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Measuring changes in Plasmodium falciparum census population size in response to sequential malaria control
Kathryn E Tiedje1,2, Qi Zhan3,4, Shazia Ruybal-Pesantez2
1Department of Microbiology and Immunology, Bio21 Institute and Peter Doherty Institute for Infection and Immunity, The University of Melbourne; Melbourne, Australia.
Medrxiv : the Preprint Server for Health Sciences
|June 9, 2023
Summary
A new method measures Plasmodium falciparum parasite population size using var gene diversity. Malaria interventions reduced parasite numbers, but populations quickly rebounded, showing parasite resilience.
Area of Science:
- Malariology
- Parasitology
- Population Genetics
Background:
- *Plasmodium falciparum* infections pose a significant global health challenge, particularly in sub-Saharan Africa.
- *Current epidemiological tools often focus on human hosts, potentially underestimating parasite burden and resilience.
- *Understanding parasite population dynamics is crucial for effective malaria control strategies.
Purpose of the Study:
- *To introduce a novel endpoint, "census population size," to quantify *P. falciparum* parasite populations.
- *To assess the impact of malaria interventions (IRS and SMC) on parasite population size and diversity.
- *To evaluate the resilience of *P. falciparum* populations to control efforts.
Main Methods:
- *Developed a Bayesian approach to estimate multiplicity of infection (MOIvar) based on var gene hyper-diversity.
- *Calculated census population size by summing MOIvar across the human population.
- *Monitored changes in parasite population size and var diversity through sequential interventions in northern Ghana (2012-2017).
Main Results:
- *Indoor residual spraying (IRS) significantly reduced parasite prevalence, transmission intensity, var diversity, MOIvar, and population size.
- *These reductions were transient, with parasite populations rebounding within 32 months after IRS cessation and introduction of seasonal malaria chemoprevention (SMC).
- *SMC interventions prevented population rebound in younger children (1-5 years), but overall parasite populations remained large and genetically diverse, characteristic of high-transmission systems.
Conclusions:
- *The "census population size" offers a valuable new metric for evaluating malaria epidemiology and control.
- * *P. falciparum* exhibits remarkable resilience, with parasite populations rapidly recovering after major perturbations from IRS and SMC.
- *Short-term malaria interventions may not be sufficient to durably reduce large and genetically diverse parasite reservoirs in high-burden settings.
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