Slater, HannahHannahSlaterRoss, AmandaAmandaRossFelger, IngridIngridFelgerHofmann, NatalieNatalieHofmannRobinson, LeanneLeanneRobinsonCook, JackieJackieCookGoncalvesBjorkmanOuedraogoMorrisMsellemKoepfliMuellerTadesseGadisaDasDomingoKapuluMidega, JanetJanetMidegaOwusu-AgyeiNabetPiarrouxDoumboDoumboKoramLucchiUdhayakumarMoshaTionoChandramohanGoslingMwingiraSauerweinRileyWhiteNostenImwongBousemaDrakeleyOkell, LucyLucyOkell2019-04-092019-04-092019-03-29Nature Communications, 2019, 102041-1723http://hdl.handle.net/10044/1/68730Malaria infections occurring below the limit of detection of standard diagnostics are common in all endemic settings. However, key questions remain surrounding their contribution to sustaining transmission and whether they need to be detected and targeted to achieve malaria elimination. In this study we analyse a range of malaria datasets to quantify the density, detectability, course of infection and infectiousness of subpatent infections. Asymptomatically infected individuals have lower parasite densities on average in low transmission settings compared to individuals in higher transmission settings. In cohort studies, subpatent infections are found to be predictive of future periods of patent infection and in membrane feeding studies, individuals infected with subpatent asexual parasite densities are found to be approximately a third as infectious to mosquitoes as individuals with patent (asexual parasite) infection. These results indicate that subpatent infections contribute to the infectious reservoir, may be long lasting, and require more sensitive diagnostics to detect them in lower transmission settings.© 2019 The Author(s). This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the CreativeCommons license, and indicate if changes were made. The images or other third partymaterial in this article are included in the article’s Creative Commons license, unlessindicated otherwise in a credit line to the material. If material is not included in thearticle’s Creative Commons license and your intended use is not permitted by statutoryregulation or exceeds the permitted use, you will need to obtain permission directly fromthe copyright holder. To view a copy of this license, visithttp://creativecommons.org/licenses/by/4.0/.MD MultidisciplinaryJournal Articlehttps://www.dx.doi.org/10.1038/s41467-019-09441-1MR/K010174/1BPO14/00561DH140134MR/R015600/1