Epidemiology of Malaria Transmission in Low to Moderate Settings of Latin America

项目1的主要目标是评估与流行病学和临床发现有关的生态和寄生虫种群的多样性，以便建立一个科学框架，支持制定新的干预战略，在洛杉矶非亚马逊地区消除疟疾。将通过以下具体目标实现这一目标：1）研究季节性疟疾的流行病学及其与寄生虫种群多样性的关系; 2）确定与洛杉矶国家非亚马逊地区疟疾传播有关的风险因素。 我们假设循环疟原虫种群及其动力学调节临床 我们认识到，疟疾的传播和感染风险与病媒生物学特性、寄生虫种群多样性、宿主生物学和行为、家庭条件和当地环境条件同时起作用。为目标1提议的研究旨在通过考虑生活在洛杉矶季节性地区的有症状和无症状的个人，确定疟疾的真实的流行率和发病率。 本研究包括基于社区的队列研究（前瞻性研究）、使用时间横断面研究的主动监测和基于医院的被动监测研究。这些研究将在哥伦比亚、秘鲁、巴拿马和危地马拉的7个地方病流行区进行，共将对21个监测点进行研究。研究将分三个阶段进行：（1）我们自己对哨点选定人口进行普查，在哨点使用人口调查表登记居民，并使用全球定位系统提供坐标;（2）在选定哨点进行厚涂片和聚合酶链反应疟疾诊断，并随机抽样，以确定无症状配子体携带者;（3）临床随访， 在两个哨点（一个在哥伦比亚（蒂尔拉尔塔），一个在秘鲁（Sulluna））发现无症状的厚涂片。对于目标2，我们将：（a）评估疟疾流行社区的抗疟药物使用情况，包括坚持使用、自我用药和预防;（B）研究公共和私营卫生机构的抗疟药物使用情况，包括护理指南的可用性和适用性。在ICEMR计划中，我们将建立一个哨点网络，将选择生物地理标准（媒介和生态条件）和流行病学信息相结合。哨点将提供关于疟疾生态学和流行病学的基线信息，目的是确定寄生虫和病媒种群对控制干预措施的适应能力。这种网络将有助于支持目前旨在发展人口的努力， 量化疾病动态的模型和疟疾风险图，以支持卫生部的消除活动。

The main objective of project 1 is to evaluate the diversity of the ecology and parasite populations related to the epidemiology and clinical findings in order to establish a scientific framework that supports the development of new intervention strategies for malaria elimination in non-Amazonian areas of LA. This goal will be approached through the following specific aims: 1) Study the epidemiology of seasonal malaria and their relationship with parasite population diversity and 2) Identification risk factors associated with malaria transmission in non-Amazonian areas of LA countries. We hypothesize that circulating Plasmodium populations and their dynamics modulate the clinical manifestations and immune responses in the affected populations and that vector bionomics, parasite population diversity, host biology and behavior, household conditions, and local environmental conditions, act simultaneously to determine malaria transmission and risk of infection. The studies proposed for aim 1 are directed to determine the real prevalence and incidence of malaria by considering both symptomatic and asymptomatic individuals living in seasonal areas in LA. This investigation includes community based cohort studies (prospective studies), active surveillance using temporal cross-sectional studies, and hospital based passive surveillance studies. The studies will be carried out in 7 endemic areas of Colombia, Peru, Panama and Guatemala, where a total of 21 sentinel sites will be studied. Studies will be carried out in three phases: 1) Our own census of the selected population from sentinel sites where inhabitants will be registered using a demographic questionnaire and houses coordinates using a GPS system; 2) thick smear and PCR for malaria diagnose in selected sentinels sites and random sampling in order to determine asymptomatic gametocytes carriers; 3) clinical follow-up and thick smear of asymptomatic at two sentinel sites (one in Colombia (Tierralta) and one in Peru (Sulluna). For aim 2 we will a) assess the conditions of antimalarial use in communities where malaria is endemic, including adherence, self-medication and prophylaxis; and (b) study the conditions of use of antimalarials in the public and private health institutions including the availability and suitability to care guides. In this ICEMR program, we will establish a network of sentinel sites that will be selected integrating bio-geographic criteria (vector and ecological conditions) and epidemiological information. Sentinel sites will provide baseline information on malaria ecology and epidemiology with the goal of characterizing parasite and vector populations resilient to control interventions. Such network will allow supporting current efforts directed to develop population models to quantify disease dynamics and malaria risk-maps to support MOH elimination activities.