Emerging Role of seroprevalence testing in the Diagnosis of malaria

Abstract

Background: Microscopy, antigen-based rapid diagnostic tests and nucleic acid amplification all detect the parasite itself, and so tell a clinician or a control programme only about infection at the moment of sampling.

Objective: This review synthesizes the evidence for antibody-based seroprevalence testing as a complementary diagnostic and surveillance tool in malaria, tracing its use from individual-level exposure classification to population-level transmission mapping.

Methods: We drew on peer-reviewed serological validation studies, cross-sectional and longitudinal field surveys, and reviews spanning five decades of malaria serology, from the earliest indirect immunofluorescence assays to present-day multiplexed bead arrays.

Findings: Age-specific seroconversion rates track entomological inoculation rate across several orders of magnitude, seropositivity persists long after parasites clear, multi-antigen panels can distinguish recent from cumulative exposure at the individual level, and serology repeatedly detects residual transmission that parasitological methods miss as endemicity falls.

Conclusions: Seroprevalence testing does not replace parasite detection for diagnosing acute malaria, but it fills a specific and increasingly important gap: quantifying exposure and transmission intensity in populations where parasite prevalence has become too low, or too noisy, for those methods to answer the question a control programme actually needs answered.