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- Title
Hyper-diverse antigenic variation and resilience to transmission-reducing intervention in falciparum malaria.
- Authors
Zhan, Qi; He, Qixin; Tiedje, Kathryn E.; Day, Karen P.; Pascual, Mercedes
- Abstract
Intervention efforts against falciparum malaria in high-transmission regions remain challenging, with rapid resurgence typically following their relaxation. Such resilience co-occurs with incomplete immunity and a large transmission reservoir from high asymptomatic prevalence. Incomplete immunity relates to the large antigenic variation of the parasite, with the major surface antigen of the blood stage of infection encoded by the multigene and recombinant family known as var. With a stochastic agent-based model, we investigate the existence of a sharp transition in resurgence ability with intervention intensity and identify molecular indicators informative of its proximity. Their application to survey data with deep sampling of var sequences from individual isolates in northern Ghana suggests that the transmission system was brought close to transition by intervention with indoor residual spraying. These results indicate that sustaining and intensifying intervention would have pushed malaria dynamics to a slow-rebound regime with an increased probability of local parasite extinction. When malaria interventions are relaxed in high transmission settings, incidence often rebounds to pre-intervention levels. Here, the authors investigate the hypothesis that this rebound occurs when transmission intensity remains above a minimum threshold value, at which prevalence and strain diversity decrease sharply with further intervention.
- Subjects
ANTIGENIC variation; CELL surface antigens; MALARIA; STOCHASTIC models; IMMUNITY
- Publication
Nature Communications, 2024, Vol 15, Issue 1, p1
- ISSN
2041-1723
- Publication type
Article
- DOI
10.1038/s41467-024-51468-6