TY - JOUR
T1 - High Genetic Diversity of Plasmodium falciparum in the Low-Transmission Setting of the Kingdom of Eswatini
AU - Roh, Michelle E.
AU - Tessema, Sofonias K.
AU - Murphy, Maxwell
AU - Nhlabathi, Nomcebo
AU - Mkhonta, Nomcebo
AU - Vilakati, Sibonakaliso
AU - Ntshalintshali, Nyasatu
AU - Saini, Manik
AU - Maphalala, Gugu
AU - Chen, Anna
AU - Wilheim, Jordan
AU - Prach, Lisa
AU - Gosling, Roly
AU - Kunene, Simon
AU - Hsiang, Michelle
AU - Greenhouse, Bryan
N1 - Funding Information:
Financial support. This work was supported by the Bill and Melinda Gates Foundation (grant number OPP1132226); the National Institutes of Health/National Institute of Allergy and Infectious Diseases (grant number AI101012); and Burroughs Wellcome Fund/American Society of Tropical Medicine and Hygiene (grant number A120079); surveillance activities were also supported by the Eswatini Ministry of Health, partly through funding from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Funding Information:
This work was supported by the Bill and Melinda Gates Foundation (grant number OPP1132226); the National Institutes of Health/National Institute of Allergy and Infectious Diseases (grant number AI101012); and Burroughs Wellcome Fund/American Society of Tropical Medicine and Hygiene (grant number A120079); surveillance activities were also supported by the Eswatini Ministry of Health, partly through funding from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The authors thank the participants for contributing their samples to the study; the health worker staff who performed sample and data collection; and the Eswatini National Malaria Program and the Clinton Health Access Initiative for their support in data collection.
Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2019/9/13
Y1 - 2019/9/13
N2 - Background: To better understand transmission dynamics, we characterized Plasmodium falciparum genetic diversity in Eswatini, where transmission is low and sustained by importation. Methods: Twenty-six P. falciparum microsatellites were genotyped in 66% of confirmed cases (2014-2016; N = 582). Population and within-host diversity were used to characterize differences between imported and locally acquired infections. Logistic regression was used to assess the added value of diversity metrics to classify imported and local infections beyond epidemiology data alone. Results: Parasite population in Eswatini was highly diverse (expected heterozygosity [HE] = 0.75) and complex: 67% polyclonal infections, mean multiplicity of infection (MOI) 2.2, and mean within-host infection fixation index (FWS) 0.84. Imported cases had comparable diversity to local cases but exhibited higher MOI (2.4 vs 2.0; P =. 004) and lower mean FWS (0.82 vs 0.85; P =. 03). Addition of MOI and FWS to multivariate analyses did not increase discrimination between imported and local infections. Conclusions: In contrast to the common perception that P. falciparum diversity declines with decreasing transmission intensity, Eswatini isolates exhibited high parasite diversity consistent with high rates of malaria importation and limited local transmission. Estimates of malaria transmission intensity from genetic data need to consider the effect of importation, especially as countries near elimination.
AB - Background: To better understand transmission dynamics, we characterized Plasmodium falciparum genetic diversity in Eswatini, where transmission is low and sustained by importation. Methods: Twenty-six P. falciparum microsatellites were genotyped in 66% of confirmed cases (2014-2016; N = 582). Population and within-host diversity were used to characterize differences between imported and locally acquired infections. Logistic regression was used to assess the added value of diversity metrics to classify imported and local infections beyond epidemiology data alone. Results: Parasite population in Eswatini was highly diverse (expected heterozygosity [HE] = 0.75) and complex: 67% polyclonal infections, mean multiplicity of infection (MOI) 2.2, and mean within-host infection fixation index (FWS) 0.84. Imported cases had comparable diversity to local cases but exhibited higher MOI (2.4 vs 2.0; P =. 004) and lower mean FWS (0.82 vs 0.85; P =. 03). Addition of MOI and FWS to multivariate analyses did not increase discrimination between imported and local infections. Conclusions: In contrast to the common perception that P. falciparum diversity declines with decreasing transmission intensity, Eswatini isolates exhibited high parasite diversity consistent with high rates of malaria importation and limited local transmission. Estimates of malaria transmission intensity from genetic data need to consider the effect of importation, especially as countries near elimination.
KW - Eswatini
KW - Swaziland
KW - malaria
KW - malaria elimination
KW - microsatellite genotyping
KW - parasite diversity
KW - population genetics
KW - transmission intensity
UR - http://www.scopus.com/inward/record.url?scp=85072234390&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072234390&partnerID=8YFLogxK
U2 - 10.1093/infdis/jiz305
DO - 10.1093/infdis/jiz305
M3 - Article
C2 - 31190073
AN - SCOPUS:85072234390
SN - 0022-1899
VL - 220
SP - 1346
EP - 1354
JO - The Journal of infectious diseases
JF - The Journal of infectious diseases
IS - 8
ER -