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A cross-sectional study was conducted in the Peruvian Amazon to test the hypothesis that a reservoir of asymptomatic malaria parasitemic patients would form the basis for continuing malaria endemicity in the region. Active surveillance yielded a Plasmodium spp. slide-positive prevalence of 4.2% (43 of 1,023) and a polymerase chain reaction (PCR)–positive prevalence of 17.6% (144 of 819). Plasmodium vivax prevalence was 2.9% and 14.2% while Plasmodium falciparum prevalence was 1.3% and 2.6% by microscopy and PCR, respectively. Approximately two-thirds of slide-positive and one-fourth of PCR-positive people were symptomatic. Anemia was associated with slide positivity (P < 0.001) and PCR positivity for P. falciparum (P = 0.003). Sensitivity of field microscopy and agreement between field and reference laboratory microscopists were low, arguing for using PCR for epidemiologic investigation and malaria control. While these data confirm recent findings from the Brazilian Amazon suggesting that sufficient numbers of asymptomatic malaria parasitemic patients are present to form a persistent reservoir for continuous reinfection within the Peruvian Amazon region, these results also indicate that clinical immunity in human populations can be driven in malaria-endemic regions that do not have high intensity malaria transmission
Received October 21, 2002. Accepted for publication April 16, 2003.
Acknowledgments: We thank the health promoters in Milagro and Moralillo, Manuel Silva Fasabi and Welinton Flores Flores, along with Yank Daniel Flores Bartra for their invaluable assistance, and the residents of Moralillo, Milagro, San Carlos, and Varillal for their gracious cooperation. We also thank Drs. C. Evans and M. A. James for their comments on the manuscript, and J. B. Phu, D. Sarah, S. Haji, and M. H. Ravan for their technical support.
Financial support: This work was supported by the Fogarty International Center at the National Institutes of Health (Bethesda, MD) (International Training and Research in Emerging Infectious Diseases grant), the National Institute of Allergy and Infectious Diseases (grants AI-45999 and AI-50049) the U.S. Agency for International Development, the Doris Duke Charitable Foundation Innovations in Clinical Research Award, and the anonymous RG-ER fund.
Authors’ addresses: Baback Roshanravan, Elina Kari, Lilia Cabrera, Ellen Lee, John Metcalfe, and Andres G. Lescano, Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Calle Carlos Gonzales 251, Urbanización, Maranga, San Miguel, Lima 32, Peru, Telephone: 51-1-464-0221, Fax: 51-1-464-0781. Robert H. Gilman, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room W3503, Baltimore, MD 21205, Telephone: 410-614-3959, Fax: 410-614-6060, E-mail: rgilman{at}jhsph.edu. Maritza Calderon, Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado, S/N San Martín de Porres, Lima 31, Peru, Telephone: 51-1-483 2942. So-nia H. Montenegro, Molecular Immunogenetics Laboratory, Division of Research, Ochsner Clinic Foundation, 1516 Jefferson Highway, Biomedical Research Building, Room 1N408, New Orleans, LA 70121, Telephone: 504-842-3768, Fax: 504-842-3381. Carlos Calampa, Dirección Regional de Salud de Loreto, Iquitos, Perú. Joseph M. Vinetz, University of California San Diego School of Medicine, Division of Infectious Diseases, 9500 Gilman Drive, 0640, Cellular and Molecular Medicine-East, Room 2052, La Jolla, CA 92093-0640. Telephone: 858-822-4469, Fax: 858-534-6020, Email: jvinetz{at}ucsd.edu.
Reprint requests: Robert H. Gilman, Department of International Health, Johns Hopkins School of Hygiene and Public Health, Room W3503, 615 North Wolfe Street, Baltimore, MD 21205.
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