Assessing the effect of parasite antigen genetic diversity on performance of Plasmodium vivax serological exposure markers for malaria: a multicentre observational diagnostic accuracy study

Abstract

Background Plasmodium vivax poses a major obstacle to malaria elimination because this parasite can lie dormant in the liver for weeks to months before reactivating and causing a relapse of infection. These dormant forms (hypnozoites) cannot be detected using standard diagnostics, but P vivax exposure in the previous 9 months and, by proxy, hypnozoite carriage, can be inferred using serological markers. In this study, we aimed to examine how genetic variation in P vivax affects the utility of these markers and whether redesigned antigens could improve performance. Methods In this observational diagnostic accuracy study, we analysed global P vivax genetic data to assess variation in leading s..