Short and Long Term Plasmodium Surveillance in the Low-Endemic Nation of Haiti Pubblico

Abstract

Worldwide, deaths from malaria infection have fallen to their lowest numbers since global reporting methods were implemented in the mid-20^th century. Malaria control programs, which aim to reduce human morbidity and mortality due to malaria infection in a defined geographical area, are now present in a high percentage of malaria endemic nations. In contrast, malaria elimination programs, which seek to exterminate all malaria parasites in a nation, are present in smaller numbers. Accurate malaria surveillance is required for both of these programs in order to identify regions with higher transmission intensity, disease burden, and human mortality. The nation of Haiti is thought to be a low endemic area for the malarial parasite Plasmodium falciparum, but inconsistent and erratic surveillance elicits many questions to the severity of malaria is on this island nation. In late 2012, a nationwide study was conducted to determine prevalence of the P. falciparum parasite and seropositivity among the Haitian populace. This survey involved 62 study sites which collected blood samples on filter paper for subsequent laboratory analysis. At the Centers for Disease Control and Prevention laboratories in Atlanta, GA, filter papers were processed and assayed for P. falciparum DNA as well as IgG antibodies against P. falciparum antigens. Analysis of parasitic DNA revealed a very low parasite rate in the nation of Haiti for the 2012 transmission season with 0.17% of samples positive for active malaria infection. Serological assays to determine the IgG titer in samples showed many of the individuals had been infected with the P. falciparum parasite at some point in their lives. Surprisingly, nationwide estimates for seropositive rates showed high rates among those in the 0-5 and 6-10 year old groups, possibly indicating a resurgence of malaria in Haiti within the past 10 years. Nationwide seropositivity curves based on the antigens MSP-1 and AMA-1 gave estimates of seroconversion rates of 0.147 and 0.275, respectively. These data show the continued persistence of malaria in Haiti and the need for consistent and nationwide surveys in the future to determine areas with the highest levels of P. falciparum transmission.

Table of Contents

Abbreviations Used in this Document...1

Background...2

Methods...10

Results...13

Discussion and Future Directions...17

References...23

Tables, Figures, and Figure Legends...26

Appendices...40

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Biology, Parasitology Health Sciences, Epidemiology
Parola chiave	seroconversion rate parasite rate malaria Haiti
Committee Chair / Thesis Advisor	Brachman, Philip S, Emory University
Committee Members	Udhayakumar, Venkatachalam, CDC
Partnering Agencies	CDC

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