Plasmodium falciparum importation does not sustain malaria transmission in a semi-arid region of Kenya.
Plasmodium falciparum importation does not sustain malaria transmission in a semi-arid region of Kenya.
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DOI：
10.1371/journal.pgph.0000807
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发表时间：
2022
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人类的运动影响着传染病的传播和传播。最近，在肯尼亚西北部历史上被认为不适合疟疾传播的半干旱地区发现了一个大型恶性疟原虫疟疾水库。了解可归因于人类活动的传播来源和模式将有助于设计和确定干预措施的目标，以减少该区域出乎意料的高疟疾负担。为此，通过扩增子深度测序，对图尔卡纳中部居民和旅客的多态寄生虫基因（ama1, csp）进行了基因分型。结合基因分型和流行病学资料评估寄生虫输入情况。旅行对疟疾传播的贡献是通过模拟包括和不包括旅行者的病例繁殖数来估计的。在入境旅客中检出恶性疟原虫6.7%(127/1891)，包括后来在本地传播感染中检出的新单倍型。病例繁殖数接近1，并且当旅行者从传播网络中移除时没有变化，这表明传播不是由前往该地区的旅行引起的，而是当地流行的。因此，疟疾不仅在图尔卡纳中部流行，而且还通过当地传播得以维持。因此，阻断输入本身不太可能是一种有效的疟疾控制战略，但是针对当地的干预措施有可能降低传播。
Human movement impacts the spread and transmission of infectious diseases. Recently, a large reservoir of Plasmodium falciparum malaria was identified in a semi-arid region of northwestern Kenya historically considered unsuitable for malaria transmission. Understanding the sources and patterns of transmission attributable to human movement would aid in designing and targeting interventions to decrease the unexpectedly high malaria burden in the region. Toward this goal, polymorphic parasite genes (ama1, csp) in residents and passengers traveling to Central Turkana were genotyped by amplicon deep sequencing. Genotyping and epidemiological data were combined to assess parasite importation. The contribution of travel to malaria transmission was estimated by modelling case reproductive numbers inclusive and exclusive of travelers. P. falciparum was detected in 6.7% (127/1891) of inbound passengers, including new haplotypes which were later detected in locally-transmitted infections. Case reproductive numbers approximated 1 and did not change when travelers were removed from transmission networks, suggesting that transmission is not fueled by travel to the region but locally endemic. Thus, malaria is not only prevalent in Central Turkana but also sustained by local transmission. As such, interrupting importation is unlikely to be an effective malaria control strategy on its own, but targeting interventions locally has the potential to drive down transmission.