28 Plasmodium vivax invasion of human erythrocytes depends on the Duffy Binding 29 Protein (PvDBP) which interacts with the Duffy antigen. PvDBP copy number varies 30 between P. vivax isolates, but the prevalence of PvDBP multiplications in Sub-Saharan 31 Africa and its impact are unknown. We determined the prevalence and type of PvDBP 32 duplications, as well as PvDBP copy number variation among 178 Ethiopian P. vivax 33 isolates using a PCR-based diagnostic method, a novel quantitative real-time PCR 34 assay and whole genome sequencing. For the 145 symptomatic samples, PvDBP 35 duplications were detected in 95 isolates, of which 81 had the Cambodian and 14 36 Malagasy-type PvDBP duplications. PvDBP varied from 1 to >4 copies. Isolates with 37 multiple PvDBP copies were found to be higher in symptomatic than asymptomatic 38 infections. For the 33 asymptomatic samples, PvDBP was detected with two copies in 39 two of the isolates, and both were the Cambodian-type PvDBP duplication. PvDBP copy 40 number in Duffy-negative heterozygotes was not significantly different from that in 41 Duffy-positives, providing no support for the hypothesis that increased copy number is a 42 specific association with Duffy-negativity, although the number of Duffy-negatives was 43 small and further sampling is required to test this association thoroughly. 44 45 46 3 47 Author summary 48 Plasmodium vivax invasion of human erythrocytes relies on interaction between the 49 Duffy antigen and P. vivax Duffy Binding Protein (PvDBP). Whole genome sequences 50 from P. vivax field isolates in Madagascar identified a duplication of the PvDBP gene 51 and PvDBP duplication has also been detected in non-African P. vivax-endemic 52 countries. Two types of PvDBP duplications have been reported, termed Cambodian 53 and Malagasy-type duplications. Our study used a combination of PCR-based 54 diagnostic method, a novel quantitative real-time PCR assay, and whole genome 55 sequencing to determine the prevalence and type of PvDBP duplications, as well as 56 PvDBP copy number on a broad number of P. vivax samples in Ethiopia. We found that 57 over 65% of P. vivax isolated from the symptomatic infections were detected with 58 PvDBP duplications and PvDBP varied from 1 to >4 copies. The majority of PvDBP 59 duplications belongs to the Cambodian-type while the Malagasy-type duplications was 60 also detected. For the asymptomatic infections, despite a small sample size, the 61 majority of P. vivax were detected with a single-copy based on both PCR and qPCR 62 assays. There was no significant difference in PvDBP copy number between Duffy-null 63 heterozygote and Duffy-positive homozygote/heterozygote. Further investigation is 64 needed with expanded Duffy-null homozygotes to examine the functional significance of 65 PvDBP expansion.66 67 68 69 4 70 Introduction 71 Plasmodium vivax and P. falciparum are the two major parasite species that cause 72 clinical malaria worldwide. While P. falciparum causes most malaria mortality, P. vivax 73 can also cause severe dis...