Low prevalence of Plasmodium falciparum parasites lacking pfhrp2/3 genes among asymptomatic and symptomatic school-age children in Kinshasa, Democratic Republic of Congo

Abstract Background. Loss of efficacy of malaria diagnostic tests may lead to untreated or mistreated cases, compromising case management and control. There is an increasing reliance on rapid diagnostic tests (RDTs), with the most widely used of these targeting the Plasmodium falciparum histidine-rich protein 2 gene. There are numerous reports of the deletion of this gene in P. falciparum parasites in some populations, rendering them undetectable by PfHRP2 RDTs. We aimed to identify P. falciparum parasites lacking the P. falciparum histidine rich protein 2 and 3 genes isolated from asymptomatic and symptomatic school-age children in Kinshasa, Democratic Republic of Congo. Methods. We assessed the performance of PfHRP2-based RDTs in comparison to microscopy and PCR. PCR was then used to identify parasite isolates lacking pfhrp2/3 genes. Results. Of 462 DNA samples analysed, deletions of the pfhrp2 and pfhrp3 genes were found in only three (2%) samples and one (1%) sample in the RDT positive subgroup, respectively. No parasites lacking the pfhrp2/3 genes were found in the RDT negative subgroup. Conclusion. Plasmodium falciparum histidine-rich protein 2/3 gene deletions are uncommon in the surveyed population, and do not result in diagnostic failure. We encourage the use of rigorous PCR methods to identify pfhrp2/3 gene deletions in order to minimize the overestimation of their prevalence.