Focal Screening to Identify the Subpatent Parasite Reservoir in an Area of Low and Heterogeneous Transmission in the Kenya Highlands

Gillian H. Stresman, Amrish Y. Baidjoe, Jennifer Stevenson, Lynn Grignard, Wycliffe Odongo, Chrispin Owaga, Victor Osoti, Euniah Makori, Shehu Shagari, Elisabeth Marube, Jonathan Cox, Chris Drakeley, Teun Bousema

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


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 nPCRpositive 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.

Original languageEnglish (US)
Pages (from-to)1768-1777
Number of pages10
JournalJournal of Infectious Diseases
Issue number10
StatePublished - 2015


  • Elimination
  • Malaria transmission
  • Screening
  • Subpatent infection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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