Community-based molecular and serological surveillance of subclinical malaria in Myanmar

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>In the Greater Mekong Subregion (GMS), current malaria surveillance strategies rely on a network of village health volunteers (VHVs) reporting the results of rapid diagnostic tests (RDTs), known to miss many asymptomatic infections. Integration of more sensitive diagnostic molecular and serological measures into the VHV network may improve surveillance of residual malaria transmission in hard-to-reach areas in the region and inform targeted interventions and elimination responses. However, data on residual malaria transmission that would be captured by these measures in the VHV-led testing and treatment surveillance network in the GMS is unknown.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>A total of 114 VHVs were trained to collect dried blood spots from villagers undergoing routine RDTs as part of VHV-led active and passive case detection from April 2015 to June 2016. Samples were subjected to molecular testing (quantitative polymerase chain reaction [qPCR]) to determine <jats:italic>Plasmodium falciparum</jats:italic> and <jats:italic>P. vivax</jats:italic> infection and serological testing (against <jats:italic>P. falciparum</jats:italic> and <jats:italic>P. vivax</jats:italic> antigens) to determine exposure to <jats:italic>P. falciparum</jats:italic> and <jats:italic>P. vivax</jats:italic>.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Over 15 months, 114 VHVs performed 32,194 RDTs and collected samples for molecular (<jats:italic>n</jats:italic> = 13,157) and serological (<jats:italic>n</jats:italic> = 14,128) testing. The prevalence of molecular-detectable <jats:italic>P. falciparum</jats:italic> and <jats:italic>P. vivax</jats:italic> infection was 3.2% compared to the 0.16% prevalence of <jats:italic>Plasmodium</jats:italic> spp. by RDT, highlighting the large burden of infections undetected by standard surveillance.