Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 220, Issue 8, Pages 1346-1354Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiz305
Keywords
malaria; malaria elimination; Eswatini; Swaziland; population genetics; microsatellite genotyping; parasite diversity; transmission intensity
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Funding
- Bill and Melinda Gates Foundation [OPP1132226]
- National Institutes of Health/National Institute of Allergy and Infectious Diseases [AI101012]
- Burroughs Wellcome Fund/American Society of Tropical Medicine and Hygiene [A120079]
- Eswatini Ministry of Health through Global Fund to Fight AIDS, Tuberculosis, and Malaria
- Bill and Melinda Gates Foundation [OPP1132226] Funding Source: Bill and Melinda Gates Foundation
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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 [H-E] = 0.75) and complex: 67% polyclonal infections, mean multiplicity of infection (MOI) 2.2, and mean within-host infection fixation index (F-WS) 0.84. Imported cases had comparable diversity to local cases but exhibited higher MOI (2.4 vs 2.0; P =.004) and lower mean F-WS (0.82 vs 0.85; P = .03). Addition of MOI and F-WS 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.
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