Burden of Submicroscopic Plasmodium Infections and Detection of kelch13 Mutant Parasites in Military and Civilian Populations in Papua New Guinea

Paul A. Pickering Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia;

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Ivor Harris Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia;

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David Smith Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia;

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Fiona McCallum Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia;

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Peter Kaminiel Papua New Guinea Defence Force Health Service, Port Moresby, Papua New Guinea

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Alyson Auliff Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia;

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Qin Cheng Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia;

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ABSTRACT.

Malaria remains a major public health problem in Papua New Guinea (PNG) and an important force health protection issue for both PNG and Australian Defence Forces. To investigate the malaria burden in the military and civilians residing on military bases, a cross-sectional survey was conducted in April 2019 at three military bases in Wewak, Manus Island, and Vanimo, PNG. A total of 1,041 participants were enrolled; 235 military personnel from three bases and 806 civilians from Wewak and Vanimo. Polymerase chain reaction (PCR) revealed an overall high prevalence of Plasmodium infection in both the military and civilians. Among the military, the infection prevalence was significantly higher in Wewak (35.5%) and Vanimo (33.3%) bases than on Manus Island (11.8%). Among civilians, children (<16 years old) had significantly higher odds of being PCR positive than adults (≥16 years old). At Wewak and Vanimo, Plasmodium vivax accounted for 85.4%, 78.2%, and 66.2% of infections in military, children, and adult populations. Overall, 87.3%, 41.3%, and 61.3% of Plasmodium infections in the military, children, and adults, respectively, were detected only by PCR, not by microscopy (submicroscopic [SM] infections). Children had a significantly lower proportion of SM infections than adults and Papua New Guinea Defence Force personnel. Infection status was not associated with hemoglobin levels in these populations at the time of the survey. Mutant kelch13 (C580Y) parasites were identified in 5/68 Plasmodium falciparum–infected individuals. The survey results indicate extensive malaria transmission on these bases, especially in Wewak and Vanimo. More intensified interventions are required to reduce malaria transmission on PNG military bases.

Author Notes

Financial support: This work was supported by the Australian Defence Organization’s International Policy Division. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclosure: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defence, Australia and the PNG Defence Force. Ethical approvals for the conduct of the survey and laboratory tests were granted by the Departments of Defence and Veterans’ Affairs Human Research Ethics Committee (DDVA HREC 084-18) and the Medical Research Advisory Committee of PNG (MRAC No: 18.21).

Data availability: Data generated from this study are included in the published article or as supplementary information. Data are also available from the corresponding author on request.

Authors’ addresses: Paul A. Pickering, Ivor Harris, David Smith, Fiona McCallum, Alyson Auliff, and Qin Cheng, Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia, E-mails: paul.pickering@defence.gov.au, ivorharris@hotmail.com, david.smith77@defence.gov.au, fiona.mccallum@defence.gov.au, alyson.auliff@defence.gov.au, and qin.cheng@defence.gov.au. Peter Kaminiel, Papua New Guinea Defence Force Health Service, Port Moresby, Papua New Guinea, E-mail: pngdfdhs007@gmail.com.

Address correspondence to Qin Cheng, Drug Resistance and Diagnostics, Australian Defence Force Malaria and Infectious Disease Institute, Weary Dunlop Dr., Gallipoli Barracks, Enoggera, Brisbane, QLD 4051, Australia. E-mail: qin.cheng@defence.gov.au
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