Reservoirs of transmission: Targets for Malaria Control Interventions

在马拉维，疟疾已对与一些国家发病率下降有关的干预措施表示不满。 周边国家标准预防和控制措施未能减少的原因 马拉维的疟疾负担仍然未知。一个可能的组成部分是，目前的干预措施旨在 控制疟疾疾病，但没有充分针对传播宿主阻断感染传播 在这种高度流行的环境中。描述从人类到蚊子的传播是复杂的。识别 人类携带配子母细胞是不够的，因为成功的传播涉及多方面的 人与病媒行为之间的关系，以及复杂的人、病媒和寄生虫生物学 交互.很少有研究试图充分描述和建模的因素，有助于人类 蚊子传播，但这些信息是必不可少的。我们的总体目标是确定最重要的 疟疾在人群中传播的来源，并应用这一信息来优化设计 针对这些水库的新战略。我们将进行纵向队列研究，包括分子生物学研究， 配子体感染的检测，昆虫学评估，人类行为表征， 膜饲料：1）系统地表征人与蚊子的传播模式，以确定 马拉维重要的疟疾传播宿主群体，2）评估当前干预措施的影响 3）使用这些数据开发分析模型，以设计和监测有针对性的 采取有效措施减少传播。我们以前的研究表明，学龄儿童 感染率和含有配子体的感染率最高， 由于相对较少使用驱虫蚊帐。我们假设，学龄儿童是主要的水库， 疟疾传播，目前的干预措施未能充分达到这一群体， 以这一群体为目标将大大减轻马拉维的疟疾负担。更好地了解 马拉维的人-蚊传播动态和疟原虫传播宿主将 改进干预措施的设计和评价，以针对最重要的人类资源库， 传播和加强干预措施的影响。发展有针对性的循证 这些干预措施将帮助马拉维和其他高负担地区应对持续存在的疟疾挑战。

Malaria in Malawi has been recalcitrant to the interventions associated with decreased incidence in some neighboring countries. The reasons for the failure of standard prevention and control measures to reduce the burden of malaria in Malawi remain unknown. One possible component is that current interventions aim to control malaria disease but do not adequately target transmission reservoirs to interrupt the spread of infection in this highly endemic setting. Characterizing transmission from humans to mosquitoes is complex. Identifying which humans harbor gametocytes is insufficient because successful transmission involves multidimensional relationships between human and vector behaviors, and complicated human, vector, and parasite biological interactions. Few studies have attempted to fully describe and model the factors that contribute to human to mosquito transmission, yet this information is essential. Our overall goal is to identify the most important sources of malaria transmission in the human population and to apply this information to optimize the design of new strategies to target these reservoirs. We will conduct longitudinal cohort studies including molecular detection of gametocyte infection, entomological assessments, human behavior characterization and membrane feeds to: 1) systematically characterize human-to-mosquito transmission patterns to identify the important transmission reservoir group(s) for malaria in Malawi, 2) assess the impacts of current interventions on these human reservoirs, and 3) develop analytical models using these data to design and monitor targeted interventions to efficiently reduce transmission. Our previous work has shown that school-age children have the highest prevalence of infection and of infections containing gametocytes, and are more available to vectors due to relatively infrequent ITN use. We hypothesize that school-age children are the primary reservoirs of Plasmodium transmission, that current interventions fail to adequately reach this group, and that interventions targeting this group would considerably reduce the burden of malaria in Malawi. Better understanding of human-to-mosquito transmission dynamics and the transmission reservoirs of Plasmodium in Malawi will improve the design and evaluation of interventions to target the most important human reservoirs of transmission and enhance the impact of interventions. The development of evidence-based targeted interventions will aid Malawi and other high burden settings to tackle the challenge of persistent malaria.