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Using serological diagnostics to characterize remaining high-incidence pockets of malaria in forest-fringe Cambodia
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Using serological diagnostics to characterize remaining high-incidence pockets of malaria in forest-fringe Cambodia
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Journal Article
Using serological diagnostics to characterize remaining high-incidence pockets of malaria in forest-fringe Cambodia
2024
Overview
Background
Over the last decades, the number of malaria cases has drastically reduced in Cambodia. As the overall prevalence of malaria in Cambodia declines, residual malaria transmission becomes increasingly fragmented over smaller remote regions. The aim of this study was to get an insight into the burden and epidemiological parameters of
Plasmodium
infections on the forest-fringe of Cambodia.
Methods
950 participants were recruited in the province of Mondulkiri in Cambodia and followed up from 2018 to 2020. Whole-blood samples were processed for
Plasmodium
spp
.
identification by PCR as well as for a serological immunoassay. A risk factor analysis was conducted for
Plasmodium vivax
PCR-detected infections throughout the study, and for
P. vivax
seropositivity at baseline. To evaluate the predictive effect of seropositivity at baseline on subsequent PCR-positivity, an analysis of
P. vivax
infection-free survival time stratified by serological status at baseline was performed.
Results
Living inside the forest significantly increased the odds of
P. vivax
PCR-positivity by a factor of 18.3 (95% C.I. 7.7–43.5). Being a male adult was also a significant predictor of PCR-positivity. Similar risk profiles were identified for
P. vivax
seropositivity. The survival analysis showed that serological status at baseline significantly correlated with subsequent infection. Serology is most informative outside of the forest, where 94.0% (95% C.I. 90.7–97.4%) of seronegative individuals survived infection-free, compared to 32.4% (95% C.I.: 22.6–46.6%) of seropositive individuals.
Conclusion
This study justifies the need for serological diagnostic assays to target interventions in this region, particularly in demographic groups where a lot of risk heterogeneity persists, such as outside of the forest.
