Meeting report of the Evidence Review Group on low-density malaria infections

Overview

In March 2014, WHO published recommendations on the use of malaria diagnostics in low transmission settings. Malaria microscopy and antigen-detecting rapid diagnostic tests (RDTs) were recommended as appropriate tools for the diagnosis of clinical malaria and routine malaria surveillance. At that time, WHO recommended that the use of more sensitive nucleic acid amplification (NAA)-based methods should only be considered in epidemiological research and surveys aimed at mapping submicroscopic infections at low transmission intensity and potentially for identifying foci for special interventions in elimination settings.

In the years following the publication of these recommendations, the application of NAA-based diagnostic tools in epidemiological research and surveys has expanded and highly sensitive, non-NAA-based point-of-care-methods have been commercialized. Therefore, WHO convened a meeting of the Evidence Review Group on low-density malaria infections to revise current recommendations based on a review of the natural history, prevalence, contribution to transmission, and ultimate public health importance of low-density Plasmodium falciparum and P. vivax infections.