title: Using serological measures to monitor changes in malaria transmission in Vanuatu.
abstract: BACKGROUND
  With renewed interest in malaria elimination, island environments present unique opportunities to achieve this goal. However, as transmission decreases, monitoring and evaluation programmes need increasingly sensitive tools to assess Plasmodium falciparum and Plasmodium vivax exposure. In 2009, to assess the role of serological markers in evaluating malaria transmission, a cross-sectional seroprevalence study was carried out in Tanna and Aneityum, two of the southernmost islands of the Vanuatu archipelago, areas where malaria transmission has been variably reduced over the past few decades.
  
  
  METHODS
  Malaria transmission was assessed using serological markers for exposure to P. falciparum and P. vivax. Filter blood spot papers were collected from 1,249 people from Tanna, and 517 people from Aneityum to assess the prevalence of antibodies to two P. falciparum antigens (MSP-119 and AMA-1) and two P. vivax antigens (MSP-119 and AMA-1). Age-specific prevalence was modelled using a simple catalytic conversion model based on maximum likelihood to generate a community seroconversion rate (SCR).
  
  
  RESULTS
  Overall seropositivity in Tanna was 9.4%, 12.4% and 16.6% to P. falciparum MSP-119, AMA-1 and Schizont Extract respectively and 12.6% and 15.0% to P. vivax MSP-119 and AMA-1 respectively. Serological results distinguished between areas of differential dominance of either P. vivax or P. falciparum and analysis of age-stratified results showed a step in seroprevalence occurring approximately 30 years ago on both islands, indicative of a change in transmission intensity at this time. Results from Aneityum suggest that several children may have been exposed to malaria since the 2002 P. vivax epidemic.
  
  
  CONCLUSIONS
  Seroepidemiology can provide key information on malaria transmission for control programmes, when parasite rates are low. As Vanuatu moves closer to malaria elimination, monitoring changes in transmission intensity and identification of residual malaria foci is paramount in order to concentrate intervention efforts.
authors.affiliation: London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Jackie.Cook@lshtm.ac.uk
authors.forename: Jackie
authors.initials: J
authors.lastname: Cook
authors.forename: Heidi
authors.initials: H
authors.lastname: Reid
authors.forename: Jennifer
authors.initials: J
authors.lastname: Iavro
authors.forename: Melissa
authors.initials: M
authors.lastname: Kuwahata
authors.forename: George
authors.initials: G
authors.lastname: Taleo
authors.forename: Archie
authors.initials: A
authors.lastname: Clements
authors.forename: James
authors.initials: J
authors.lastname: McCarthy
authors.forename: Andrew
authors.initials: A
authors.lastname: Vallely
authors.forename: Chris
authors.initials: C
authors.lastname: Drakeley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000913:Antibodies, Protozoan / Q000097:blood*; D000953:Antigens, Protozoan / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007074:Immunoglobulin G; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D016780:Malaria, Vivax / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D008297:Male; D008565:Membrane Proteins / Q000276:immunology; D020066:Merozoite Surface Protein 1 / Q000378:metabolism; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000235:genetics / Q000276:immunology*; D010966:Plasmodium vivax / Q000235:genetics / Q000276:immunology*; D015995:Prevalence; D015800:Protozoan Proteins / Q000276:immunology; D016036:Seroepidemiologic Studies; D009514:Vanuatu / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D007074:Immunoglobulin G; D008565:Membrane Proteins; D020066:Merozoite Surface Protein 1; D015800:Protozoan Proteins; C090077:apical membrane antigen I, Plasmodium