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Why Asymptomatic Plasmodium falciparum Infections Are Common in Low-Transmission Settings
Anders Björkman1, Ulrika Morris1
1Karolinska Institutet, Stockholm, Sweden.
Abstract:
Plasmodium falciparum infections in low-transmission settings are often asymptomatic with low parasite densities despite low herd immunity. Based on studies in Zanzibar, this may be due to parasitic (nonvirulence) rather than host (immunity) factors. In high-transmission settings, high replication rate and virulence represents a competitive advantage, whereas in low-transmission settings nonvirulent parasites escape both competition and treatment. Such parasites also survive longer in low-transmission settings due to lower host immunity response and less frequent indirect drug exposure. This has major implications for optimal malaria control and elimination strategies.
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