ENDEMIC MALARIA IN THE PERUVIAN AMAZON REGION OF IQUITOS

BABACK ROSHANRAVAN Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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ELINA KARI Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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ROBERT H. GILMAN Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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LILIA CABRERA Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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ELLEN LEE Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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JOHN METCALFE Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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MARITZA CALDERON Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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ANDRES G. LESCANO Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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SONIA H. MONTENEGRO Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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CARLOS CALAMPA Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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JOSEPH M. VINETZ Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Universidad Peruana Cayetano Heredia, Lima, Peru; Ochsner Clinic Foundation, New Orleans, Louisiana; Proyectos en Informática Salud, Medicina y Agricultura (Asociación Benéfica PRISMA), Lima, Peru; Dirección Regional de Salud de Loreto, Iquitos, Peru; World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas

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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

Author Notes

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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