ArticleThe Journal of infectious diseases2026
Uneven Plasmodium falciparum Transmission and Cryptic ovale Transmission From the Asymptomatic Reservoir in Bagamoyo, Tanzania.
Article in The Journal of infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAsymptomatic malaria carriers often harbor low parasite densities missed by rapid diagnostic tests (RDTs), yet they contribute to transmission. Direct skin feeding (DSF) assays can sensitively measure their infectiousness to mosquitoes.
methodsTo characterize human-to-mosquito transmission from the asymptomatic reservoir in Bagamoyo, Tanzania, DSFs were performed in persons >5 years of age positive for Plasmodium falciparum by RDT or real-time PCR. Fifty colony-reared Anopheles gambiae were fed on the posterior calves. Successful mosquito infection was defined as ≥1 oocyst-positive mosquito midgut among 25 dissected eight days postskin feeding.
resultsAmong 491 participants with median parasite density of 5.1 parasites/μL who underwent DSF, 22% were infectious to mosquitoes. RDT-positive participants infected roughly twice as many mosquitoes compared to RDT-negative/PCR-positive persons. However, up to 21% of infectious carriers were PCR-negative at the time of skin feeding, after screening PCR-positive a few days earlier. Overall, 9.1% (342/3741) of mosquitoes fed on infectious carriers were parasite-positive at dissection. Half of infectious individuals infected a single mosquito, while the top 16 transmitters (3% of those undergoing DSF) cumulatively infected 57% of infected mosquitoes. RDT-positive school-age children (6-15 years), 27% of the DSF cohort, contributed to 58% of infected mosquitoes. Unexpectedly, mosquito midguts from 39 DSFs (44% of oocyst-positive feeds analyzed) tested positive for Plasmodium ovale.
conclusionsParasites circulating at the limit of PCR detection commonly infect mosquitoes. However, a small proportion of highly infectious carriers contribute disproportionately to transmission, offering potential for targeted interventions. P. ovale was frequently co-transmitted with P. falciparum to mosquitoes.
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