The ears of the hippopotamus: Epidemiology and infectivity of asymptomatic P. falciparum and P. vivax malaria infections in Ethiopia

In this study, we have gathered evidence that can support the approach to malaria elimination. We focused on areas in Ethiopia where P. vivax and P. falciparum are co-endemic but see applicability in other regions where both malaria species are also present. Asymptomatic infections can be prolonged in areas where elimination is pursued and can be strongly geographically or demographically clustered. Parasite densities fluctuate over time, and not all infected individuals develop symptoms (at any time). Sometimes infections clear spontaneously, but often precede an infectious period during which asymptomatic infections serve as a source of further mosquito infection. This supports the idea of tailored approaches with more sensitive diagnostic tools that are specific. This work uniquely addresses the operational challenges in detecting and treating asymptomatic malaria infections and their potential for further transmission in P. falciparum and P. vivax co-endemic setting.