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Solomon Islands is intensifying national efforts to achieve malaria elimination. A long history of indoor spraying with residual insecticides, combined recently with distribution of long lasting insecticidal nets and artemether-lumefantrine therapy, has been implemented in Solomon Islands. The impact of these interventions on local endemicity of  Plasmodium  spp. is unknown.    Methods  In 2012, a cross-sectional survey of 3501 residents of all ages was conducted in Ngella, Central Islands Province, Solomon Islands. Prevalence of  Plasmodium falciparum ,  P .  vivax ,  P .  ovale  and  P .  malariae  was assessed by quantitative PCR (qPCR) and light microscopy (LM). Presence of gametocytes was determined by reverse transcription quantitative PCR (RT-qPCR).    Results  By qPCR, 468  Plasmodium  spp. infections were detected (prevalence = 13.4%; 463  P .  vivax , five mixed  P .  falciparum/P .  vivax , no  P .  ovale  or  P .  malariae ) versus 130 by LM (prevalence = 3.7%; 126  P .  vivax , three  P .  falciparum  and one  P .  falciparum/P .  vivax ). The prevalence of  P .  vivax  infection varied significantly among villages (range 3.0–38.5%,  p <0.001) and across age groups (5.3–25.9%,  p <0.001). Of 468  P .  vivax  infections, 72.9% were sub-microscopic, 84.5% afebrile and 60.0% were both sub-microscopic and afebrile. Local residency, low education level of the household head and living in a household with at least one other  P .  vivax  infected individual increased the risk of  P .  vivax  infection. Overall, 23.5% of  P .  vivax  infections had concurrent gametocytaemia. Of all  P .  vivax  positive samples, 29.2% were polyclonal by MS16 and  msp1 F3 genotyping. All five  P .  falciparum  infections were detected in residents of the same village, carried the same  msp2  allele and four were positive for  P .  falciparum  gametocytes.    Conclusion    P .  vivax  infection remains endemic in Ngella, with the majority of cases afebrile and below the detection limit of LM.  P .  falciparum  has nearly disappeared, but the risk of re-introductions and outbreaks due to travel to nearby islands with higher malaria endemicity remains.

plos neglected tropical diseases

High Rates of Asymptomatic, Sub-microscopic Plasmodium vivax Infection and Disappearing Plasmodium falciparum Malaria in an Area of Low Transmission in Solomon Islands