Trial reportScientific reports2021
Epidemiology of mutant Plasmodium falciparum parasites lacking histidine-rich protein 2/3 genes in Eritrea 2 years after switching from HRP2-based RDTs.
Trial report in Scientific reports, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 34 citations in OpenAlex.
- First TES in Djibouti: A Critical Milestone Amid Rising Regional Threats.Open forum infectious diseases · 2026Article
- Low prevalence ofFrontiers in epidemiology · 2026Article
- First report of pfhrp2 and pfhrp3 gene deletions compromising HRP2-based malaria rapid diagnostic tests in Malawi.Infectious diseases of poverty · 2025Article
- Plasmodium falciparum Kelch13 Variants and Histidine-Rich Protein 2/3 Deletions in Central Ethiopia, 2023.The American journal of tropical medicine and hygiene · 2025Article
- Deletion of target gene (histidine-rich protein 2/3) for Plasmodium falciparum rapid diagnostic tests in Amhara region, Ethiopia: a cross-sectional study.Malaria journal · 2025Article
- Prevalence of Plasmodium falciparum parasites with pfhrp2 exon 2 gene deletion in symptomatic malaria patients across Ghana in 2021.Malaria journal · 2025Article
- The spread of molecular markers of artemisinin partial resistance and diagnostic evasion in Eritrea: a retrospective molecular epidemiology study.The Lancet. Microbe · 2025Article
- Molecular surveillance of Plasmodium falciparum histidine-rich protein 2/3 gene deletions in Mozambique, 2023.Malaria journal · 2024Article
- Plasmodium falciparum with pfhrp2 and pfhrp3 gene deletions in asymptomatic malaria infections in the Lake Victoria region, Kenya.Tropical medicine and health · 2024Article
- Histidine-rich protein (hrp) 2-based RDT false-negatives and Plasmodium falciparum hrp 2 and 3 gene deletions in low, seasonal and intense perennial transmission zones in Cameroon: a cross - sectional study.BMC infectious diseases · 2024Article
- Widespread pfhrp2/3 deletions and HRP2-based false-negative results in southern Ethiopia.Malaria journal · 2024Article
- Imported malaria into Australia: surveillance insights and opportunities.Journal of travel medicine · 2024Article
- Assessment of the Performance of Lactate Dehydrogenase-Based Rapid Diagnostic Test for Malaria in Djibouti in 2022-2023.Diagnostics (Basel, Switzerland) · 2024Article
- Review
- Key considerations, target product profiles, and research gaps in the application of infrared spectroscopy and artificial intelligence for malaria surveillance and diagnosis.Malaria journal · 2023Review
- Increasing Prevalence of Artemisinin-Resistant HRP2-Negative Malaria in Eritrea.The New England journal of medicine · 2023Article
- Molecular investigation of malaria-infected patients in Djibouti city (2018-2021).Malaria journal · 2023Article
- Low Prevalence ofPathogens (Basel, Switzerland) · 2023Article
- Low frequency ofFrontiers in epidemiology · 2023Article
- Surveillance of pfhrp2 and pfhrp3 gene deletions among symptomatic Plasmodium falciparum malaria patients in Central Vietnam.Malaria journal · 2022Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 3 countries.
Funding
Abstract
Eritrea was the first African country to complete a nationwide switch in 2016 away from HRP2-based RDTs due to high rates of false-negative RDT results caused by Plasmodium falciparum parasites lacking hrp2/hrp3 genes. A cross-sectional survey was conducted during 2019 enrolling symptomatic malaria patients from nine health facilities across three zones consecutively to investigate the epidemiology of P. falciparum lacking hrp2/3 after the RDT switch. Molecular analyses of 715 samples revealed the overall prevalence of hrp2-, hrp3-, and dual hrp2/3-deleted parasites as 9.4% (95%CI 7.4-11.7%), 41.7% (95% CI 38.1-45.3%) and 7.6% (95% CI 5.8-9.7%), respectively. The prevalence of hrp2- and hrp3-deletion is heterogeneous within and between zones: highest in Anseba (27.1% and 57.9%), followed by Gash Barka (6.4% and 37.9%) and Debub zone (5.2% and 43.8%). hrp2/3-deleted parasites have multiple diverse haplotypes, with many shared or connected among parasites of different hrp2/3 status, indicating mutant parasites have likely evolved from multiple and local parasite genetic backgrounds. The findings show although prevalence of hrp2/3-deleted parasites is lower 2 years after RDT switching, HRP2-based RDTs remain unsuitable for malaria diagnosis in Eritrea. Continued surveillance of hrp2/3-deleted parasites in Eritrea and neighbouring countries is required to monitor the trend.
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