India should consider sero-epidemiology as an additional tool to bolster malaria elimination

Abstract

Malaria remains a major vector-borne parasitic disease and a leading cause of morbidity and mortality. According to the World Malaria Report 2024, India accounts for over half of Southeast Asia's malaria burden, mainly from Plasmodium falciparum and Plasmodium vivax. Several countries, including Indonesia, Malaysia, Myanmar, Thailand, Vietnam, Suriname, and African regions, have integrated malaria serology into elimination strategies to detect past exposure and guide targeted interventions. India achieved notable control until 2021 (161,753 cases), but cases have increased from 176,522 in 2022 to 255,500 in 2024 (∼58% increase since 2021). Serology offers a valuable surveillance tool to determine true disease burden, verify elimination, assess transmission in high-risk groups, detect low-density or dormant infections, and measure intervention impact. Routine surveys in India should incorporate serology alongside rapid diagnostic tests and microscopy. Evidence suggests serological surveys can strengthen control and elimination, particularly in low-transmission settings. This review explores the potential of malaria serology as a public health tool to enhance India's elimination efforts. Search strategy and selection criteria References for this review were identified through searches of PubMed, Scopus, and Google Scholar using the terms 'malaria serology', seroprevalence, malaria antibodies, 'India', and specific species names (e.g., P. falciparum, P. vivax, P. ovale, and P. malariae) up to July 2025.

Keywords: Elimination verification; Low-density infections; Malaria surveillance; Sero-epidemiology; Serological surveys.