UC Berkeley

Surveillance plays a key role in malaria control and elimination efforts by allowing for informed and effective allocation of often limited resources. Current methods for estimating malaria exposure are limited either by cost or accuracy. Serological data offers the potential to provide inexpensive and accurate estimates of exposure, but to date there is no consensus on which antibody responses are informative and how they can be interpreted. Previous studies have been limited to single age groups, transmission intensities, and geographic locations that are not generalizable across populations. This dissertation describes an investigation into serologic biomarkers of recent exposure to Plasmodium falciparum, the most deadly species causing malaria, using samples from 8 cohort studies representing diverse populations. Using an innovative approach that combined detailed individual-level exposure data, high-throughput screening of hundreds of antibody responses, and robust statistical methods, we were unable to identify a set of antibody responses predictive of recent exposure that was generalizable across settings. Although universal seromarkers may not exist, we found that accurate prediction of recent exposure was possible in a cohort of return travelers, suggesting the potential for seromarkers to be developed for specific settings, particularly those with limited cumulative exposure.