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    Sero-epidemiological evaluation of malaria transmission in The Gambia before and after mass drug administration

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    Author
    Wu, L; Mwesigwa, J; Affara, M; Bah, M; Correa, S; Hall, T; Singh, SK; Beeson, JG; Tetteh, KKA; Kleinschmidt, I; ...
    Date
    2020-11-13
    Source Title
    BMC Medicine
    Publisher
    BMC
    University of Melbourne Author/s
    Beeson, James
    Affiliation
    Medicine and Radiology
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Wu, L., Mwesigwa, J., Affara, M., Bah, M., Correa, S., Hall, T., Singh, S. K., Beeson, J. G., Tetteh, K. K. A., Kleinschmidt, I., D'Alessandro, U. & Drakeley, C. (2020). Sero-epidemiological evaluation of malaria transmission in The Gambia before and after mass drug administration. BMC MEDICINE, 18 (1), https://doi.org/10.1186/s12916-020-01785-6.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/252988
    DOI
    10.1186/s12916-020-01785-6
    Abstract
    BACKGROUND: As The Gambia aims to achieve malaria elimination by 2030, serological assays are a useful surveillance tool to monitor trends in malaria incidence and evaluate community-based interventions. METHODS: Within a mass drug administration (MDA) study in The Gambia, where reduced malaria infection and clinical disease were observed after the intervention, a serological sub-study was conducted in four study villages. Spatio-temporal variation in transmission was measured with a panel of recombinant Pf antigens on a multiplexed bead-based assay. Village-level antibody levels were quantified as under-15 sero-prevalence, sero-conversion rates, and age-adjusted antibody acquisition rates. Antibody levels prior to MDA were assessed for association with persistent malaria infection after community chemoprophylaxis. RESULTS: Seasonal changes in antibodies to Etramp5.Ag1 were observed in children under 15 years in two transmission settings-the West Coast and Upper River Regions (4.32% and 31.30% Pf prevalence, respectively). At the end of the malaria season, short-lived antibody responses to Etramp5.Ag1, GEXP18, HSP40.Ag1, EBA175 RIII-V, and Rh2.2030 were lower amongst 1-15 year olds in the West Coast compared to the Upper River, reflecting known differences in transmission. Prior to MDA, individuals in the top 50th percentile of antibody levels had two-fold higher odds of clinical malaria during the transmission season, consistent with previous findings from the Malaria Transmission Dynamics Study, where individuals infected before the implementation of MDA had two-fold higher odds of re-infection post-MDA. CONCLUSIONS: Serological markers can serve dual functions as indicators of malaria exposure and incidence. By monitoring age-specific sero-prevalence, the magnitude of age-stratified antibody levels, or identifying groups of individuals with above-average antibody responses, these antigens have the potential to complement conventional malaria surveillance tools. Further studies, particularly cluster randomised trials, can help establish standardised serological protocols to reliably measure transmission across endemic settings.

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