Targeting Asymptomatic Malaria Infections: Active Surveillance in Control and Elimination

Hugh J. W. Sturrock mail,
Michelle S. Hsiang,
Justin M. Cohen,
David L. Smith,
Bryan Greenhouse,
Teun Bousema,
Roly D. Gosling

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Citation: Sturrock HJW, Hsiang MS, Cohen JM, Smith DL, Greenhouse B, et al. (2013) Targeting Asymptomatic Malaria Infections: Active Surveillance in Control and Elimination. PLoS Med 10(6): e1001467. doi:10.1371/journal.pmed.1001467

Published: June 18, 2013

Copyright: © 2013 Sturrock et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: HJWS and RDG are supported by a grant from the Bill & Melinda Gates Foundation [#OPP1013170]. MSH is supported by a National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (NIAID) K23 Award [#P0045532] and a Burroughs Wellcome Fund-American Society of Tropical Medicine and Hygiene Fellowship [#P0049395]. DLS acknowledges support from the Bill & Melinda Gates Foundation [#49446], the RAPIDD Program of the Science & Technology Directorate, Department of Homeland Security, and the Fogarty International Center, National Institutes of Health. BG is supported by a NIH/NIAID K23 Award [#AI076614] and is a recipient of a Doris Duke Clinical Scientist Development Award. DLS and BG are also supported by an International Centers of Excellence in Malaria Research U19 [#AI089674]. TB is supported by a Grand Challenge Grant of the Bill & Melinda Gates Foundation (No. OPP1024438). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: ACD, active case detection; ACT, artemisinin combination therapy; G6PD, glucose-6-phosphate-dehydrogenase; GPS, global positioning system; IRS, indoor residual spraying; ITN, insecticide-treated nets; LAMP, loop-attenuated isothermal amplification; LLIN, long-lasting insecticidal nets; MDA, mass drug administration; RACD, reactive case detection; PACD, proactive case detection; PCR, polymerase chain reaction; RDT, rapid diagnostic tests

Provenance: Not commissioned; externally peer reviewed

Summary Points

Active case detection (ACD) is a recommended intervention in low malaria transmission settings, yet evidence for its effectiveness is sparse.
The potential of ACD to impact transmission is hampered by the ability of current field diagnostics to detect very low density infections and continued importation of parasites, as well as the operational challenges of achieving high coverage.
The type of ACD employed should be guided by transmission setting and an understanding of risk factors.
Standardized monitoring and evaluation of ACD strategies should be an integral component of ACD campaigns.
In light of the current sensitivity of field diagnostic tests, targeted mass drug administration should be evaluated as an alternative or addition to ACD in low transmission settings.