SUBMICROSCOPIC PLASMODIUM FALCIPARUM GAMETOCYTE DENSITIES FREQUENTLY RESULT IN MOSQUITO INFECTION

PETRA SCHNEIDER Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; International Centre for Insect Physiology and Ecology, Mbita, Kenya; Kenya Medical Research Institute, Nairobi, Kenya

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J. TEUN BOUSEMA Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; International Centre for Insect Physiology and Ecology, Mbita, Kenya; Kenya Medical Research Institute, Nairobi, Kenya

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LOUIS C. GOUAGNA Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; International Centre for Insect Physiology and Ecology, Mbita, Kenya; Kenya Medical Research Institute, Nairobi, Kenya

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SILAS OTIENO Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; International Centre for Insect Physiology and Ecology, Mbita, Kenya; Kenya Medical Research Institute, Nairobi, Kenya

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MARGA VAN DE VEGTE-BOLMER Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; International Centre for Insect Physiology and Ecology, Mbita, Kenya; Kenya Medical Research Institute, Nairobi, Kenya

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SABAH A. OMAR Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; International Centre for Insect Physiology and Ecology, Mbita, Kenya; Kenya Medical Research Institute, Nairobi, Kenya

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ROBERT W. SAUERWEIN Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; International Centre for Insect Physiology and Ecology, Mbita, Kenya; Kenya Medical Research Institute, Nairobi, Kenya

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Submicroscopic Plasmodium falciparum gametocytemia (< 5,000 gametocytes/mL) is common and may result in mosquito infection. We assessed the relation between gametocyte density and mosquito infection under experimental and field conditions using real-time quantitative nucleic acid sequence-based amplification (QT-NASBA) for gametocyte quantification. Serial dilutions of NF54 P. falciparum gametocytes showed a positive association between gametocyte density and the proportion of infected mosquitoes (β = 6.1; 95% confidence interval [CI], 2.7–9.6; P = 0.001). Successful infection became unlikely below an estimated density of 250–300 gametocytes/mL. In the field, blood samples of 100 naturally infected children showed a positive association between gametocyte density and oocyst counts in mosquitoes (β = 0.38; 95% CI, 0.14–0.61; P = 0.002). The relative contribution to malaria transmission was similar for carriers with submicroscopic and microscopic gametocytemia. Our results show that transmission occurs efficiently at submicroscopic gametocyte densities and that carriers harboring submicroscopic gametocytemia constitute a considerable proportion of the human infectious reservoir.

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