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    Prevalence and seroprevalence of Plasmodium infection in Myanmar reveals highly heterogeneous transmission and a large hidden reservoir of infection

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    Author
    Edwards, Hannah M
    Dixon, Ruth
    Zegers de Beyl, Celine
    Celhay, Olivier
    Rahman, Mousumi
    Myint Oo, Moe
    Lwin, Thandar
    Lin, Zaw
    San, Thiri
    Thwe Han, Kay
    Myaing Nyunt, Myaing
    Plowe, Christopher
    Stresman, Gillian
    Hall, Tom
    Drakeley, Chris
    Hamade, Prudence
    Aryal, Siddhi
    Roca-Feltrer, Arantxa
    Hlaing, Thaung
    Thi, Aung
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    Date
    2021-06-09
    Journal
    PLoS ONE
    Publisher
    Public Library of Science
    Type
    Article
    
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    See at
    https://doi.org/10.1371/journal.pone.0252957
    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.
    Keyword
    Malaria
    Plasmodium
    Prevalence
    Myanmar
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/15996
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pone.0252957
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