Impact of malaria elimination on immunity and risk of malaria rebound in Myanmar (360G-Wellcome-214208_Z_18_Z)

The emergence and spread of ACT resistant falciparum malaria ,and the discovery that there were substantial reservoirs of subpatent parasites in populations residing at low transmission area has led to calls for radical interventions to eliminate the disease from the Greater Mekong SubRegion. Several pilot studies of mass drug administration (MDA) have now taken place, including two in Myanmar. With adequate population coverage MDA leads to rapid reductions in malaria incidence. It is hoped that these reductions will be sustained by networks of village health workers who provide early malaria diagnosis and treatment to symptomatic cases. However submicroscopic malaria (undetectable by conventional diagnostic tools) could be a substantial source of resurgent malaria and undermine the success of MDA. Defining the probability of malaria resurgence relies on knowledge of the immune status of a population overtime. I plan to study longitudinal changes in malaria antibody responses in individuals residing in villages where MDA was implemented along the Thai-Myanmar border, and see if they can predict reintroduction of submicroscopic malaria infection. Using high-throughput ELISA, I will measure antibodies to P. falciparum and vivax antigens to evaluate whether there is any change in antibody level which could predict submicroscopic (or symptomatic) malaria infection.