Using serological diagnostics to characterize remaining high-incidence pockets of malaria in forest-fringe Cambodia.

BACKGROUND: Over the last decades, the number of malaria cases has drastically reduced in Cambodia. As the overall prevalence of malaria in Cambodia declines, residual malaria transmission becomes increasingly fragmented over smaller remote regions. The aim of this study was to get an insight into the burden and epidemiological parameters of Plasmodium infections on the forest-fringe of Cambodia. METHODS: 950 participants were recruited in the province of Mondulkiri in Cambodia and followed up from 2018 to 2020. Whole-blood samples were processed for Plasmodium spp. identification by PCR as well as for a serological immunoassay. A risk factor analysis was conducted for Plasmodium vivax PCR-detected infections throughout the study, and for P. vivax seropositivity at baseline. To evaluate the predictive effect of seropositivity at baseline on subsequent PCR-positivity, an analysis of P. vivax infection-free survival time stratified by serological status at baseline was performed. RESULTS: Living inside the forest significantly increased the odds of P. vivax PCR-positivity by a factor of 18.3 (95% C.I. 7.7-43.5). Being a male adult was also a significant predictor of PCR-positivity. Similar risk profiles were identified for P. vivax seropositivity. The survival analysis showed that serological status at baseline significantly correlated with subsequent infection. Serology is most informative outside of the forest, where 94.0% (95% C.I. 90.7-97.4%) of seronegative individuals survived infection-free, compared to 32.4% (95% C.I.: 22.6-46.6%) of seropositive individuals. CONCLUSION: This study justifies the need for serological diagnostic assays to target interventions in this region, particularly in demographic groups where a lot of risk heterogeneity persists, such as outside of the forest.

Modelling the effect of a border closure between Switzerland and Italy on the spatiotemporal spread of COVID-19 in Switzerland.

We present an approach to extend the endemic-epidemic (EE) modelling framework for the analysis of infectious disease data. In its spatiotemporal formulation, spatial dependencies have originally been captured by static neighbourhood matrices. These weight matrices are adjusted over time to reflect changes in spatial connectivity between geographical units. We illustrate this extension by modelling the spread of COVID-19 disease between Swiss and bordering Italian regions in the first wave of the COVID-19 pandemic. The spatial weights are adjusted with data describing the daily changes in population mobility patterns, and indicators of border closures describing the state of travel restrictions since the beginning of the pandemic. These time-dependent weights are used to fit an EE model to the region-stratified time series of new COVID-19 cases. We then adjust the weight matrices to reflect two counterfactual scenarios of border closures and draw counterfactual predictions based on these, to retrospectively assess the usefulness of border closures. Predictions based on a scenario where no closure of the Swiss-Italian border occurred increased the number of cumulative cases in Switzerland by a factor of 2.7 (10th to 90th percentile: 2.2 to 3.6) over the study period. Conversely, a closure of the Swiss-Italian border two weeks earlier than implemented would have resulted in only a 12% (8% to 18%) decrease in the number of cases and merely delayed the epidemic spread by a couple of weeks. Our study provides useful insight into modelling the effect of epidemic countermeasures on the spatiotemporal spread of COVID-19.