Efficient Transmission of Mixed Plasmodium falciparum/ vivax Infections from Humans to Mosquitoes

Sujata Balasubramanian, Rifat S. Rahman, Chanthap Lon, Christian Parobek, Ratawan Ubalee, Nicholas Hathaway, Worachet Kuntawunginn, Mok My, Dav Vy, Jeremy Saxe, Charlotte Lanteri, Feng Chang Lin, Michele Spring, Steven R. Meshnick, Jonathan J. Juliano, David L. Saunders, Jessica T. Lin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background. In Southeast Asia, people are often coinfected with different species of malaria (Plasmodium falciparum [Pf] and Plasmodium vivax [Pv]) as well as with multiple clones of the same species. Whether particular species or clones within mixed infections are more readily transmitted to mosquitoes remains unknown. Methods. Laboratory-reared Anopheles dirus were fed on blood from 119 Pf-infected Cambodian adults, with 5950 dissected to evaluate for transmitted infection. Among 12 persons who infected mosquitoes, polymerase chain reaction and amplicon deep sequencing were used to track species and clone-specific transmission to mosquitoes. Results. Seven of 12 persons that infected mosquitoes harbored mixed Pf/Pv infection. Among these 7 persons, all transmitted Pv with 2 transmitting both Pf and Pv, leading to Pf/Pv coinfection in 21% of infected mosquitoes. Up to 4 clones of each species were detected within persons. Shifts in clone frequency were detected during transmission. However, in general, all parasite clones in humans were transmitted to mosquitoes, with individual mosquitoes frequently carrying multiple transmitted clones. Conclusions. Malaria diversity in human hosts was maintained in the parasite populations recovered from mosquitoes fed on their blood. However, in persons with mixed Pf/Pv malaria, Pv appears to be transmitted more readily, in association with more prevalent patent gametocytemia.

Original languageEnglish
Pages (from-to)428-437
Number of pages10
JournalJournal of Infectious Diseases
Issue number3
StatePublished - 2020
Externally publishedYes


  • Anopheles dirus
  • Deep sequencing
  • Gametocyte
  • Malaria transmission
  • Plasmodium vivax


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