title: Malaria Parasites in the Asymptomatic: Looking for the Hay in the Haystack.
abstract: With malaria elimination back on the international agenda, programs face the challenge of targeting all Plasmodium infections, not only symptomatic cases. As asymptomatic individuals are unlikely to seek treatment, they are missed by passive surveillance while remaining infectious to mosquitoes, thus acting as silent reservoirs of transmission. To estimate the risk of asymptomatic infections in various phases of malaria elimination, we need a deeper understanding of the underlying mechanisms favoring carriage over disease, which may involve both pathogen and host factors. Here we review our current knowledge on the determinants leading to Plasmodium falciparum symptomless infections. Understanding the host-pathogen interactions that are most likely to affect transitions between malaria disease states could guide the development of tools to tackle asymptomatic carriers in elimination settings.
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Galatas
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. Electronic address: alfredo.mayor@isglobal.org.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mayor
mesh_terms: D058070:Asymptomatic Diseases; D060740:Disease Eradication; D054884:Host-Pathogen Interactions; D006801:Humans; D016778:Malaria, Falciparum / Q000276:immunology / Q000469:parasitology* / Q000473:pathology / Q000635:transmission; D010963:Plasmodium falciparum / Q000502:physiology
keywords: asymptomatic; elimination.; immunity; malaria; tolerance; transmission; virulence