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Background  With low and markedly seasonal malaria transmission, increasingly sensitive tools for better stratifying the risk of infection and targeting control interventions are needed. A cross-sectional survey to characterize the current malaria transmission patterns, identify hotspots, and detect recent changes using parasitological and serological measures was conducted in three sites of the Peruvian Amazon.    Material and Methods  After full census of the study population, 651 participants were interviewed, clinically examined and had a blood sample taken for the detection of malaria parasites (microscopy and PCR) and antibodies against  P .  vivax  (PvMSP1 19 , PvAMA1) and  P .  falciparum  (PfGLURP, PfAMA1) antigens by ELISA. Risk factors for malaria infection (positive PCR) and malaria exposure (seropositivity) were assessed by multivariate survey logistic regression models. Age-specific seroprevalence was analyzed using a reversible catalytic conversion model based on maximum likelihood for generating seroconversion rates (SCR, λ). SaTScan was used to detect spatial clusters of serology-positive individuals within each site.    Results  The overall parasite prevalence by PCR was low, i.e. 3.9% for  P .  vivax  and 6.7% for  P .  falciparum , while the seroprevalence was substantially higher, 33.6% for  P .  vivax  and 22.0% for  P .  falciparum , with major differences between study sites. Age and location (site) were significantly associated with  P .  vivax  exposure; while location, age and outdoor occupation were associated with  P .  falciparum  exposure.  P .  falciparum  seroprevalence curves showed a stable transmission throughout time, while for  P .  vivax  transmission was better described by a model with two SCRs. The spatial analysis identified well-defined clusters of  P .  falciparum  seropositive individuals in two sites, while it detected only a very small cluster of  P .  vivax  exposure.    Conclusion  The use of a single parasitological and serological malaria survey has proven to be an efficient and accurate method to characterize the species specific heterogeneity in malaria transmission at micro-geographical level as well as to identify recent changes in transmission.

Hotspots of Malaria Transmission in the Peruvian Amazon: Rapid Assessment through a Parasitological and Serological Survey