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Background  Recent studies from different malaria-endemic regions including western Africa have now shown that  Plasmodium vivax  can infect red blood cells (RBCs) and cause clinical disease in Duffy-negative people, though the Duffy-negative phenotype was thought to confer complete refractoriness against blood invasion with  P. vivax . The actual prevalence of  P. vivax  in local populations in Ghana is unknown and little information is available about the distribution of Duffy genotypes. The aim of this study was to assess the prevalence of  P. vivax  in both asymptomatic and symptomatic outpatients and the distribution of Duffy genotypes in Ghana.    Methods  DNA was extracted from dried blood spots (DBS) collected from 952 subjects (845 malaria patients and 107 asymptomatic persons) from nine locations in Ghana.  Plasmodium  species identification was carried out by nested polymerase chain reaction (PCR) amplification of the small-subunit (SSU) rRNA genes. For  P. vivax  detection, a second PCR of the central region of the  Pvcsp  gene was carried out. Duffy blood group genotyping was performed by allele-specific PCR to detect the presence of the  FY   ES   allele.    Results  No cases of  P. vivax  were detected in any of the samples by both PCR methods used. Majority of infections (542, 94.8%) in the malaria patient samples were due to  P. falciparum  with only 1 infection (0.0017%) due to  Plasmodium malariae,  and 2 infections (0.0034%) due to  Plasmodium ovale . No case of mixed infection was identified. Of the samples tested for the  FY   ES   allele from all the sites, 90.5% (862/952) had the  FY   ES   allele. All positive samples were genotyped as  FY*B-33 / FY*B-33  (Duffy-negative homozygous) and therefore classified as Fy(a−b−).    Conclusions  No cases of  P. vivax  were detected by both PCRs and majority of the subjects tested carried the  FY   ES   allele. The lack of  P. vivax  infections observed can be attributed to the high frequency of the  FY   ES   allele that silences erythroid expression of the Duffy. These results provide insights on the host susceptibility for  P. vivax  infections that had not been investigated in Ghana before.

High frequency of the Duffy-negative genotype and absence of Plasmodium vivax infections in Ghana