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结果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，支持在洛杉矶的非亚马逊地区制定新的防治疟疾的干预战略。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，循环中的疟原虫种群及其动态调节了临床 病媒生物学、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，以确定疟疾传播和感染风险。为目标1提出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来确定疟疾的实际流行和发病率。 这项调查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，以及基于医院的被动监测研究。研究将在哥伦比亚、秘鲁、巴拿马和危地马拉的7个流行区进行，总共将对21个哨所进行研究。研究将分三个阶段进行：1)我们自己从哨所进行人口普查，那里的居民将使用人口统计问卷进行登记，并使用GPS系统进行住房坐标；2)在选定的哨所进行厚涂片和聚合酶链式反应诊断疟疾，并随机抽样，以确定无症状的配子体携带者；3)临床随访和 在两个哨所(一个在哥伦比亚(泰拉尔塔)，一个在秘鲁(苏卢纳))出现厚厚的无症状涂片。为实现目标2，我们将a)评估疟疾流行社区中抗疟疾药物的使用情况，包括坚持、自我用药和预防；以及(B)研究公共和私营卫生机构中抗疟疾药物的使用情况，包括护理指南的可得性和适宜性。在ICEMR计划中，我们将建立一个哨点网络，该网络将结合生物地理标准(媒介和生态条件)和流行病学信息进行选择。哨兵站点将提供有关疟疾生态和流行病学的基线信息，目的是确定寄生虫和媒介人口对控制干预措施的适应能力。这种网络将能够支持目前旨在发展人口努力 量化疾病动态和疟疾风险地图的模型，以支持消除卫生部的活动。

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.