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<p>Asymptomatic malaria frequently evades routine diagnostics and sustains a hidden transmission reservoir, as low-density gametocytes remain undetectable by microscopy or RDT. Sensitive molecular tools—especially RT-qPCR targeting pfs16 and pfs25—are essential for identifying this reservoir, yet such data are limited for Northeast India. We surveyed 343 asymptomatic individuals from three districts of Assam (Dibrugarh, Sivasagar, and Udalguri) between February and June 2022. Inclusion criteria were age ≥ 10&#xa0;years, absence of fever or malaria-related symptoms in the preceding 72&#xa0;h, and no antimalarial drug use at enrollment. RT-qPCR targeting pfs25 and pfs16 transcripts was performed to detect gametocytes. In addition, 12 RT-qPCR–positive patients from Dibrugarh were followed longitudinally to assess gametocyte persistence post-treatment. Overall malaria prevalence was 2.6% (9/343) by RDT and light microscopy and 2.9% (10/343) by nested 18S rDNA PCR. In contrast, RT-qPCR detected mature gametocytes in 12.5% (43/343) of participants. Adults represented 97.7% (335/343) of the cohort, with 13.7% (41/335) gametocyte-positive, while 25% (2/8) of adolescents carried gametocytes. Gametocyte prevalence varied by district, being highest in Udalguri (24/153, 15.7%). In the follow-up study, all 12 patients retained detectable gametocyte transcripts up to Day 7 post-treatment, despite receiving artemether–lumefantrine plus primaquine. Transcript levels of pfs16 and pfs25 declined but did not reach complete clearance. Submicroscopic gametocytemia was widespread among asymptomatic individuals, with RT-qPCR detecting over five-fold more infections than routine diagnostics. Gametocyte transcripts persisted up to seven days after treatment, indicating continued transmission potential and reinforcing the need for sensitive molecular surveillance and effective transmission-blocking measures.</p>

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Asymptomatic carriage of Plasmodium falciparum gametocytes in Northeast India: evidence from a multicentric molecular study

  • 期刊论文

  • 发表日期：

    2026年5月29日

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  • Nivedita Sharma,
  • Hari Shankar,
  • M. Abdul Kareem,
  • Neelima Mishra

摘要

Asymptomatic malaria frequently evades routine diagnostics and sustains a hidden transmission reservoir, as low-density gametocytes remain undetectable by microscopy or RDT. Sensitive molecular tools—especially RT-qPCR targeting pfs16 and pfs25—are essential for identifying this reservoir, yet such data are limited for Northeast India. We surveyed 343 asymptomatic individuals from three districts of Assam (Dibrugarh, Sivasagar, and Udalguri) between February and June 2022. Inclusion criteria were age ≥ 10 years, absence of fever or malaria-related symptoms in the preceding 72 h, and no antimalarial drug use at enrollment. RT-qPCR targeting pfs25 and pfs16 transcripts was performed to detect gametocytes. In addition, 12 RT-qPCR–positive patients from Dibrugarh were followed longitudinally to assess gametocyte persistence post-treatment. Overall malaria prevalence was 2.6% (9/343) by RDT and light microscopy and 2.9% (10/343) by nested 18S rDNA PCR. In contrast, RT-qPCR detected mature gametocytes in 12.5% (43/343) of participants. Adults represented 97.7% (335/343) of the cohort, with 13.7% (41/335) gametocyte-positive, while 25% (2/8) of adolescents carried gametocytes. Gametocyte prevalence varied by district, being highest in Udalguri (24/153, 15.7%). In the follow-up study, all 12 patients retained detectable gametocyte transcripts up to Day 7 post-treatment, despite receiving artemether–lumefantrine plus primaquine. Transcript levels of pfs16 and pfs25 declined but did not reach complete clearance. Submicroscopic gametocytemia was widespread among asymptomatic individuals, with RT-qPCR detecting over five-fold more infections than routine diagnostics. Gametocyte transcripts persisted up to seven days after treatment, indicating continued transmission potential and reinforcing the need for sensitive molecular surveillance and effective transmission-blocking measures.