Plasmodium vivax Malaria in Duffy-Positive Patients in Rwanda

Welmoed van Loon Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany;

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Rafael Oliveira Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany;
John Curtin School of Medical Research, Australian National University, Canberra, Australia;

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Clara Bergmann Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany;

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Felix Habarugira Pathology Department, University Teaching Hospital of Butare, Huye, Rwanda;

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Costanza Tacoli Malaria Molecular Epidemiology Unit Institut Pasteur du Cambodge, Phnom Penh, Cambodia;

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Julia Jäger Associatid Group Immune Ontogeny and Viral Infections, Leibniz Institute of Virology, Hamburg, Germany;

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Darius Savelsberg Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany;

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Djibril Mbarushimana Pathology Department, University Teaching Hospital of Butare, Huye, Rwanda;

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Jules M. Ndoli Clinical Education and Research Division, University Teaching Hospital of Butare, Huye, Rwanda;

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Augustin Sendegeya Chief Medical Office, King Faisal Hospital, Kigali, Rwanda;

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Claude Bayingana Clinical Biology, University of Rwanda, Kigali, Rwanda

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Frank P. Mockenhaupt Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany;

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ABSTRACT.

Plasmodium vivax is the second-most common malaria pathogen globally, but is considered very rare in the predominantly Duffy-negative sub-Saharan African population. In 259 malaria patients from highland southern Rwanda, we assessed Plasmodium species and Duffy blood group status by polymerase chain reaction (PCR). Plasmodium falciparum, P. vivax, Plasmodium malariae, and Plasmodium ovale were seen in 90.7%, 8.1%, 11.6%, and 5.0%, respectively. Plasmodium vivax occurred more frequently as a monoinfection than in combination with P. falciparum. All P. vivax–infected individuals showed heterozygous Duffy positivity, whereas this was the case for only 3.1% of patients with P. falciparum monoinfection and malaria-negative control subjects (P < 0.01). Based on PCR diagnosis, P. vivax is not rare in southern Rwanda. All episodes of P. vivax were observed in heterozygous Duffy-positive patients, whereas elsewhere in Africa, P. vivax is also reported in Duffy-negative individuals. Refined mapping of Plasmodium species is required to establish control and elimination strategies including all malaria species.

Author Notes

Address correspondence to Welmoed van Loon, Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin 13353, Germany. E-mail: welmoed.van-loon@charite.de

Financial support: The German Research Foundation supported this study through grants to W. v. L. (GRK2046) and R. O. and C. B. (GRK2290). The funding body had no role in designing the study; collecting, analyzing, or interpreting data; or writing the manuscript.

Ethical clearance was granted by the Rwanda National Ethics Committee (No. 416/RNEC/2017 and No. 686/RNEC/2019).

Authors’ addresses: Welmoed van Loon, Clara Bergmann, Darius Savelsberg, and Frank P. Mockenhaupt, Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany, E-mails: welmoed.van-loon@charite.de, clara.bergmann@charite.de, darius.savelsberg@charite.de, and frank.mockenhaupt@charite.de. Rafael Oliveira, Institute of International Health, Center for Global Health, Charité–Universitätsmedizin Berlin, Berlin, Germany, and John Curtin School of Medical Research, Australian National University, Canberra, Australia, E-mail: rafael.oliveira@charite.de. Felix Habarugira, and Djibril Mbarushimana, Pathology Department, University Teaching Hospital of Butare, Huye, Rwanda, E-mails: jndoli1971@gmail.com, camaradee@gmail.com. Costanza Tacoli, Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia, E-mail: ctacoli@pasteur-kh.org. Julia Jäger, Associated Group Immune Ontogeny and Viral Infections, Leibniz Institute of Virology, Hamburg, Germany, E-mail: julia.jaeger@leibniz-liv.de. Jules M. Ndoli, Clinical Education and Research Division,University Teaching Hospital of Butare, Huye, Rwanda, E-mail: djidji01@gmail.com. Augustin Sendegeya, Chief Medical Office, King Faisal Hospital, Kigali, Rwanda, E-mail: augdr2002@gmail.com. Claude Bayingana, Clinical Biology, University of Rwanda, Kigali, Rwanda, E-mail: cbayrw2000@yahoo.fr.

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