Figure 1.

Established and next-generation methods for evaluating malaria transmission via antibodies provide higher resolution than parasite prevalence. (A) The seroconversion rate (SCR) for a population can be calculated from age-stratified prevalence of antibody responses, often with a long half-life. Data shown here are responses to apical membrane antigen 1 from three cross-sectional surveys in Uganda.³⁴ (B) Paired SCR and parasite rate (PR) data from multiple sites^10,34–43 demonstrate that SCR (using merozoite surface protein 1, MSP-1) has a tighter association with transmission, as measured by the annual entomologic inoculation rate (EIR). (C) Using six antibodies identified as informative about recent exposure, predictions of P. falciparum exposure in a community can be obtained from relatively small surveys, in contrast to PR data obtained from the same surveys.¹⁹ (D) A simulation of a small village (N = 100) with seasonal, low transmission illustrates how ongoing transmission can be detected consistently from an antibody test measuring recent exposure, but less reliably from rapid diagnostic test (RDT).⁴⁴ This figure appears in color at www.ajtmh.org.