Original Article

Absence of Asymptomatic Malaria Reservoirs in an Area with a Previous History of Local Malaria Transmission: A Successful Experience in Line with the Malaria Elimination Program in Iran


Background: Asymptomatic malaria is a major challenge to be addressed in the implementation of the malaria elimina­tion program. The main goal of the malaria surveillance system in the elimination phase is to identify reliably all the positive cases of malaria reliably (symptomatic and asymptomatic) in the shortest possible time. This study focused on the monitoring of asymptomatic malaria reservoirs in areas where local transmission had been previously established.

Methods: It was a case-study approach that was conducted in the Anarestan area. A total of 246 residents and immi­grants living in the area at the age range of 4–60 years old were randomly selected to be tested for malaria by micro­scope, RDT, and nested-PCR techniques. The inclusion criterion for participants to be entered into the study was the absence of specific symptoms of malaria. Moreover, participants who have been taking antimalarials for the last month were excluded from the study.

Results: The results indicated no positive cases of asymptomatic malaria among the participants tested by all methods.

Conclusion: The results of this study have shown that, without concerns for asymptomatic parasitic patients, a malaria elimination program has been successfully implemented within the studies area. In addition, the findings emphasized the existence of a strong malaria surveillance system in this area.

1. Sato S (2021) Plasmodium-a brief intro-duc¬tion to the parasites causing human ma¬lar¬ia and their basic biology. J Phys¬iol Anthro¬pol. 40(1): 1–13.
2. Bykersma A (2021) The new zoonotic ma-laria: Plasmodium cynomolgi. Trop Med In¬fect Dis. 6(2): 46.
3. World Health Organization (2022) World Malaria Report 2022. Geneva, WHO.
4. Tanner M, Greenwood B, Whitty CJ, Ansah EK, Price RN, Dondorp AM, Seidlein LV, Baird JK, Beeson JG, Fowkes FJI, Hem¬ing¬way J, Marsh K, Osier F (2015) Ma¬laria eradication and elimination: Views on how to translate a vision into reality. BMC Med. 13: 167.
5. Schapira A, Zaim M, Raeisi A, Ranjbar M, Kolifarhood G, Nikpour F, Al¬masi M, Faraji L (2018) History of the suc¬cessful struggle against malaria in the Islamic Re¬public of Iran. Tehran; Neekpey. ISBN: 978-600-6665-79-5
6. World Health Organization (2012) Disease surveillance for malaria elimination: an op¬erational manual (archived). Geneva, WHO.
7. Rahmani KH, Moradi GH, Khadem Erfan MB, Faraji L, Zamini GH, Moham¬madi-an B, Karimi M, Bahrami F, Raeisi A (2019) Malaria surveillance system in the Is¬lam¬ic Republic of Iran: History, structures, and achievements. Iranian J Epidemiol. 15(4): 313–322.
8. Hassanpour G, Mohebali M, Zeraati H, Rae¬isi A, Keshavarz H (2017) Asympto-matic malaria and its challenges in the malaria elimination program in Iran: a systemat¬ic re¬view. J Arthropod Borne Dis. 11(2): 172–181.
9. Turki H, Soltani A (2019) Follow-up and mon¬itoring of malaria treated cases to-ward malaria elimination program in Ba-shagard District, Hormozgan Prov¬ince, Iran, in 2016. Jundishapur J Mi¬crobiol. 12(2): e85267.
10. Turki H, Zoghi S, Mehrizi AA, Zakeri S, Raeisi A, Khazan H, Haghdoost AA (2012) Absence of asymptomatic malar¬ia infection in endemic area of Ba¬shagard District, Hor¬mozgan Province, Iran J Par¬asitol. 7(1): 36–44.
11. Zoghi S, Mehrizi AA, Raeisi A, Hagh-doost AA, Turki H, Safari R, Kahanali AA, Zakeri S (2012) Survey for asymp-tomat¬ic malaria cases in low transmis¬sion set¬tings of Iran under elimination programme. Malaria J. 11(1): 126.
12. Turki H, Rashid G, Shekari M, Raeisi A, Sharifi-Sarasiabi K (2017) Malaria elim¬i-nation program: absence of asympto-matic ma¬laria and low parasitic in en-demic ar¬ea of Ru¬dan District, Hor-mozgan Prov¬ince, Iran. Hor¬mozgan Med J. 21(4): 225–231.
13. Pirahmadi S, Zakeri S, Raeisi A (2017) Ab¬sence of asymptomatic malaria in-fection in a cross-sectional study in Iranshahr Dis¬trict, Iran under elimination pro¬grammes. Iran J Parasitol. 12(1): 90–100.
14. Sarani M, Javdan GH, Ghanbarnejad A, Eftek¬har E, Safari R, Sharifi-Sarasiabi K, Khojasteh SH, Turki H (2023) Ma-laria cctive case finding is a necessary strate¬gy in the ma¬laria elimination pro-gram: A successful expe¬rience in Iran. J Health Sci Surveill Sys. 11(1): 105–111.
15. Turki H, Raeisi A, Malekzadeh K, Ghan-barnejad A, Zoghi S, Yeryan M, Nejad MA, Mohseni F, Shekari M (2015) Effi-ciency of nested-PCR in detecting asymp¬tomatic cases toward malaria elimination program in an endemic area of Iran. Iran J Parasitol. 10(1): 39–45.
16. Shahbazi A, Farhadi P, Yerian M, Ba-zmani A, Nakhjiri SK, Rasouli A, Raeisi A (2013) Detection of asymptomatic carri¬ers of Plasmodium vivax among treated patients by nested PCR method in Min¬ab, Rudan and Ba¬shagard, Iran. Iran J Parasitol. 8(4): 586–592.
17. Nateghpour M, Akbarzadeh K, Farivar L, Amiri A (2011) Detection of asympto-matic malaria infection among the Af-ghani im¬mi¬grant population in Iranshahr District of south¬eastern Iran. Bull Soc Path Exot. 104 (4): 321–323.
18. Rashid G, Soltani A, Eftekhar E, Shafiei R, Turki H (2020) Immigrants: Big chal-lenge and silent threat to implement ma-laria elimination program in Hormozgan Province, Iran. Jundishapur J Microbiol. 13(1): e99725.
19. Ebrahimzadeh A, Dalir SN, Mirah¬madi H, Mehravaran A, Khorashad AS, Turki H (2017) The incidence of current infec-tion with different human malaria spe-cies by pol¬ymerase chain reaction for diagnosis of suspi¬cious malaria patients on elimination region Sistan and Balu-chistan Province, southeast of Iran. Jun-dishapur J Microbi¬ol. 10(10): e58254.
20. Pinto A, Avalos S, Girón C, Mejia R, Fon-techa G (2018) Absence of asymptomat-ic malaria in pregnant women of Hondu-ras. Rev Panam Enf Inf. 1(2): 68–72.
21. Fernando D, Abeyasingh RR, Gala¬paththy GLN (2009) Absence of Asympto¬matic Ma¬laria Infections in Previously High En¬demic Areas of Sri Lanka. Am J Trop Med Hyg. 81(5): 763–767.
22. Dhiman S, Goswami D, Rabha B, Yadav K, Chattopadhyay P, Veer V (2015) Ab-sence of asymptomatic malaria in a co-hort of 133 individuals in a malaria en-demic area of Assam, India. BMC Pub-lic Health. 15: 1–7.
23. Mosawi SH, Dalimi A, Najibullah SA, Ghaf¬farifar F, Sadraei J (2020) Evalua-tion of asymptomatic malaria status in eastern of Af¬ghanistan using high reso-lution melting anal¬ysis. Iranian J Parasi-tol. 15(2): 177–186.
24. Jiram AI, Ooi CH, Rubio JM, Hisam S, Kar¬man G, Sukor NM, Artic MM, Is-mail NP, Alias NW (2019) Evidence of asympto¬matic submicroscopic malaria in low trans¬mission areas in Belaga Dis-trict, Kapit di¬vi¬sion, Sarawak, Malay¬sia. Malar J. 18: 156.
25. Umunnakwe FA, Idowu ET, Ajibaye O, Eto¬ketim B, Akindele S, Shokunbi A, Otu¬banjo OA, Awandare GA, Amambua-Ngwa A, Oyebola KM (2019) High cas¬es of submicroscop-ic Plasmodium falci¬pa¬rum infections in a suburban popula¬tion of Lagos, Nige¬ria. Malar J. 18: 433.
26. Chen I, Clarke SE, Gosling R, Hamainza B, Killeen G, Magill A, O’Meara W, Price RN, Riley EM (2016) Asympto-matic Ma¬laria: a chronic and debilitating infection that should be treated. PLoS Med. 13: e1001942.
27. Wangchuk S, Gyeltshen S, Dorji K, Wangdi T, Dukpa T, Namgay R, Dorjee S, Tobgay T, Chaijaroenkul W, Na-Bangchang K (2019) Malaria elimina¬tion in Bhutan: asymp¬tomatic malaria cases in the Bhu¬tanese population living in malaria-risk areas and in migrant workers. Rev Inst Med Trop. 12(61): 1–8.
28. Van Eijk AM, Sutton PL, Ramanatha-puram L, Sullivan S, Kanagaraj D, Priya L, Rav¬ishankaran S, Asokan A, Sang-eetha V, Rao PN, Wassmer SC, Tandel N, Patel A, Desai N, Choubey S, Ali SZ, Barla P, Oraon RR, Mohanty S, Mishra S, Kale S, Bandyopadhyay N, Mallick PK, Huck J, Valecha N, Singh OP, Pradhan K, Singh R, Sharma SK, Srivastava HS, Carlton JM, Eapen A (2019) The burden of sub¬mi¬croscopic and asymptomatic ma¬lar¬ia in India revealed from epidemiology stud¬ies at three var¬ied transmission sites in In-dia. Sci Rep. 9: 17095.
29. Baum E, Sattabongkot J, Sirichaisinthop J, Kiattibutr K, Davies DH, Jain A, Lo E, Lee MC, Randall AZ, Mo¬lina DM, Liang X (2015) Submicroscopic and asympto¬matic Plasmodium falcipa¬rum and Plas¬modium vivax infections are common in western Thailand- mo¬lecular and serolog¬ical evidence. Malar J. 14: 95.
30. Zhao Y, Zeng J, Zhao Y, Liu Q, He Y, Zhang J, Yang Z, Fan Q, Wang Q, Cui L, Cao Y (2018) Risk factors for asymp-tomatic ma¬laria infections from seasonal cross-sectional surveys along the China–Myanmar bor¬der. Malar J. 17: 247.
31. Tadesse FG, van den Hoogen L, Lan¬ke K, Schildkraut J, Aseffa A, Mamo H, Sau-erwein R, Felger I, Drakeley C, Gadissa E (2017) The shape of the iceberg: quan-tifica¬tion of submicroscop¬ic Plasmodium falcipa¬rum and Plasmodium vivax para-sitaemia and gametocytaemia in five low endem¬ic settings in Ethiopia. Malar J. 16: 99.
32. Almeida A, Kuehn A, Castro A, Vitor-Sil-va1 S, Figueiredo E, Brasil LW, Bri¬to MA, Sampaio VS, Bassat Q, Felger I, Tadei WP (2018) High proportions of asymp¬tomatic and submicroscopic Plasmodium vivax infec¬tions in a peri-urban area of low transmission in the Brazilian Amazon. Par¬asit Vectors. 11: 194.
33. World Health Organization (2018) Malar¬ia Surveillance, Monitoring and Evalua-tion: A Reference Manual. Geneva, WHO.
34. Nazari M, Najafi A, Abai MR (2018) Spe-cies composition and some biologi¬cal fea¬tures of scorpions in Kazerun District, South¬ern Iran. J Arthropod-Borne Dis. 12(3): 296–309.
35. Cochran WG (1963) Sampling Tech-niques, 2nd Ed., New York: John Wiley and Sons, Inc.
36. World Health Organization (2016) Malar¬ia microscopy quality assurance manu¬al-version 2. Geneva, WHO.
37. Nateghpour M, Turki H, Keshavarz H, Edris¬sian GH, Mohebali M, Foroushani AR (2010) A parasitological and sero-logical study in malaria suspected pa-tients in Hormozgan Province, south-eastern Iran. Iran Red Crescent Med J. 12(3): 242–246.
38. Maltha J, Gillet P, Jacobs JJ (2013) Ma¬lar-ia rapid diagnostic tests in endemic set-tings. Clin Microbiol Infect. 19(5): 399–407.
39. Snounou G, Viriyakosol S, Jarra W, Thaithong S, Brown KN (1993) Identi-fication of the four human malaria para-site species in field samples by the pol-ymerase chain reac¬tion and detection of a high prevalence of mixed infections. Mol Biochem Parasitol. 58(2): 283–292.
40. Shamseddin J, Ghanbarnejad A, Zakeri A, Abedi F, Khojasteh S, Turki H (2022) Molecular method is essential to iden¬tify asymptomatic malaria reservoirs: A suc-cessful experience in the malaria elimi¬na-tion program in Iran. Diagnostics. 12(12): 3025.
41. Salahi-Moghaddam A, Turki H, Yeryan M, Fuentes MV (2022) Spatio-temporal pre¬diction of the malaria transmis¬sion risk in Minab District (Hormozgan Prov-ince, Southern Iran). Acta Parasitol. 67(4): 1500–1513.
42. Ghanbarnejad A, Turki H, Yaseri M, Rae-isi A, Rahimi-Foroushani A (2021) Spa-tial modelling of malaria in south of Iran in line with the implementation of the ma¬laria elimination program: A Bayesi¬an Poisson-Gamma random field model. J Arthropod-Borne Dis. 15(1): 108–125.
43. Mirahmadi H, Spotin A, Fallahi S, Taghi-pour N, Turki H, Seyyed Tabaei SJ (2015) Cloning and sequence analysis of re¬com¬bi¬nant Plasmodium vivax merozo-ite sur¬face protein 1 (PvMSP-142 kDa) In pTZ57R/T vector. Iran J Parasitol. 10(2): 197–205.
IssueVol 17 No 2 (2023) QRcode
SectionOriginal Article
DOI https://doi.org/10.18502/jad.v17i2.13618
Asymptomatic malaria; Plasmodium; Elimination; Surveillance system

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How to Cite
Hosseini Z, Azizi K, Moghadami M, Hassaniazad M, Shafiei R, Turki H. Absence of Asymptomatic Malaria Reservoirs in an Area with a Previous History of Local Malaria Transmission: A Successful Experience in Line with the Malaria Elimination Program in Iran. J Arthropod Borne Dis. 2023;17(2):128–137.