title: Population structure and spatio-temporal transmission dynamics of Plasmodium vivax after radical cure treatment in a rural village of the Peruvian Amazon.
abstract: BACKGROUND
  Despite the large burden of Plasmodium vivax, little is known about its transmission dynamics. This study explored the population structure and spatio-temporal dynamics of P. vivax recurrent infections after radical cure in a two-year cohort study carried out in a rural community of the Peruvian Amazon.
  
  
  METHODS
  A total of 37 P. vivax participants recruited in San Carlos community (Peru) between April and December 2008 were treated radically with chloroquine and primaquine and followed up monthly for two years with systematic blood sampling. All samples were screened for malaria parasites and subsequently all P. vivax infections genotyped using 15 microsatellites. Parasite population structure and dynamics were determined by computing different genetic indices and using spatio-temporal statistics.
  
  
  RESULTS
  After radical cure, 76% of the study participants experienced one or more recurrent P. vivax infections, most of them sub-patent and asymptomatic. The parasite population displayed limited genetic diversity (He = 0.49) and clonal structure, with most infections (84%) being monoclonal. Spatio-temporal clusters of specific haplotypes were found throughout the study and persistence of highly frequent haplotypes were observed over several months within the same participants/households.
  
  
  CONCLUSIONS
  In San Carlos community, P. vivax recurrences were commonly observed after radical treatment, and characterized by asymptomatic, sub-patent and clustered infections (within and between individuals from a few neighbouring households). Moreover low genetic diversity as well as parasite inbreeding are likely to define a clonal parasite population which has important implications on the malaria epidemiology of the study area.
authors.affiliation: Unit of International Health, ESOC Department, Faculty of Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium. richardchristopher.delgadoratto@uantwerpen.be.
authors.forename: Christopher
authors.initials: C
authors.lastname: Delgado-Ratto
authors.forename: Veronica E
authors.initials: VE
authors.lastname: Soto-Calle
authors.forename: Peter
authors.initials: P
authors.lastname: Van den Eede
authors.forename: Dionicia
authors.initials: D
authors.lastname: Gamboa
authors.forename: Angel
authors.initials: A
authors.lastname: Rosas
authors.forename: Emmanuel N
authors.initials: EN
authors.lastname: Abatih
authors.forename: Hugo
authors.initials: H
authors.lastname: Rodriguez Ferrucci
authors.forename: Alejandro
authors.initials: A
authors.lastname: Llanos-Cuentas
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Van Geertruyden
authors.forename: Annette
authors.initials: A
authors.lastname: Erhart
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D014644:Genetic Variation; D006239:Haplotypes; D006801:Humans; D016780:Malaria, Vivax / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission*; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D010966:Plasmodium vivax / Q000235:genetics*; D016133:Polymerase Chain Reaction; D011319:Primaquine / Q000627:therapeutic use; D012424:Rural Population; D055815:Young Adult
chemical_list: D000962:Antimalarials; D002738:Chloroquine; D011319:Primaquine