Hitting Hotspots: Spatial Targeting of Malaria for Control and Elimination

Abstract

Teun Bousema and colleagues argue that targeting malaria “hotspots” is a highly efficient way to reduce malaria transmission at all levels of transmission intensity.

Infectiousness of the Human Population to Anopheles arabiensis by Direct Skin Feeding in an Area Hypoendemic for Malaria in Senegal

“…[11][12][13][14][15] Often, these studies were restricted to microscopically detected gametocyte carriers, even though it has been repeatedly shown that submicroscopic gametocyte densities may result in mosquito infection. 16,17 Although microscopically detectable gametocyte densities are more likely to result in mosquito infections compared with submicroscopic gametocyte densities, the contribution of submicroscopic gametocyte carriers to the total infectious reservoir may be considerable 18 and can only be determined in xenodiagnostic surveys where individuals are recruited for feeding experiments, regardless of their parasitemic status. A recent meta-analysis further suggests that direct skin feeding assays may be the most sensitive approach to determine human infectiousness to mosquitoes.…”

“…A recent meta-analysis further suggests that direct skin feeding assays may be the most sensitive approach to determine human infectiousness to mosquitoes. 16 In this study, we determine infectivity of the human population to mosquitoes in a hypoendemic area of Senegal using direct skin feeding mosquito assays and observe a considerable contribution of adults and submicroscopic gametocyte carriers to malaria transmission.…”

The Hitchhiking Parasite: Why Human Movement Matters to Malaria Transmission and What We Can Do About It

“…First, because significant funds are being invested in global malaria control, prevalence is declining overall, but significant heterogeneity in transmission remains at all spatial scales [1]. Within this context, an understanding of human movement is essential to determine how best to optimize control strategies by targeting: (i) sources of transmission; (ii) conduits of travel by high-risk travelers; and (iii) receptive locations vulnerable to outbreaks as a result of importation [2].…”

“…Within this context, an understanding of human movement is essential to determine how best to optimize control strategies by targeting: (i) sources of transmission; (ii) conduits of travel by high-risk travelers; and (iii) receptive locations vulnerable to outbreaks as a result of importation [2]. While human movement is ubiquitous across transmission settings, it is a particular concern in locations where local transmission has been reduced but the environment is still conducive to transmission [1,3]. In these settings, an increasing proportion of remaining transmission is often due to parasite importation and, hence, malaria programs must address this to prevent resurgence.…”

Parasite sources and sinks in a patched Ross–Macdonald malaria model with human and mosquito movement: Implications for control

“…Host mediated parasite movement on these landscapes drives source-sink parasite dynamics which elimination programs must account for [9], as areas with enough transmission to sustain parasite populations locally will export excess parasites through host movement, known as transmission foci, supporting parasite populations in sink areas, or areas where parasites would not persist otherwise [9]. As transmission foci enable parasite persistence in sinks, they have been proposed as prime targets for control efforts [9,27]. Conceptually, regional malaria elimination can then be achieved by reducing transmission within all transmission foci to below self-sustaining levels [25].…”