Estimating Plasmodium falciparum Malaria Prevalence inHaiti Using Serologic Testing Open Access

Abstract

Hispaniola is the only island in the Caribbean where endemic malaria transmission still occurs. Elimination of malaria in Hispaniola has been viewed as an attainable goal when malaria control and elimination efforts are focused in Haiti, where the majority of cases are. We estimated the prevalence of P. falciparum malaria in Haiti using serological assays, which are more useful at detecting exposure and transmission of the disease in low-endemic countries. We used Luminex® assay to assess Immunoglobulin G (IgG) antibody prevalence to three P. falciparum antigens (AMA-1, MSP-1-19 & LSA-1) measured through nationwide surveys in 2012 and 2015. Persons with antibodies to all three antigens were found throughout the country, with MSP-1-19 being the most prevalent in both surveys, followed by AMA-1 and LSA-1. Higher antibody prevalence was found in pregnant women, older age groups (>50-years old), rural areas and in the administrative region (department) of Centre. A poor agreement between microscopy and Rapid Diagnostic Tests (RDTs) to Luminex® assay indicated serologic testing, rather than diagnostic testing, is more suitable for identification of transmission in areas with low prevalence of malaria. This study suggests that ongoing monitoring of P. falciparum antibody prevalence should continue under the country's malaria prevention and control efforts, and that interventions should be intensified in rural areas, especially in the geographic region of Centre for the attainment a malaria-free Haiti.

Table of Contents

Definition of terms……………………………………………………………………………….........1

Chapter I: Introduction……………………………………………………………………………......4

Chapter II: Literature Review, Problem, Purpose & Significance Statements……….….10

A. Literature Review……………………………………………………………………….................10

a. Epidemiology of malaria………………………………………………………...…....................10

b. Diagnosis and serologic testing for malaria………………………………………….............12

c. Malaria prevalence and transmission studies in low-endemic countries……………...17

d. Malaria prevalence and transmission studies in Haiti…………………………….….........20

B. Problem Statement……………………………………………………………………….................22

C. Purpose Statement…………………………………………………………………….….................22

D. Research Questions……………………………………………………………………….................23

E. Significance Statement…………………………………………………………………...................23

Chapter III: Manuscript……………………………………………………………………….…............24

Abstract………………………………………………………………………………………......................24

A. Introduction……………………………………………………………………………….....................24

B. Methods……………………………………………………………………………….…........................27

a. Survey design………………………………………………………………………..............................27

b. Data and sample collection……………………………………………………...….......................28

c. Blood spot elution and immunoassays…………………………………………...…..................29

d. Control sample collection……………………………………………………...............................31

e. Malaria prevalence…………………………………………………………………............................31

f. Demographic and clinical variables………………………………………………….....................32

g. Data analysis………………………………………………………………………….............................33

h. Ethical considerations…………………………………………………………….…..........................34

C. Results…………………………………………………………………………………….........................34

a. Demographic characteristics………………………………………………………….......................34

b. Malaria clinical and diagnostic data………………………………………………….....................35

c. Antibody prevalence…………………………………………………………………..........................36

i. Overall prevalence………………………………………………………….................................36

ii. Prevalence by gender………………………………………………………................................36

iii. Prevalence by pregnancy status……………………………………………...........................37

iv. Prevalence by age groups……………………………………………………............................38

v. Prevalence by geographic location……………………………………….….........................39

vi. Prevalence by administrative region (department)……………………….….................39

d. RDT, microscopy and Luminex® antibody positive agreement……………………..........41

D. Discussion……………………………………………………………………………........................42

E. Acknowledgements………………………………………………………………………..................50

Tables and figures……………………………………………………………………….………..............51

Chapter IV: Conclusion and Recommendations……………………………………………….......57

References…………………………………………………………………….......................................60

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Biology, Parasitology Health Sciences, Epidemiology
Keyword	MSP-1-19 Plasmodium falciparum Luminex assay Malaria AMA-1 Antibody Seroprevalence LSA-1 Prevalence Haiti
Committee Chair / Thesis Advisor	Farhat, Ghada N, Emory University
Committee Members	Rogier, Eric, CDC
Partnering Agencies	CDC

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