PT  - JOURNAL ARTICLE
AU  - Daniel M. Parker
AU  - Sai Thein Than Tun
AU  - Lisa J. White
AU  - Ladda Kajeechiwa
AU  - May Myo Thwin
AU  - Jordi Landier
AU  - Victor Chaumeau
AU  - Vincent Corbel
AU  - Arjen M. Dondorp
AU  - Lorenz von Seidlein
AU  - Nicholas J. White
AU  - Richard J. Maude
AU  - François H. Nosten
TI  - Herd protection against <em>Plasmodium falciparum</em> infections conferred by mass antimalarial drug administrations and the implications for malaria elimination
AID  - 10.1101/393843
DP  - 2018 Jan 01
TA  - bioRxiv
PG  - 393843
4099  - http://biorxiv.org/content/early/2018/09/05/393843.short
4100  - http://biorxiv.org/content/early/2018/09/05/393843.full
AB  - The global malaria burden has decreased over the last decade and many nations are attempting elimination. Asymptomatic infections aren’t normally diagnosed or treated, posing a major hurdle for elimination efforts. One solution to this problem is mass drug administration (MDA), which is dependent on adequate population participation to disrupt transmission. There is little empirical evidence regarding the necessary threshold level of participation. Here we present a detailed spatiotemporal analysis of malaria episodes and asymptomatic infections in four villages undergoing MDA in Myanmar. Individuals from neighborhoods with high MDA adherence had 90% decreased odds of having a malaria episode post-MDA, regardless of individual participation, suggesting a strong herd effect. High mosquito biting rates, living in a house with someone else with malaria, or having an asymptomatic malaria infection were also predictors of clinical episodes. Spatial clustering of non-adherence to MDA, even in villages with high overall participation, can frustrate elimination efforts.