Malaria infections occurring below the limit of detection of standard diagnostics are common in all endemic settings. However, key questions remain surrounding their contribution to sustaining transmission and whether they need to be detected and targeted to achieve malaria elimination. In this study we analyse a range of malaria datasets to quantify the density, detectability, course of infection and infectiousness of subpatent infections. Asymptomatically infected individuals have lower parasite densities on average in low transmission settings compared to individuals in higher transmission settings. In cohort studies, subpatent infections are found to be predictive of future periods of patent infection and in membrane feeding studies, individuals infected with subpatent asexual parasite densities are found to be approximately a third as infectious to mosquitoes as individuals with patent (asexual parasite) infection. These results indicate that subpatent infections contribute to the infectious reservoir, may be long lasting, and require more sensitive diagnostics to detect them in lower transmission settings.

在所有地方性流行病中，低于标准诊断方法检测限的疟疾感染是很常见的。但是，关键问题仍然围绕着它们对维持传播的贡献以及是否需要被发现和确定目标以消除疟疾。在这项研究中，我们分析了一系列疟疾数据集，以量化亚专利感染的密度，可检测性，感染过程和传染性。与较高传播环境中的个体相比，在低传播环境中无症状感染的个体平均具有较低的寄生虫密度。在队列研究中，发现亚专利感染可预测未来专利感染的时期，而在膜喂养研究中，发现感染了亚专利的无性寄生虫密度的个体对蚊子的感染性大约是感染专利（无性寄生虫）的个体的三分之一。这些结果表明，亚专利感染会增加感染的储库，可能会持续很长时间，并且需要更灵敏的诊断程序才能在较低的传播环境下检测到它们。