Low-Density Infections (LDI) in Malaria: Challenges for Detection, Surveillance, and Elimination

Malaria control efforts have achieved notable reductions in morbidity and mortality over the past two decades; however, progress toward elimination has plateaued in many endemic regions. A key challenge is the persistence of low-density infections (LDI), which are often asymptomatic and remain undetected by conventional diagnostic tools such as microscopy and rapid diagnostic tests. These infections are increasingly recognized as an important reservoir sustaining transmission, particularly in low-transmission and pre-elimination settings. Their cryptic nature complicates surveillance, leading to underestimation of the true malaria burden and limiting the effectiveness of targeted interventions. As malaria programs transition from control to elimination, addressing LDI is essential to interrupt residual transmission and achieve sustainable outcomes.This Research Topic aims to address critical gaps in understanding the epidemiology, detection, and programmatic implications of LDI in malaria. It seeks to advance knowledge on how these infections contribute to ongoing transmission and how they can be effectively identified and managed within malaria control and elimination frameworks. Emphasis will be placed on improving detection through highly sensitive diagnostic approaches, including molecular and sequencing-based tools, and evaluating their feasibility in field settings. The Topic also aims to explore innovative surveillance strategies that integrate LDI detection into routine systems, enabling more accurate burden estimation and targeted interventions. By fostering interdisciplinary research, this collection will support the development of evidence-based strategies to better capture, monitor, and respond to LDI, ultimately strengthening malaria elimination efforts globally.We welcome original research articles, systematic reviews, meta-analyses, short communications, and policy or perspective papers addressing key aspects of LDI in malaria. Topics of interest include, but are not limited to: - Epidemiology and transmission dynamics of LDI- Advances in sensitive diagnostic tools (e.g., PCR-based methods, next-generation sequencing, and point-of-care innovations)- Infectiousness of low-density infections to mosquito vectors- The role of LDI in residual transmission. We also encourage submissions on operational and implementation challenges, including surveillance strategies (e.g., reactive case detection, mass screening and treatment), integration into national programs, and cost-effectiveness analyses. Modeling studies and policy-relevant research that inform malaria elimination strategies are particularly encouraged. This Research Topic aims to provide a comprehensive platform for advancing knowledge and guiding practice in addressing LDI. Topic editors: Sam Joy, Puspendra Pal Singh Source: https://www.frontiersin.org/research-topics/81069/low-density-infections-ldi-in-malaria-challenges-for-detection-surveillance-and-elimination