# Epidemiology and transmission of subclinical malaria

> **NIH NIH U19** · DUKE UNIVERSITY · 2020 · $122,113

## Abstract

Project 1 of the Myanmar Regional ICEMR addresses questions in Research Areas A, Epidemiology and B,
Transmission. Malaria elimination may require eradicating all parasites from all infected persons, not just those
with clinical symptoms. If clinical malaria represents the “tip of the iceberg”, understanding the rest of the
iceberg—whether it poses risk or even benefit to infected individuals, and how it contributes to transmission in
different epidemiological settings—will be important for malaria control and elimination. Using an ultrasensitive
reverse transcription PCR (usPCR) assay, we are finding highly heterogeneous malaria prevalence of malaria
in Myanmar. The World Health Organization recently endorsed mass drug administration (MDA) in Southeast
Asia, and MDA is being undertaken in Myanmar based on subclinical malaria prevalence as measured by
usPCR. However, no previous studies have assessed the clinical risks or transmission potential of the
extremely low density malaria infections detected by these tests. The first aim of Project 1 is to measure the
dynamics of subclinical malaria infections and assess their contribution to the risk of clinical malaria and to
transmission potential in Southeast Asia. We hypothesize that persistent subclinical Plasmodium falciparum
and P. vivax infections represent chronic infection that protects against clinical manifestations of malaria, and
that subclinical malaria infections represent a potential source of transmission. A multicenter, matched cohort
study will be conducted at six sites in Myanmar and along its borders with China and Bangladesh. usPCR will
be used to measure the prevalence and dynamics of subclinical ultralow density P. falciparum and P. vivax
infection. The association of subclinical infection with incidence of clinical malaria and infectivity will be
estimated using multivariate and time-to-event models. This aim will generate evidence to guide
recommendations about MDA and other elimination interventions. We also designed and are using protein and
peptide microarrays to measure antibody responses to large numbers of variants of diverse malaria and
mosquito proteins. These microarrays may prove useful as surveillance tools to measure exposure to parasites
and mosquitoes, and provide a way to characterize genetic diversity in low density infections that are difficult to
genotype. The second aim is to estimate recent and remote exposure to malaria parasites and vectors in
humans using these arrays to measure seroreactivity to diverse malaria and mosquito antigens, testing the
hypotheses that antibody responses to diverse variants of P. falciparum and P. vivax antigens are associated
with exposure to new malaria infections; antibody responses to diverse Anopheles antigens are independently
associated with risk factors for mosquito exposure and with local vector diversity and abundance; and
seroreactivity to gametocyte proteins is associated with infectivity. This aim will generate set...

## Key facts

- **NIH application ID:** 9912075
- **Project number:** 5U19AI129386-04
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Myaing Myaing Nyunt
- **Activity code:** U19 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $122,113
- **Award type:** 5
- **Project period:** — → 2021-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9912075

## Citation

> US National Institutes of Health, RePORTER application 9912075, Epidemiology and transmission of subclinical malaria (5U19AI129386-04). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/9912075. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*