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Background  It was unknown whether the main reservoir of  Plasmodium falciparum  and  Plasmodium vivax,  which infects mosquitoes in Thailand, was (a) in people feeling sufficiently ill with malaria to come to a clinic or (b) in people who had remained in their home villages with some fever symptoms or with none.    Methods  Mass surveys were carried out in Thai villages to identify people with  Plasmodium  infections and with fever. Malaria patients were also located at a clinic which served these villages. Adults from both sources whose blood slides registered positive for  Plasmodium  spp. were requested to allow laboratory-bred  Anopheles minimus  to feed on them. Seven to nine days after the blood feeds the mosquitoes were dissected and checked for presence of oocysts.    Results and Discussion  There were higher rates of  Plasmodium  infection among people in the villages with fever than without fever and much higher rates of infection among clinic patients than among people who had remained in the villages. People with malarial infections identified via the clinic and the village surveys could infect mosquitoes, especially, but not only, if their blood slides showed visible gametocytes. Because only a very small minority of the village populations were visiting the clinic on any one day, assessment indicated that the main reservoir of infection was not primarily among clinic patients but among those in the villages, especially those feeling feverish.    Conclusions  Efficient use of an anti-gametocyte drug to suppress the parasite reservoir in a population requires that it be given, not just to clinic patients, but to infected people located by mass surveys of the villages, especially those feeling feverish.

Infectious reservoir of Plasmodium infection in Mae Hong Son Province, north-west Thailand.