Migbaru Keffale
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia.,Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Girma Shumie
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Sinknesh Wolde Behaksra
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Wakweya Chali
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Lotus L van den Hoogen
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Elifaged Hailemeskel
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia.,Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Daniel Mekonnen
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia.,Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Menberework Chanyalew
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Demekech Damte
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Tiruwork Fanta
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Temesgen Ashine
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Sagni Chali
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Kevin K A Tetteh
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Taye T Balcha
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Tesfaye S Tessema
- Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Haileeyesus Adamu
- Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK.,Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Endalamaw Gadisa
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Fitsum G Tadesse
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia.,Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia.,Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
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8
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Challi S, Miecha H, Damtie D, Shumie G, Chali W, Hailu T, Balcha TT, Tadesse FG, Gadisa E. The Unmet Need: Low Performance of Laboratory Professionals in Malaria Microscopy, Oromia Regional State, Ethiopia. Am J Trop Med Hyg 2020; 102:117-120. [PMID: 31733053 DOI: 10.4269/ajtmh.19-0106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Ethiopia aims to diagnose and treat all clinical malaria within 24 hours of fever onset in its stride to eliminate the disease by 2030. Microscopy remains to be the mainstay for diagnosis at the health center and hospital level. Continuous evaluation and performance upgrading of malaria microscopists is one of the cornerstones in this effort. We assessed the performance of malaria microscopists compared with reference readers in diagnosing, identifying the species, and quantifying parasitemia. A total of 174 microscopists were enrolled from health facilities located in 86 districts in Oromia region (Ethiopia) from January 2017 to June 2018. Panel slides with known Plasmodium species, diagnostic blood stage, and parasite density were prepared by the reference readers. Sociodemographics, education, in-service training, and routine practice of participants were captured. Sensitivity, specificity, percent agreement, and kappa score were calculated. An overall low performance was observed that could threaten the malaria diagnostic service. Of all the slides distributed (1,218), only 17.0% of the positive and 30.0% of the negative slides were correctly identified and 22.4% were correctly quantified. Compared with the reference readers, participants had lower competence in diagnosing (74.3% agreement and kappa 0.45) and identifying the species (71.2% agreement and kappa 0.40). Two-fifths of the participants were graded as "in training" with respect to identifying the species (41.0%) and the diagnostic stages (40.0%). An in-service training/retraining and supportive supervision are needed to raise and maintain the competence of microscopists in settings with a recent decline in malaria transmission and aiming for ultimate elimination of the disease.
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Affiliation(s)
- Sagni Challi
- Malaria and Neglected Tropical Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Hirpa Miecha
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Demekech Damtie
- Malaria and Neglected Tropical Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Girma Shumie
- Malaria and Neglected Tropical Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Wakweya Chali
- Malaria and Neglected Tropical Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tsegaye Hailu
- Malaria and Neglected Tropical Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Taye Tolera Balcha
- Malaria and Neglected Tropical Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Fitsum G Tadesse
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia.,Malaria and Neglected Tropical Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Endalamaw Gadisa
- Malaria and Neglected Tropical Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Ayelign B, Jemal M, Negash M, Genetu M, Wondmagegn T, Zeleke AJ, Worku L, Bayih AG, Shumie G, Behaksra SW, Fenta T, Damte D, Yeshanew A, Gadisa E. Validation of in-house liquid direct agglutination test antigen: the potential diagnostic test in visceral Leishimaniasis endemic areas of Northwest Ethiopia. BMC Microbiol 2020; 20:90. [PMID: 32293265 PMCID: PMC7158028 DOI: 10.1186/s12866-020-01780-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background Visceral leishmaniasis in Ethiopia is a re-emerging threat to public health, with increased geographical distribution and number of cases. It is a fatal disease without early diagnosis and treatment; thus, the availability of affordable diagnostic tools is crucial. However, due to delays caused by import regulations, procurement and late delivery of imported test kits, accessibility remains a problem in the control program. Therefore, we aimed to produce and evaluate the performance of an in-house liquid (AQ) direct agglutination test (DAT) antigen. Result The AQ-DAT was produced at the Armauer Hansen Research Institute, using Leishmania donovani strain (MHOM/ET/67/L82). Sera from 272 participants; 110 microscopically confirmed cases of VL, 76 apparently healthy and 86 patients who had infectious disease other than VL were tested with AQ-DAT, and standard kits: Freeze-dried DAT (FD-DAT) and rK39. Taking microscopy as a gold standard; the sensitivity and specificity of the AQ-DAT were 97.3 and 98.8%, respectively. It had high degrees of agreement (k > 0.8), with a significant (P < 0.05) correlation compared to microscopy, FD-DAT, and rK39. Conclusion Although further standardization is required, the in-house AQ-DAT could improve diagnostic accessibility, minimize intermittent stock outs and strengthen the national VL control program.
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Affiliation(s)
- Birhanu Ayelign
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mohammedamin Jemal
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Markos Negash
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meaza Genetu
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadelo Wondmagegn
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayalew Jejaw Zeleke
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ligabaw Worku
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Genetu Bayih
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Girma Shumie
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Tiruwork Fenta
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Demekech Damte
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Arega Yeshanew
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
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Chali W, Ashine T, Hailemeskel E, Gashaw A, Tafesse T, Lanke K, Esayas E, Kedir S, Shumie G, Behaksra SW, Bradley J, Yewhalaw D, Mamo H, Petros B, Drakeley C, Gadisa E, Bousema T, Tadesse FG. Comparison of infectivity of Plasmodium vivax to wild-caught and laboratory-adapted (colonized) Anopheles arabiensis mosquitoes in Ethiopia. Parasit Vectors 2020; 13:120. [PMID: 32143713 PMCID: PMC7059271 DOI: 10.1186/s13071-020-3998-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mosquito-feeding assays that assess transmission of Plasmodium from man-to-mosquito typically use laboratory mosquito colonies. The microbiome and genetic background of local mosquitoes may be different and influence Plasmodium transmission efficiency. In order to interpret transmission studies to the local epidemiology, it is therefore crucial to understand the relationship between infectivity in laboratory-adapted and local mosquitoes. METHODS We assessed infectivity of Plasmodium vivax-infected patients from Adama, Ethiopia, using laboratory-adapted (colony) and wild-caught (wild) mosquitoes raised from larval collections in paired feeding experiments. Feeding assays used 4-6 day-old female Anopheles arabiensis mosquitoes after starvation for 12 h (colony) and 18 h (wild). Oocyst development was assessed microscopically 7 days post-feeding. Wild mosquitoes were identified morphologically and confirmed by genotyping. Asexual parasites and gametocytes were quantified in donor blood by microscopy. RESULTS In 36 paired experiments (25 P. vivax infections and 11 co-infections with P. falciparum), feeding efficiency was higher in colony (median: 62.5%; interquartile range, IQR: 47.0-79.0%) compared to wild mosquitoes (median: 27.8%; IQR: 17.0-38.0%; Z = 5.02; P < 0.001). Plasmodium vivax from infectious individuals (51.6%, 16/31) infected a median of 55.0% (IQR: 6.7-85.7%; range: 5.5-96.7%; n = 14) of the colony and 52.7% (IQR: 20.0-80.0%; range: 3.2-95.0%; n = 14) of the wild mosquitoes. A strong association (ρ(16) = 0.819; P < 0.001) was observed between the proportion of infected wild and colony mosquitoes. A positive association was detected between microscopically detected gametocytes and the proportion of infected colony (ρ(31) = 0.452; P = 0.011) and wild (ρ(31) = 0.386; P = 0.032) mosquitoes. CONCLUSIONS Infectivity assessments with colony and wild mosquitoes yielded similar infection results. This finding supports the use of colony mosquitoes for assessments of the infectious reservoir for malaria in this setting whilst acknowledging the importance of mosquito factors influencing sporogonic development of Plasmodium parasites.
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Affiliation(s)
- Wakweya Chali
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Temesgen Ashine
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Elifaged Hailemeskel
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia.,Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia.,Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Abrham Gashaw
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Temesgen Tafesse
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Kjerstin Lanke
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Endashaw Esayas
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Soriya Kedir
- Oromia Regional Laboratory, Oromia Regional Health Bureau, Adama, Ethiopia
| | - Girma Shumie
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Sinknesh Wolde Behaksra
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - John Bradley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Delenasaw Yewhalaw
- Tropical and Infectious Diseases Research Center, Jimma University, P.O.Box 5195, Jimma, Ethiopia
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia
| | - Beyene Petros
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Endalamaw Gadisa
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands.,Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Fitsum G Tadesse
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia. .,Department of Medical Microbiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands. .,Institute of Biotechnology, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia.
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11
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Tadesse FG, Slater HC, Chali W, Teelen K, Lanke K, Belachew M, Menberu T, Shumie G, Shitaye G, Okell LC, Graumans W, van Gemert GJ, Kedir S, Tesfaye A, Belachew F, Abebe W, Mamo H, Sauerwein R, Balcha T, Aseffa A, Yewhalaw D, Gadisa E, Drakeley C, Bousema T. The Relative Contribution of Symptomatic and Asymptomatic Plasmodium vivax and Plasmodium falciparum Infections to the Infectious Reservoir in a Low-Endemic Setting in Ethiopia. Clin Infect Dis 2019; 66:1883-1891. [PMID: 29304258 DOI: 10.1093/cid/cix1123] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
Background The majority of Plasmodium vivax and Plasmodium falciparum infections in low-endemic settings are asymptomatic. The relative contribution to the infectious reservoir of these infections compared to clinical malaria cases is currently unknown. Methods We assessed infectivity of passively recruited symptomatic malaria patients (n = 41) and community-recruited asymptomatic individuals with microscopy-detected (n = 41) and polymerase chain reaction (PCR)-detected infections (n = 82) using membrane feeding assays with Anopheles arabiensis mosquitoes in Adama, Ethiopia. Malaria incidence and prevalence data were used to estimate the contributions of these populations to the infectious reservoir. Results Overall, 34.9% (29/83) of P. vivax- and 15.1% (8/53) P. falciparum-infected individuals infected ≥1 mosquitoes. Mosquito infection rates were strongly correlated with asexual parasite density for P. vivax (ρ = 0.63; P < .001) but not for P. falciparum (ρ = 0.06; P = .770). Plasmodium vivax symptomatic infections were more infectious to mosquitoes (infecting 46.5% of mosquitoes, 307/660) compared to asymptomatic microscopy-detected (infecting 12.0% of mosquitoes, 80/667; P = .005) and PCR-detected infections (infecting 0.8% of mosquitoes, 6/744; P < .001). Adjusting for population prevalence, symptomatic, asymptomatic microscopy-detected, and PCR-detected infections were responsible for 8.0%, 76.2%, and 15.8% of the infectious reservoir for P. vivax, respectively. For P. falciparum, mosquito infections were sparser and also predominantly from asymptomatic infections. Conclusions In this low-endemic setting aiming for malaria elimination, asymptomatic infections were highly prevalent and responsible for the majority of onward mosquito infections. The early identification and treatment of asymptomatic infections might accelerate elimination efforts.
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Affiliation(s)
- Fitsum G Tadesse
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Armauer Hansen Research Institute, Addis Ababa University, Ethiopia.,Institute of Biotechnology, Addis Ababa University, Ethiopia
| | - Hannah C Slater
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, Imperial College London, United Kingdom
| | - Wakweya Chali
- Armauer Hansen Research Institute, Addis Ababa University, Ethiopia
| | - Karina Teelen
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kjerstin Lanke
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mulualem Belachew
- Adama Regional Laboratory, Oromia Region Health Bureau, Adama, Ethiopia
| | - Temesgen Menberu
- Adama Regional Laboratory, Oromia Region Health Bureau, Adama, Ethiopia
| | - Girma Shumie
- Adama Regional Laboratory, Oromia Region Health Bureau, Adama, Ethiopia
| | - Getasew Shitaye
- Adama Regional Laboratory, Oromia Region Health Bureau, Adama, Ethiopia
| | - Lucy C Okell
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, Imperial College London, United Kingdom
| | - Wouter Graumans
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Geert-Jan van Gemert
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Soriya Kedir
- Adama Regional Laboratory, Oromia Region Health Bureau, Adama, Ethiopia
| | - Addisu Tesfaye
- Adama Regional Laboratory, Oromia Region Health Bureau, Adama, Ethiopia
| | - Feleke Belachew
- Adama Regional Laboratory, Oromia Region Health Bureau, Adama, Ethiopia
| | - Wake Abebe
- Adama Regional Laboratory, Oromia Region Health Bureau, Adama, Ethiopia
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, Ethiopia
| | - Robert Sauerwein
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Taye Balcha
- Armauer Hansen Research Institute, Addis Ababa University, Ethiopia.,Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa University, Ethiopia
| | - Delenasaw Yewhalaw
- Tropical and Infectious Diseases Research Center, Jimma University, Ethiopia.,Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences, Jimma University, Ethiopia
| | - Endalamaw Gadisa
- Armauer Hansen Research Institute, Addis Ababa University, Ethiopia
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Teun Bousema
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, United Kingdom
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