title: The role of submicroscopic parasitemia in malaria transmission: what is the evidence?
abstract: Achieving malaria elimination requires targeting the human reservoir of infection, including those with asymptomatic infection. Smear-positive asymptomatic infections detectable by microscopy are an important reservoir because they often persist for months and harbor gametocytes, the parasite stage infectious to mosquitoes. However, many asymptomatic infections are submicroscopic and can only be detected by molecular methods. Although there is some evidence that individuals with submicroscopic malaria can infect mosquitoes, transmission is much less likely to occur at submicroscopic gametocyte levels. As malaria elimination programs pursue mass screening and treatment of asymptomatic individuals, further research should strive to define the degree to which submicroscopic malaria contributes to the infectious reservoir and, in turn, what diagnostic detection threshold is needed to effectively interrupt transmission.
authors.affiliation: Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA. Electronic address: jessica_lin@med.unc.edu.
authors.forename: Jessica T
authors.initials: JT
authors.lastname: Lin
authors.affiliation: Department of Immunology and Medicine, USAMC Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
authors.forename: David L
authors.initials: DL
authors.lastname: Saunders
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
mesh_terms: D000818:Animals; D000852:Anopheles / Q000469:parasitology; D004197:Disease Reservoirs; D006801:Humans; D008288:Malaria / Q000469:parasitology / Q000635:transmission*; D018512:Parasitemia / Q000469:parasitology / Q000635:transmission*; D010961:Plasmodium / Q000502:physiology; D012106:Research / Q000639:trends
keywords: asymptomatic infection; diagnostic; gametocyte; malaria elimination; reservoir