Amazonian Center of Excellence in Malaria Research

该项目的广泛和长期目标是指导亚马逊地区消除疟疾的战略，包括 考虑人类、环境和生物特征，这些特征结合在一起，使疟疾保持在低流行状态 区域。亚马逊疟疾的复杂性因与工作和工作相关的激烈人类活动而加剧 社会互动，再加上无症状的感染，导致疟疾寄生虫的“沉默”宿主 穿越空间和时间。在过去的ICEMR项目期间，以人口为基础的纵向队列 巴西和秘鲁的研究表明，疟疾在流行病学上的传播模式复杂。 对比不同的地点(例如，疟疾的传播增加与消失)。这个新项目将继续 纵向研究勾勒出疟疾传播的良好水平和这些地区的地方性复杂性 新网站。该项目基于基本假设(整个亚马逊ICEMR计划也是如此) 这种无症状、次专利的寄生虫病推动了持续的低地方性疟疾。残留疟疾(到期 到户外叮咬的达林伊按蚊，可能与人类驱动有关 改变媒介行为和遗传，项目2)和新出现的复杂疟疾模式 重新引入使研究消除疟疾的替代方法成为一个关键问题。在这 我们试图了解两种不同疟疾流行病学的模式和决定因素 亚马逊地区的环境：残留疟疾，持续虚传，高度传播的疫源地。这些 环境具有不同的当地生态(河流、公路和城市地区)和人类行为(例如，蚊帐 使用、职业、流动性)。在目标1中，我们将收集数据来计算和解释当地传播指数， 并全面确定疟疾传播的当地决定因素。AIM 1整合了所有三个项目 通过确定和描述疟疾病例的背景，并将有症状和 无症状患者参与项目2，以指导蚊子种群特征和传播生物学 研究和项目3，分别用于免疫学实验。在AIM 2中合成分子 流行病学方法和种群遗传学将被用来识别种群的时间变化。 间日疟原虫和恶性疟原虫，以检测重新引入和寄生虫种群替换，并估计 基线时和干预后可能的寄生虫种群复杂性。目标3，也整合了这三个 ICEMR项目，将模拟疟疾传播的动态，模拟最佳干预方案 在流行病学不同的环境中减少疟疾，明确考虑生态异质性 以及人类社会人口统计学上的差异。该项目将为正在进行的和 亚马逊地区新出现的疟疾挑战。综合分子和流行病学数据集来自 本项目与项目2--媒介生态学和传播生物学研究--以及项目3相结合， 无症状疟疾的免疫学研究将为消除疟疾的新方法提供路线图。

The broad, long-term objective of this project is to guide malaria elimination strategies in Amazonia taking into account human, environmental, and biological features that combine to maintain hypoendemic malaria in the region. The complexity of Amazonian malaria is augmented by intense human movement related to work and social interactions, which combined with asymptomatic infections lead to “silent” reservoirs of malaria parasites moving across space and time. Over the past ICEMR project period, population-based longitudinal cohort studies in Brazil and Peru have demonstrated complex patterns of malaria transmission in epidemiologically contrasting sites (e.g., increasing transmission vs. disappearing malaria). This new Project will continue longitudinal studies to delineate a fine level of malaria transmission and endemicity complexity in these and new sites. This Project is based on the primary hypothesis (as is the entire Amazonia ICEMR program) that asymptomatic, subpatent parasitemia drive ongoing hypoendemic malaria. Residual malaria (due to outdoor-biting Anopheles darlingi mosquitoes potentially related to anthropogenically-driven changing vector behaviors and genetics, Project 2) and emerging, complex patterns of malaria reintroductions has made studying alternative approaches to malaria elimination a critical issue. In this project we seek to understand the patterns and determinants of two contrasting malaria epidemiological settings in the Amazon: residual malaria with continuing hypoendemicity, and foci of high transmission. These settings have different local ecologies (riverine, highway and urban areas) and human behavior (e.g., bednet use, occupation, mobility). In Aim 1, we will gather data to calculate and interpret local indices of transmission, and to comprehensively identify local determinants of malaria transmission. Aim 1 integrates all three Projects of the ICEMR by identifying and characterizing the context of malaria cases, and referring symptomatic and asymptomatic patients to Project 2 to guide mosquito population characterization and transmission biology studies, and to Project 3 for immunological experiments, respectively. In Aim 2 comprehensive molecular epidemiological approaches and population genetics will be used to identify temporal population changes in P. vivax and P. falciparum, to detect reintroductions and parasite population replacements, and to estimate parasite population complexity at baseline and potentially after interventions. Aim 3, also integrating all three ICEMR projects, will model the dynamics of malaria transmission, simulate the optimal intervention packages to reduce malaria in epidemiologically contrasting settings, explicitly accounting for ecological heterogeneity and differences in human socio-demographics. This Project will contribute new solutions to ongoing and emerging malaria challenges in Amazonia. The comprehensive molecular and epidemiological data sets from this Project, integrated with Project 2, studies of vector ecology and transmission biology, and with Project 3, immunology of asymptomatic malaria, will provide a roadmap for new approaches to malaria elimination.