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BMC Medicine
Published in: BMC Medicine 1/2019

Open Access 01-12-2019 | Malaria | Research article

Differential impact of malaria control interventions on P. falciparum and P. vivax infections in young Papua New Guinean children

Authors: Maria Ome-Kaius, Johanna Helena Kattenberg, Sophie Zaloumis, Matthew Siba, Benson Kiniboro, Shadrach Jally, Zahra Razook, Daisy Mantila, Desmond Sui, Jason Ginny, Anna Rosanas-Urgell, Stephan Karl, Thomas Obadia, Alyssa Barry, Stephen J. Rogerson, Moses Laman, Daniel Tisch, Ingrid Felger, James W. Kazura, Ivo Mueller, Leanne J. Robinson

Published in: BMC Medicine | Issue 1/2019

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Abstract

Introduction

As malaria transmission declines, understanding the differential impact of intensified control on Plasmodium falciparum relative to Plasmodium vivax and identifying key drivers of ongoing transmission is essential to guide future interventions.

Methods

Three longitudinal child cohorts were conducted in Papua New Guinea before (2006/2007), during (2008) and after scale-up of control interventions (2013). In each cohort, children aged 1–5 years were actively monitored for infection and illness. Incidence of malaria episodes, molecular force of blood-stage infections (molFOB) and population-averaged prevalence of infections were compared across the cohorts to investigate the impact of intensified control in young children and the key risk factors for malaria infection and illness in 2013.

Results

Between 2006 and 2008, P. falciparum infection prevalence, molFOB, and clinical malaria episodes reduced by 47%, 59% and 69%, respectively, and a further 49%, 29% and 75% from 2008 to 2013 (prevalence 41.6% to 22.1% to 11.2%; molFOB: 3.4 to 1.4 to 1.0 clones/child/year; clinical episodes incidence rate (IR) 2.6 to 0.8 to IR 0.2 episodes/child/year). P. vivax clinical episodes declined at rates comparable to P. falciparum between 2006, 2008 and 2013 (IR 2.5 to 1.1 to 0.2), while P. vivax molFOB (2006, 9.8; 2008, 12.1) and prevalence (2006, 59.6%; 2008, 65.0%) remained high in 2008. However, in 2013, P. vivax molFOB (1.2) and prevalence (19.7%) had also substantially declined. In 2013, 89% of P. falciparum and 93% of P. vivax infections were asymptomatic, 62% and 47%, respectively, were sub-microscopic. Area of residence was the major determinant of malaria infection and illness.

Conclusion

Intensified vector control and routine case management had a differential impact on rates of P. falciparum and P. vivax infections but not clinical malaria episodes in young children. This suggests comparable reductions in new mosquito-derived infections but a delayed impact on P. vivax relapsing infections due to a previously acquired reservoir of hypnozoites. This demonstrates the need to strengthen implementation of P. vivax radical cure to maximise impact of control in co-endemic areas. The high heterogeneity of malaria in 2013 highlights the importance of surveillance and targeted interventions to accelerate towards elimination.
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Metadata
Title
Differential impact of malaria control interventions on P. falciparum and P. vivax infections in young Papua New Guinean children
Authors
Maria Ome-Kaius
Johanna Helena Kattenberg
Sophie Zaloumis
Matthew Siba
Benson Kiniboro
Shadrach Jally
Zahra Razook
Daisy Mantila
Desmond Sui
Jason Ginny
Anna Rosanas-Urgell
Stephan Karl
Thomas Obadia
Alyssa Barry
Stephen J. Rogerson
Moses Laman
Daniel Tisch
Ingrid Felger
James W. Kazura
Ivo Mueller
Leanne J. Robinson
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2019
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-019-1456-9

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