Amazonian Center of Excellence in Malaria Research

该项目广泛的长期目标是指导亚马逊地区的疟疾消除战略， 考虑到人类，环境和生物特征，这些特征联合收割机，使疟疾在非洲低流行， 地区亚马逊疟疾的复杂性由于与工作有关的密集的人类流动而增加， 社会交往与无症状感染相结合，导致疟疾寄生虫“沉默”储存库 穿越时空在过去的ICEMR项目期间，基于人群的纵向队列 在巴西和秘鲁进行的研究从流行病学角度证明了疟疾传播的复杂模式， 对比位点（例如，传播增加与疟疾消失）。这个新项目将继续 进行纵向研究，以确定这些地区疟疾传播和地方性复杂性的精细水平， 新网站该项目是基于主要假设（整个亚马逊ICEMR计划） 无症状的隐性寄生虫血症导致了持续的低流行性疟疾。残余疟疾（到期） 到户外叮咬的达氏按蚊可能与生殖驱动有关， 改变病媒行为和遗传学，项目2）和新出现的复杂疟疾模式 重新引入使得研究消灭疟疾的替代方法成为一个关键问题。在这 项目我们试图了解两种截然不同的疟疾流行病学的模式和决定因素， 在亚马逊地区的环境中：持续低流行性的残余疟疾和高传播病灶。这些 环境具有不同的局部生态（河流、公路和城市区域）和人类行为（例如，蚊帐 使用、职业、流动性）。在目标1中，我们将收集数据以计算和解释当地的传播指数， 并全面查明疟疾传播的当地决定因素。目标1整合了所有三个项目 通过确定和描述疟疾病例的背景， 无症状患者的项目2，以指导蚊子种群特征和传播生物学 研究和项目3的免疫学实验。In Aim 2综合分子 流行病学方法和群体遗传学将被用来确定时间的人口变化，P。 间日疟原虫和恶性疟原虫，以检测重新引入和寄生虫种群更替，并估计 基线时和干预后的潜在寄生虫种群复杂性。目标3，也将三者结合起来 ICEMR项目将建立疟疾传播动力学模型，模拟最佳干预方案， 在流行病学对比鲜明的环境中减少疟疾，明确说明生态异质性 和人类社会人口统计学的差异。该项目将为正在进行的和 亚马逊地区新出现的疟疾挑战。来自美国的综合分子和流行病学数据集 该项目与项目2（病媒生态学和传播生物学研究）和项目3相结合， 无症状疟疾的免疫学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.