Surveillance for malaria elimination in Swaziland

A national cross-sectional study using pooled PCR and serology

Michelle S. Hsiang, Jimee Hwang, Simon Kunene, Chris Drakeley, Deepika Kandula, Joseph Novotny, Justin Parizo, Trevor Jensen, Marcus Tong, Jordan Kemere, Sabelo Dlamini, Bruno Moonen, Evelina Angov, Sheetij Dutta, Christian Ockenhouse, Grant Dorsey, Bryan Greenhouse

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background: To guide malaria elimination efforts in Swaziland and other countries, accurate assessments of transmission are critical. Pooled-PCR has potential to efficiently improve sensitivity to detect infections; serology may clarify temporal and spatial trends in exposure. Methodology/Principal Findings: Using a stratified two-stage cluster, cross-sectional design, subjects were recruited from the malaria endemic region of Swaziland. Blood was collected for rapid diagnostic testing (RDT), pooled PCR, and ELISA detecting antibodies to Plasmodium falciparum surface antigens. Of 4330 participants tested, three were RDT-positive yet false positives by PCR. Pooled PCR led to the identification of one P. falciparum and one P. malariae infection among RDT-negative participants. The P. falciparum-infected participant reported recent travel to Mozambique. Compared to performing individual testing on thousands of samples, PCR pooling reduced labor and consumable costs by 95.5%. Seropositivity was associated with age ≥20 years (11·7% vs 1·9%, P<0.001), recent travel to Mozambique (OR 4.4 [95% CI 1.0-19.0]) and residence in southeast Swaziland (RR 3.78, P<0.001). Conclusions: The prevalence of malaria infection and recent exposure in Swaziland are extremely low, suggesting elimination is feasible. Future efforts should address imported malaria and target remaining foci of transmission. Pooled PCR and ELISA are valuable surveillance tools for guiding elimination efforts.

Original languageEnglish (US)
Article numbere29550
JournalPLoS One
Volume7
Issue number1
DOIs
StatePublished - Jan 6 2012

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Swaziland
Serology
cross-sectional studies
malaria
Malaria
Cross-Sectional Studies
Plasmodium falciparum
Polymerase Chain Reaction
monitoring
Testing
Mozambique
travel
testing
enzyme-linked immunosorbent assay
infection
Surface Antigens
Infection
Enzyme-Linked Immunosorbent Assay
surface antigens
Blood

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Surveillance for malaria elimination in Swaziland : A national cross-sectional study using pooled PCR and serology. / Hsiang, Michelle S.; Hwang, Jimee; Kunene, Simon; Drakeley, Chris; Kandula, Deepika; Novotny, Joseph; Parizo, Justin; Jensen, Trevor; Tong, Marcus; Kemere, Jordan; Dlamini, Sabelo; Moonen, Bruno; Angov, Evelina; Dutta, Sheetij; Ockenhouse, Christian; Dorsey, Grant; Greenhouse, Bryan.

In: PLoS One, Vol. 7, No. 1, e29550, 06.01.2012.

Research output: Contribution to journalArticle

Hsiang, MS, Hwang, J, Kunene, S, Drakeley, C, Kandula, D, Novotny, J, Parizo, J, Jensen, T, Tong, M, Kemere, J, Dlamini, S, Moonen, B, Angov, E, Dutta, S, Ockenhouse, C, Dorsey, G & Greenhouse, B 2012, 'Surveillance for malaria elimination in Swaziland: A national cross-sectional study using pooled PCR and serology', PLoS One, vol. 7, no. 1, e29550. https://doi.org/10.1371/journal.pone.0029550
Hsiang, Michelle S. ; Hwang, Jimee ; Kunene, Simon ; Drakeley, Chris ; Kandula, Deepika ; Novotny, Joseph ; Parizo, Justin ; Jensen, Trevor ; Tong, Marcus ; Kemere, Jordan ; Dlamini, Sabelo ; Moonen, Bruno ; Angov, Evelina ; Dutta, Sheetij ; Ockenhouse, Christian ; Dorsey, Grant ; Greenhouse, Bryan. / Surveillance for malaria elimination in Swaziland : A national cross-sectional study using pooled PCR and serology. In: PLoS One. 2012 ; Vol. 7, No. 1.
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AU - Drakeley, Chris

AU - Kandula, Deepika

AU - Novotny, Joseph

AU - Parizo, Justin

AU - Jensen, Trevor

AU - Tong, Marcus

AU - Kemere, Jordan

AU - Dlamini, Sabelo

AU - Moonen, Bruno

AU - Angov, Evelina

AU - Dutta, Sheetij

AU - Ockenhouse, Christian

AU - Dorsey, Grant

AU - Greenhouse, Bryan

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