Characterization of Plasmodium infections among inhabitants of rural areas in Gabon.

Plasmodium infections in endemic areas are often asymptomatic, can be caused by different species and contribute significantly to transmission. We performed a cross-sectional study in February/March 2016 including 840 individuals ≥ 1 year living in rural Gabon (Ngounié and Moyen-Ogooué). Plasmodium parasitemia was measured by high-sensitive, real-time quantitative PCR. In a randomly chosen subset of P. falciparum infections, gametocyte carriage and prevalence of chloroquine-resistant genotypes were analysed. 618/834 (74%) individuals were positive for Plasmodium 18S-rRNA gene amplification, of these 553 (66.3%) carried P. falciparum, 193 (23%) P. malariae, 74 (8.9%) P. ovale curtisi and 38 (4.6%) P.ovale wallikeri. Non-falciparum infections mostly presented as mixed infections. P. malariae monoinfected individuals were significantly older (median age: 60 years) than coinfected (20 years) or P. falciparum monoinfected individuals (23 years). P. falciparum gametocyte carriage was confirmed in 109/223 (48.9%) individuals, prevalence of chloroquine-resistant genotypes was high (298/336, 89%), including four infections with a new SVMNK genotype. In rural Gabon, Plasmodium infections with all endemic species are frequent, emphasizing that malaria control efforts shall cover asymptomatic infections also including non-falciparum infections when aiming for eradication.