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Edwards HM, Dixon R, Zegers de Beyl C, Celhay O, Rahman M, Myint Oo M, Lwin T, Lin Z, San T, Thwe Han K, Myaing Nyunt M, Plowe C, Stresman G, Hall T, Drakeley C, Hamade P, Aryal S, Roca-Feltrer A, Hlaing T, Thi A. Prevalence and seroprevalence of Plasmodium infection in Myanmar reveals highly heterogeneous transmission and a large hidden reservoir of infection. PLoS One 2021; 16:e0252957. [PMID: 34106995 PMCID: PMC8189444 DOI: 10.1371/journal.pone.0252957] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/25/2021] [Indexed: 01/09/2023] Open
Abstract
Malaria incidence in Myanmar has significantly reduced over recent years, however, completeness and timeliness of incidence data remain a challenge. The first ever nationwide malaria infection and seroprevalence survey was conducted in Myanmar in 2015 to better understand malaria epidemiology and highlight gaps in Annual Parasite Index (API) data. The survey was a cross-sectional two-stage stratified cluster-randomised household survey conducted from July-October 2015. Blood samples were collected from household members for ultra-sensitive PCR and serology testing for P. falciparum and P. vivax. Data was gathered on demography and a priori risk factors of participants. Data was analysed nationally and within each of four domains defined by API data. Prevalence and seroprevalence of malaria were 0.74% and 16.01% nationwide, respectively. Prevalent infection was primarily asymptomatic P. vivax, while P. falciparum was predominant in serology. There was large heterogeneity between villages and by domain. At the township level, API showed moderate correlation with P. falciparum seroprevalence. Risk factors for infection included socioeconomic status, domain, and household ownership of nets. Three K13 P. falciparum mutants were found in highly prevalent villages. There results highlight high heterogeneity of both P. falciparum and P. vivax transmission between villages, accentuated by a large hidden reservoir of asymptomatic P. vivax infection not captured by incidence data, and representing challenges for malaria elimination. Village-level surveillance and stratification to guide interventions to suit local context and targeting of transmission foci with evidence of drug resistance would aid elimination efforts.
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Affiliation(s)
| | | | | | | | | | | | | | - Zaw Lin
- Ministry of Health and Sports, Yangon, Myanmar
| | - Thiri San
- Ministry of Health and Sports, Yangon, Myanmar
| | - Kay Thwe Han
- Parasitology Research Division, Department of Medical Research, Yangon, Myanmar
| | - Myaing Myaing Nyunt
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Christopher Plowe
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Gillian Stresman
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tom Hall
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | | | - Aung Thi
- Ministry of Health and Sports, Yangon, Myanmar
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