title: Focal Screening to Identify the Subpatent Parasite Reservoir in an Area of Low and Heterogeneous Transmission in the Kenya Highlands.
abstract: BACKGROUND
  Mass screening and treatment currently fails to identify a considerable fraction of low parasite density infections, while mass treatment exposes many uninfected individuals to antimalarial drugs. Here we test a hybrid approach to screen a sentinel population to identify clusters of subpatent infections in the Kenya highlands with low, heterogeneous malaria transmission.
  
  
  METHODS
  Two thousand eighty-two inhabitants were screened for parasitemia by nested polymerase chain reaction (nPCR). Children aged ≤ 15 years and febrile adults were also tested for malaria by rapid diagnostic test (RDT) and served as sentinel members to identify subpatent infections within the household. All parasitemic individuals were assessed for multiplicity of infections by nPCR and gametocyte carriage by nucleic acid sequence-based amplification.
  
  
  RESULTS
  Households with RDT-positive individuals in the sentinel population were more likely to have nPCR-positive individuals (odds ratio: 1.71, 95% confidence interval, 1.60-1.84). The sentinel population identified 64.5% (locality range: 31.6%-81.2%) of nPCR-positive households and 77.3% (locality range: 24.2%-91.0%) of nPCR-positive individuals. The sensitivity of the sentinel screening approach was positively associated with transmission intensity (P = .037).
  
  
  CONCLUSIONS
  In this low endemic area, a focal screening approach with RDTs prior to the high transmission season was able to identify the majority of the subpatent parasite reservoirs.
authors.affiliation: Department of Immunology and Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Gillian H
authors.initials: GH
authors.lastname: Stresman
authors.affiliation: Radboud University Nijmegen Medical Centre, The Netherlands.
authors.forename: Amrish Y
authors.initials: AY
authors.lastname: Baidjoe
authors.affiliation: Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stevenson
authors.affiliation: Department of Immunology and Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Lynn
authors.initials: L
authors.lastname: Grignard
authors.affiliation: Kenya Medical Research Institute, Centre for Global Health Research, Kisumu.
authors.forename: Wycliffe
authors.initials: W
authors.lastname: Odongo
authors.affiliation: Kenya Medical Research Institute, Centre for Global Health Research, Kisumu.
authors.forename: Chrispin
authors.initials: C
authors.lastname: Owaga
authors.affiliation: Kenya Medical Research Institute, Centre for Global Health Research, Kisumu.
authors.forename: Victor
authors.initials: V
authors.lastname: Osoti
authors.affiliation: Kenya Medical Research Institute, Centre for Global Health Research, Kisumu.
authors.forename: Euniah
authors.initials: E
authors.lastname: Makori
authors.affiliation: Kenya Medical Research Institute, Centre for Global Health Research, Kisumu.
authors.forename: Shehu
authors.initials: S
authors.lastname: Shagari
authors.affiliation: Kenya Medical Research Institute, Centre for Global Health Research, Kisumu.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Marube
authors.affiliation: Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cox
authors.affiliation: Department of Immunology and Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Drakeley
authors.affiliation: Department of Immunology and Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom Radboud University Nijmegen Medical Centre, The Netherlands.
authors.forename: Teun
authors.initials: T
authors.lastname: Bousema
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058345:Asymptomatic Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D018512:Parasitemia / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D055815:Young Adult
keywords: elimination; malaria transmission; screening; subpatent infection