Addressing low-density malaria infections in India and other endemic part of the world—the opportune time?

Shifting from high- to low-malaria transmission accompanies a higher proportion of asymptomatic low-density malaria infections (LDMI). Currently, several endemic countries, such as India, are experiencing this shift as it is striving to eliminate malaria. LDMI is a complex concept for which there are several important questions yet unanswered on its natural history, infectiousness, epidemiology, and pathological and clinical impact. India is on the right path to eliminating malaria, but it is facing the LDMI problem. A brief discussion on the concept and definitions of LDMI is beforehand presented. Also, an exhaustive review and critical analysis of the existing literature on LDMI in malaria-endemic areas, including India, are included in this review. Finally, we opine that addressing LDMI in India is ethically and pragmatically achievable, and a pool of <i>sine qua non</i> conditions is required to efficiently and sustainably eliminate malaria.

疟疾传播强度由高向低转变时，无症状低密度疟疾感染（asymptomatic low-density malaria infections, LDMI）的占比会显著提升。目前，包括印度在内的多个疟疾流行国家正处于这一转变进程中，各国均致力于消除疟疾。低密度疟疾感染是一个复杂的概念，其在自然史、传染性、流行病学以及病理与临床影响等诸多维度仍有关键问题尚未得到解答。印度正处于消除疟疾的正确轨道之上，但正面临低密度疟疾感染相关的挑战。本文首先对低密度疟疾感染的概念与定义展开简要探讨。同时，本综述对包括印度在内的疟疾流行区域内有关低密度疟疾感染的现有文献进行了全面梳理与批判性分析。最后，我们认为，在印度解决低密度疟疾感染问题在伦理与实践层面均具备可行性；若要高效且可持续地消除疟疾，则需满足一系列不可或缺的先决条件。