Comparison of diagnostics for the detection of asymptomatic Plasmodium falciparum infections to inform control and elimination strategies
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Published version
Author(s)
Type
Journal Article
Abstract
The global burden of malaria has been substantially reduced over the past two decades. Future efforts to reduce malaria further will require moving beyond the treatment of clinical infections to targeting malaria transmission more broadly in the community. As such, the accurate identification of asymptomatic human infections, which can sustain a large proportion of transmission, is becoming a vital component of control and elimination programmes. We determined the relationship across common diagnostics used to measure malaria prevalence — polymerase chain reaction (PCR), rapid diagnostic test and microscopy — for the detection of Plasmodium falciparum infections in endemic populations based on a pooled analysis of cross-sectional data. We included data from more than 170,000 individuals comparing the detection by rapid diagnostic test and microscopy, and 30,000 for detection by rapid diagnostic test and PCR. The analysis showed that, on average, rapid diagnostic tests detected 41% (95% confidence interval = 26–66%) of PCR-positive infections. Data for the comparison of rapid diagnostic test to PCR detection at high transmission intensity and in adults were sparse. Prevalence measured by rapid diagnostic test and microscopy was comparable, although rapid diagnostic test detected slightly more infections than microscopy. On average, microscopy captured 87% (95% confidence interval = 74–102%) of rapid diagnostic test-positive infections. The extent to which higher rapid diagnostic test detection reflects increased sensitivity, lack of specificity or both, is unclear. Once the contribution of asymptomatic individuals to the infectious reservoir is better defined, future analyses should ideally establish optimal detection limits of new diagnostics for use in control and elimination strategies.
Date Issued
2015-12-03
Date Acceptance
2015-12-02
Citation
Nature, 2015, 528 (7580), pp.S86-S93
ISSN
0028-0836
Publisher
Nature Publishing Group
Start Page
S86
End Page
S93
Journal / Book Title
Nature
Volume
528
Issue
7580
Copyright Statement
This work is licensed under the Creative Commons Attribution 4.0 International
License. The images or other third party material in this article
are included in the article’s Creative Commons license, unless indicated
otherwise in the credit line; if the material is not included under the Creative Commons
license, users will need to obtain permission from the license holder to reproduce the material.
To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0
License. The images or other third party material in this article
are included in the article’s Creative Commons license, unless indicated
otherwise in the credit line; if the material is not included under the Creative Commons
license, users will need to obtain permission from the license holder to reproduce the material.
To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0
License URL
Sponsor
Bill & Melinda Gates Foundation
Bill & Melinda Gates Foundation
Medical Research Council (MRC)
Grant Number
OPP1095124
OPP1068440
MR/L012189/1
Subjects
Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
POLYMERASE-CHAIN-REACTION
INTENSE MALARIA TRANSMISSION
OF-CARE DETECTION
COMBINATION THERAPY
HIGH PREVALENCE
GOLD STANDARD
ENDEMIC AREA
REAL-TIME
TESTS
MICROSCOPY
Publication Status
Published