ULTIMASero · Understanding Long-term Trends in Multi-pathogen Epidemiology in Africa using Multiplex Serological and Molecular Assays

Enormous progress is being made in the fight against parasitic diseases such as malaria in sub-Saharan Africa, which is driving a long-term epidemiological shift in the burden of infectious diseases. Until recently, most febrile patients presenting to rural health facilities were presumptively treated for malaria. However, the decline in malaria cases coupled with the roll out of rapid diagnostic tests has revealed a substantial burden of non-malaria fevers. I hypothesise that the predominant disease burden in Africa is changing from parasites to viruses, and that the diversity of infecting pathogens is increasing over time.ULTIMASero aims to investigate long-term trends in the epidemiology of infectious diseases by taking a multi-pathogen approach using multiplex serological and molecular assays, epidemiological studies, and statistical modelling. This will be achieved through four aims: (i) Investigate febrile patients in longitudinal studies in Senegal, Cameroon, and Madagascar; (ii) Develop a multiplex serological assay for viral, parasitic, and bacterial pathogens in Africa; (iii) Create statistical and machine learning tools for multiplex data; and (iv) Implement sero-epidemiological analyses of long-term trends in infectious disease in general populations.The key technological output will be a multiplex serological assay using Luminex bead-based technology to measure antibodies to infectious diseases transmitted in Africa. The assay will test small volume blood samples for antibodies to >300 antigens from >100 pathogens. We will test samples from prospective cohorts of febrile patients to provide an in-depth assessment of the burden of febrile illness, and from 50,000 biobanked samples dating back over 30 years to assess long-term trends in multi-pathogen epidemiology in the general population.The knowledge generated from this interdisciplinary project will have major implications for how we study, track, prevent and treat febrile illness in Africa.