Asymptomatic School-Aged Children Are Important Drivers of Malaria Transmission in a High Endemicity Setting in Uganda

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Abstract
Achieving malaria elimination requires a better understanding of the transmissibility of human infections in different transmission settings. This study aimed to characterize the human infectious reservoir in a high endemicity setting in eastern Uganda, using gametocyte quantification and mosquito feeding assays. In asymptomatic infections, gametocyte densities were positively associated with the proportion of infected mosquitoes (β = 1.60; 95% CI, 1.32–1.92; P < .0001). Combining transmissibility and abundance in the population, symptomatic and asymptomatic infections were estimated to contribute to 5.3% and 94.7% of the infectious reservoir, respectively. School-aged children (5–15 years old) contributed to 50.4% of transmission events and were important drivers of malaria transmission.
Funding Information
  • National Institutes of Health (AI089674, AI075045)
  • Bill and Melinda Gates Foundation (INDIE OPP1173572, OPP1169785)
  • European Research Council (ERC-CoG 864180)
  • Fogarty International Center (P0529898, TW009343)
  • American Society of Tropical Medicine and Hygiene

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