Serological measures of malaria transmission in Haiti: comparison of longitudinal and cross-sectional methods

PLoS One. 2014 Apr 1;9(4):e93684. doi: 10.1371/journal.pone.0093684. eCollection 2014.

Abstract

Background: Efforts to monitor malaria transmission increasingly use cross-sectional surveys to estimate transmission intensity from seroprevalence data using malarial antibodies. To date, seroconversion rates estimated from cross-sectional surveys have not been compared to rates estimated in prospective cohorts. Our objective was to compare seroconversion rates estimated in a prospective cohort with those from a cross-sectional survey in a low-transmission population.

Methods and findings: The analysis included two studies from Haiti: a prospective cohort of 142 children ages ≤ 11 years followed for up to 9 years, and a concurrent cross-sectional survey of 383 individuals ages 0-90 years old. From all individuals, we analyzed 1,154 blood spot specimens for the malaria antibody MSP-1(19) using a multiplex bead antigen assay. We classified individuals as positive for malaria using a cutoff derived from the mean plus 3 standard deviations in antibody responses from a negative control set of unexposed individuals. We estimated prospective seroconversion rates from the longitudinal cohort based on 13 incident seroconversions among 646 person-years at risk. We also estimated seroconversion rates from the cross-sectional survey using a reversible catalytic model fit with maximum likelihood. We found the two approaches provided consistent results: the seroconversion rate for ages ≤ 11 years was 0.020 (0.010, 0.032) estimated prospectively versus 0.023 (0.001, 0.052) in the cross-sectional survey.

Conclusions: The estimation of seroconversion rates using cross-sectional data is a widespread and generalizable problem for many infectious diseases that can be measured using antibody titers. The consistency between these two estimates lends credibility to model-based estimates of malaria seroconversion rates using cross-sectional surveys. This study also demonstrates the utility of including malaria antibody measures in multiplex assays alongside targets for vaccine coverage and other neglected tropical diseases, which together could comprise an integrated, large-scale serological surveillance platform.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antibodies, Protozoan / blood
  • Antibodies, Protozoan / immunology*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Haiti
  • Humans
  • Infant
  • Malaria, Falciparum / blood
  • Malaria, Falciparum / epidemiology
  • Malaria, Falciparum / immunology*
  • Malaria, Falciparum / parasitology
  • Malaria, Falciparum / transmission
  • Male
  • Merozoite Surface Protein 1 / blood
  • Merozoite Surface Protein 1 / immunology*
  • Plasmodium falciparum / immunology
  • Plasmodium falciparum / pathogenicity
  • Seroepidemiologic Studies*
  • Serogroup

Substances

  • Antibodies, Protozoan
  • Merozoite Surface Protein 1

Grants and funding

The authors appreciate the financial support of the National Institutes of Health, CDC and the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (grants #920528 and #940441). Katy Hamlin was supported by a CDC/APHL Emerging Infectious Disease Fellowship. Besides the CDC, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Use of trade names is for identification only and does not imply endorsement by the Public Health Service of by the U.S. Department of Health and Human Services. The findings and conclusions in this report do not represent the official position of the Centers for Disease Control and Prevention.