Macalinao, M. L. M. et al. (2023) Analytical approaches for antimalarial antibody responses to confirm historical and recent malaria transmission: an example from the Philippines. Lancet Regional Health - Western Pacific, 37, 100792. (doi: 10.1016/j.lanwpc.2023.100792) (PMID:37693871) (PMCID:PMC10485684)
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Abstract
Background: Assessing the status of malaria transmission in endemic areas becomes increasingly challenging as countries approach elimination. Serology can provide robust estimates of malaria transmission intensities, and multiplex serological assays allow for simultaneous assessment of markers of recent and historical malaria exposure. Methods: Here, we evaluated different statistical and machine learning methods for analyzing multiplex malaria-specific antibody response data to classify recent and historical exposure to Plasmodium falciparum and Plasmodium vivax. To assess these methods, we utilized samples from a health-facility based survey (n = 9132) in the Philippines, where we quantified antibody responses against 8 P. falciparum and 6 P. vivax-specific antigens from 3 sites with varying transmission intensity. Findings: Measurements of antibody responses and seroprevalence were consistent with the 3 sites’ known endemicity status. Among the models tested, a machine learning (ML) approach (Random Forest model) using 4 serological markers (PfGLURP R2, Etramp5.Ag1, GEXP18, and PfMSP119) gave better predictions for P. falciparum recent infection in Palawan (AUC: 0.9591, CI 0.9497–0.9684) than individual antigen seropositivity. Although the ML approach did not improve P. vivax infection predictions, ML classifications confirmed the absence of recent exposure to P. falciparum and P. vivax in both Occidental Mindoro and Bataan. For predicting historical P. falciparum and P. vivax transmission, seroprevalence and seroconversion rates based on cumulative exposure markers AMA1 and MSP119 showed reliable trends in the 3 sites. Interpretation: Our study emphasizes the utility of serological markers in predicting recent and historical exposure in a sub-national elimination setting, and also highlights the potential use of machine learning models using multiplex antibody responses to improve assessment of the malaria transmission status of countries aiming for elimination. This work also provides baseline antibody data for monitoring risk in malaria-endemic areas in the Philippines. Funding: Newton Fund, Philippine Council for Health Research and Development, UK Medical Research Council.
| Item Type: | Articles |
|---|---|
| Additional Information: | This study was supported by the Newton Fund, Philippine Council for Health Research and Development, and UK Medical Research Council through funding received for the ENSURE project (MR/N019199/1). KMF was supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and Royal Society (grant no 221963/Z/20/Z). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Fornace, Dr Kimberly |
| Authors: | Macalinao, M. L. M., Fornace, K. M., Reyes, R. A., Hall, T., Bareng, A. P. N., Adams, J. H., Huon, C., Chitnis, C. E., Luchavez, J. S., Tetteh, K. K.A., Yui, K., Hafalla, J. C. R., Espino, F. E. J., and Drakeley, C. J. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine |
| Journal Name: | Lancet Regional Health - Western Pacific |
| Publisher: | Lancet Publishing Group |
| ISSN: | 2666-6065 |
| ISSN (Online): | 2666-6065 |
| Published Online: | 20 May 2023 |
| Copyright Holders: | Copyright © 2023 Elsevier Ltd. |
| First Published: | First published in Lancet Regional Health - Western Pacific 37:100792 |
| Publisher Policy: | Reproduced under a Creative Commons license |
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