Review Article

Asymptomatic Malaria and its Challenges in the Malaria Elimination Program in Iran: a Systematic Review


Background: The ob­jective of this study was to find an appropriate approach to asymptomatic malaria in elimination setting through a systematic review.Methods: A broad search was conducted to find articles with the words ‘malaria’ in their titles and ‘asymptomatic’ or ‘submicroscopic’ in their texts, irrespective of the type of study conducted. The Cochrane, Medline/PubMed, and Scopus databases, as well as Google Scholar were systematically searched for English articles and reports and Iran’s databases- IranMedex, SID and Magiran were searched for Persian reports and articles, with no time limitation. The study was qualitatively summarized if it contained precise information on the role of asymptomatic malaria in the elimination phase.Results: Six articles were selected from the initial 2645 articles. The results all re-emphasize the significance of asymptomatic malaria in the elimination phase, and empha­size the significance of diagnostic tests of higher sensitivity to locate these patients and perform interventions to re­duce the asymptomatic parasitic reservoirs particularly in regions of low transmission. However, we may infer from the results that the current evidence cannot yet specify an accurate strategy on the role of asymptomatic malaria in the elimination phase.Conclusion: To eliminate malaria, alongside vector control, and treatment of symptomatic and asymptomatic pa­tients, active and inactive methods of case detection need to be employed. The precise monitoring of asymptomatic individuals and submicroscopic cases of malaria through molecular assays and valid serological methods, especially in regions where seasonal and low transmission exists can be very helpful at this phase.

Bousema T, Dinglasan RR, Morlais I, Gou- agna LC, van Warmerdam T, Awono- Ambene PH, Bonnet S, Diallo M, Coulibaly M, Tchuinkam T, Mulder B (2012) Mosquito feeding assays to de- termine the infectiousness of naturally infected Plasmodium falciparum game tocyte carriers. PloS One. 7(8): e42821.

Bousema T, Okell L, Felger I, Drakeley C (2014) Asymptomatic malaria infec- tions: detectability, transmissibility and public health relevance. Nature Rev Mi- crobiol. 12(12): 833–840.

Diagnoses CG (2011) A research agenda for malaria eradication: diagnoses and di- agnostics. PLoS Med. 8(1): e1000396.

Gueye CS, Sanders KC, Galappaththy GN, Rundi C, Tobgay T, Sovannaroth S, Gao Q, Surya A, Thakur GD, Baquilod

M, Lee WJ (2013) Active case detection for malaria elimination: a survey among Asia Pacific countries. Malar J. 12: 358.

Haghi AM, Khoramizade MR, Nateghpour M, Mohebali M, Edrissian GH, Eshraghi- an MR, Sepehrizadeh Z (2012) A re- combinant Plasmodium vivax apical membrane antigen-1 to detect human infection in Iran. Korean J Parasitol.50(1): 15–21.

Hanafi-Bojd AA, Azari-Hamidian S, Vatan- doost H, Charrahy Z (2011) Spatio- temporal distribution of malaria vectors (Diptera: Culicidae) across differ- ent climatic zones of Iran. Asian Pac J Trop Med. 4(6): 498–504.

Hassanpour Gh R, Mohebali M, Raeisi A, Abolghasemi H, Zeraati H, Alipour M, Azizi E, Keshavarz H (2011) Detection of malaria infection in blood transfusion: a comparative study among real-time PCR, rapid diagnostic test and microscopy. Parasitol Res. 108(6): 1519–1523.

Laishram DD, Sutton PL, Nanda N, Sharma VL, Sobti RC, Carlton JM, Joshi H (2012) The complexities of malaria disease manifestations with a focus onasymptomatic malaria. Malar J. 11: 29. Lin JT, Saunders DL, Meshnick SR (2014)

The role of submicroscopic parasitemia in malaria transmission: what is the evidence? Trends Parasitol. 30(4): 183–190.

Lindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L (2013) The si- lent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti Infect Ther. 11(6): 623–639.

Lo E, Zhou G, Oo W, Afrane Y, Githeko A, Yan G (2015) Low parasitemia in sub- microscopic infections significantly impacts malaria diagnostic sensitivity in the highlands of Western Kenya. PloS One. 10(3): e0121763.

Ministry of Health and Medical Education(2012) Malaria Elimination Program. Prospective of Iran 2025. Ministry of Health Publ., Tehran.

Moonen B, Cohen JM, Snow RW, Slutsker L, Drakeley C, Smith DL, Abeyasinghe RR, Rodriguez MH, Maharaj R, Tanner M, Targett G (2010) Operational strategies to achieve and maintain malaria elimi- nation. Lancet. 376(9752): 1592–1603.

Nateghpour M, Akbarzadeh K, Farivar L, Amiri A (2011) Detection of asymp- tomatic malaria infection among the Afghani immigrant population in Iranshahr district of southeastern Iran. Bull Soc Path Exot. 104(4): 321–323.

Sturrock HJ, Hsiang MS, Cohen JM, Smith DL, Greenhouse B, Bousema T, Gos- ling RD (2013) Targeting asymptomatic malaria infections: active surveillance in control and elimination. PLoS Med.10(6): e1001467.

Tietje K, Hawkins K, Clerk C, Ebels K, McGray S, Crudder C, Okell L, LaBarre P (2014) The essential role of infection detection technologies for malaria elimination and eradication. Trends Parasitol.30(5): 259–266.

Vatandoost H, Hanafi-Bojd AA (2012) Indi cation of pyrethroid resistance in the main malaria vector, Anopheles stephensi from Iran. Asian Pac J Trop Med. 5(9):722–726.

World Health Organization (2007) Malaria Elimination: A Field Manual for Low and Moderate Endemic Countries. World Health Organization (2014) World Malaria Report 2014. WHO Publ,Geneva.

World Health Organization (2013) Eliminat- ing malaria in Iran. Available at: iainiran.pdf

Zoghi S, Mehrizi AA, Raeisi A, Haghdoost AA, Turki H, Safari R, Kahanali AA, Zakeri S (2012) Survey for asympto- matic malaria cases in low transmis- sion settings of Iran under elimination programme. Malar J. 11: 126.

IssueVol 11 No 2 (2017) QRcode
SectionReview Article
Malaria Asymptomatic infection Elimination

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Hassanpour G, Mohebali M, Zeraati H, Raeisi A, Keshavarz H. Asymptomatic Malaria and its Challenges in the Malaria Elimination Program in Iran: a Systematic Review. J Arthropod Borne Dis. 2017;11(2):172-181.