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- Title
Advocating for PCR-RFLP as molecular tool within malaria programs in low endemic areas and low resource settings.
- Authors
Labadie-Bracho, Mergiory Y.; Adhin, Malti R.
- Abstract
The road to malaria elimination for low- and middle-income countries is paved with obstacles, including the complexity and high costs of advanced molecular methods for genomic analysis. The usefulness of PCR-RFLP as less complex and affordable molecular surveillance tool in low-endemic malaria regions was assessed in a cross-sectional study conducted in Suriname, currently striving for malaria elimination, but plagued by recent P. vivax outbreaks. Molecular analysis of two highly polymorphic genes Pvmsp-1 F2 and Pvmsp-3α was performed for 49 samples, collected during October 2019 through September 2021 from four different regions with varying malaria transmission risks. RFLP-profiling revealed that outbreak samples from three indigenous villages, almost exclusively, harbored a single clonal type, matching the "Palumeu" lineage previously described in 2019, despite multiple relapses and drug pressure exerted by mass drug administration events, suggesting a limited P. vivax hypnozoite reservoir in Suriname. In contrast, isolates originating from Sophie, a mining area in neighboring French Guiana displayed a highly heterogeneous parasite population consistent with its endemic malaria status, demonstrating the differentiating capacity and thus the usefulness of PCR-RFLP for P. vivax genetic diversity studies. Outbreak reconstruction emphasized the impact of undetected human movement and relapses on reintroduction and resurgence of P. vivax malaria and PCR-RFLP monitoring of circulating parasites guided the roll-out of targeted interventions. PCR-RFLP seems a suitable molecular alternative in low-endemic areas with restricted resources for outbreak analysis, for monitoring the spread or containment of circulating strains and for identification of imported cases or potential foci. Author summary: The global malaria landscape has changed considerably since 2000, with a drastic reduction of overall malaria cases, but a regional increase of Plasmodium vivax malaria. Suriname is a South American country striving for malaria elimination and Plasmodium vivax malaria is the main impediment, mostly due to the parasite's ability to stay dormant in the liver and relapse within months/years after the initial infection, triggering new outbreaks. As most low- and middle-income countries we are confronted with the lack of effective and affordable molecular tools to assess and monitor the genetic diversity of circulating P. vivax populations. We report the successful application of the PCR-RFLP technique in determining genetic signatures of Plasmodium vivax isolates, obtained from four different regions with varying malaria transmission risks. RFLP-profiling revealed that outbreak samples from three indigenous villages, almost exclusively, harbored a single clonal type, suggesting a limited P. vivax hypnozoite reservoir in Suriname. In contrast, isolates originating from Sophie, a mining area in neighboring French Guiana displayed a heterogeneous parasite population, consistent with its endemic malaria status. We demonstrated the usefulness of PCR-RFLP for assessments of P. vivax genetic diversity, outbreak analysis and identification of imported cases in a low-transmission setting, where resources are limited.
- Subjects
SURINAME; FRENCH Guiana; RESOURCE-limited settings; MALARIA; DISEASE eradication; CIRCULATING tumor DNA; PLASMODIUM vivax; MIDDLE-income countries; GENOMICS
- Publication
PLoS Neglected Tropical Diseases, 2023, Vol 17, Issue 11, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0011747