The role of asymptomatic P. falciparum parasitaemia in the evolution of antimalarial drug resistance in areas of seasonal transmission

Hamza A. Babiker, Amal A H Gadalla, Lisa C. Ranford-Cartwright

Research output: Contribution to journalArticle

18 Citations (Scopus)


In areas with seasonal transmission, proper management of acute malaria cases that arise in the transmission season can markedly reduce the disease burden. However, asymptomatic carriage of Plasmodium falciparum sustains a long-lasting reservoir in the transmission-free dry season that seeds cyclical malaria outbreaks. Clinical trials targeting asymptomatic parasitaemia in the dry season failed to interrupt the malaria epidemics that follow annual rains. These asymptomatic infections tend to carry multiple-clones, capable of producing gametocytes and infecting Anopheles mosquitoes. Different clones within an infection fluctuate consistently, indicative of interaction between clones during the long course of asymptomatic carriage. However, the therapy-free environment that prevails in the dry season dis-advantages the drug resistant lineages and favors the wild-type parasites. This review highlights some biological and epidemiological characteristics of asymptomatic parasitaemia and calls for consideration of polices to diminish parasite exposure to drugs "therapy-free" and allow natural selection to curb drug resistance in the above setting.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalDrug Resistance Updates
Issue number1-2
Publication statusPublished - Feb 2013



  • Asymptomatic malaria
  • Drug resistance
  • Evolutionary
  • Fitness cost
  • Plasmodium falciparum
  • Seasonal transmission

ASJC Scopus subject areas

  • Cancer Research
  • Infectious Diseases
  • Oncology
  • Pharmacology (medical)
  • Pharmacology

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