Active case surveillance, passive case surveillance and asymptomatic malaria parasite screening illustrate different age distribution, spatial clustering and seasonality in western Kenya.

Background: Epidemiological characteristics of clinical malaria may differ from asymptomatic infections, thus both cross-sectional parasite screening and longitudinal clinical case surveillance are necessary for malaria transmission monitoring and control. Methods: In order to monitor malaria transmission, surveillance of clinical malaria from two years of active case surveillance in three cohorts of 6,750 individuals, asymptomatic parasitaemia cases of 5,300 individuals and clinical cases in three study areas were carried out in the western Kenyan highlands in 2009 and 2010. Age distribution, seasonality and spatial clustering were analysed. Results: The results revealed a significant difference in the age distribution of clinical cases between passive and active case surveillance, and between clinical case rate and asymptomatic parasite rate. The number of reported cases from health facilities significantly underestimated clinical malaria incidence. The increase in asymptomatic parasite prevalence from low to high transmission seasons was significantly higher for infants (<two years) and adults (≥15 years) (500% increase) than that for children (two to 14 years, 65%), but the increase in clinical incidence rates was significantly higher for children (700%) than that for adults (300%). Hotspot of asymptomatic infections remained unchanged over time, whereas new clusters of clinical malaria cases emerged in the uphill areas during the peak season. Conclusions: Different surveillance methods revealed different characteristics of malaria infections. The new transmission hotspots identified during the peak season with only active case surveillance is an important observation with clear implications in the context of malaria elimination. Both mass parasite screening and active case surveillance are essential for malaria transmission monitoring and control. [ABSTRACT FROM AUTHOR]