@article{Parr:2016:infdis/jiw538,
author = {Parr, JB and Verity, R and Doctor, SM and Janko, M and Carey-Ewend, K and Turman, BJ and Keeler, C and Slater, HC and Whitesell, AN and Mwandagalirwa, K and Ghani, AC and Likwela, JL and Tshefu, AK and Emch, M and Juliano, JJ and Meshnick, SR},
doi = {infdis/jiw538},
journal = {Journal of Infectious Diseases},
pages = {36--44},
title = {Pfhrp2-deleted Plasmodium falciparum parasites in the Democratic Republic of the Congo: a national cross-sectional survey},
url = {http://dx.doi.org/10.1093/infdis/jiw538},
volume = {216},
year = {2016}
}

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TY  - JOUR
AB  - Background.Rapid diagnostic tests (RDTs) account for more than two-thirds of malaria diagnoses in Africa. Deletions of the Plasmodium falciparum hrp2 (pfhrp2) gene cause false-negative RDT results and have never been investigated on a national level. Spread of pfhrp2-deleted P. falciparum mutants, resistant to detection by HRP2-based RDTs, would represent a serious threat to malaria elimination efforts.Methods.Using a nationally representative cross-sectional study of 7,137 children under five years of age from the Democratic Republic of Congo (DRC), we tested 783 subjects with RDT-/PCR+ results using PCR assays to detect and confirm deletions of the pfhrp2 gene. Spatial and population genetic analyses were employed to examine the distribution and evolution of these parasites.Results.We identified 149 pfhrp2-deleted parasites, representing 6.4% of all P. falciparum infections country-wide (95% confidence interval 5.1–8.0%). Bayesian spatial analyses identified statistically significant clustering of pfhrp2 deletions near Kinshasa and Kivu. Population genetic analysis revealed significant genetic differentiation between wild-type and pfhrp2-deleted parasite populations (GST = .046, p ≤ .00001).Conclusions.Pfhrp2-deleted P. falciparum is a common cause of RDT-/PCR+ malaria among asymptomatic children in the DRC and appears to be clustered within select communities. Surveillance for these deletions is needed, and alternatives to HRP2-specific RDTs may be necessary.
AU  - Parr,JB
AU  - Verity,R
AU  - Doctor,SM
AU  - Janko,M
AU  - Carey-Ewend,K
AU  - Turman,BJ
AU  - Keeler,C
AU  - Slater,HC
AU  - Whitesell,AN
AU  - Mwandagalirwa,K
AU  - Ghani,AC
AU  - Likwela,JL
AU  - Tshefu,AK
AU  - Emch,M
AU  - Juliano,JJ
AU  - Meshnick,SR
DO  - infdis/jiw538
EP  - 44
PY  - 2016///
SN  - 0022-1899
SP  - 36
TI  - Pfhrp2-deleted Plasmodium falciparum parasites in the Democratic Republic of the Congo: a national cross-sectional survey
T2  - Journal of Infectious Diseases
UR  - http://dx.doi.org/10.1093/infdis/jiw538
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000405951900007&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/50661
VL  - 216
ER  - 

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