Infectivity of symptomatic malaria patients to Anopheles farauti colony mosquitoes in Papua New Guinea

Despite being a weak point in their life cycle, transmission of Plasmodium parasites from humans to mosquitoes is an understudied field of research. Direct membrane feeding assays (DMFA) are an important tool, allowing detailed mechanistic malaria transmission studies from humans to mosquitoes. Especially for Plasmodium vivax , which cannot be cultured long-term under laboratory conditions, implementation of DMFAs requires proximity to P. vivax endemic areas. In the present study, we investigated the infectivity of symptomatic Plasmodium infections to Anopheles farauti colony mosquitoes in Papua New Guinea (PNG), a country with one of the highest rates of Plasmodium vivax in the world. A total of 182 DMFAs were performed with venous blood collected from symptomatic malaria patients positive by rapid diagnostic test (RDT). DMFAs resulted in mosquito infection in 20.9% (38/182) of cases. The parasite species in the blood feeds were determined retrospectively by expert light microscopy and quantitative real-time qPCR. Based on light microscopy, 9.2% of P. falciparum and 42% of P. vivax human infections resulted in mosquito infections. Infections containing gametocytes detected by microscopy led to mosquito infections in 58.8% of P. vivax and 8.7% of P. falciparum infections. Based on qPCR, 10% of P. falciparum and 43.6% of P. vivax lead to a successful mosquito infection. Venous blood samples from symptomatic P. vivax patients were more infectious to An. farauti mosquitoes in DMFAs compared to P. falciparum infected patients. The capacity to perform DMFAs in a high-burden P. vivax setting creates a unique opportunity to address critical gaps in our understanding of P. vivax human-tomosquito transmission.