Abstract
Assessing the importance of targeting the chronic Plasmodium falciparum malaria reservoir is pivotal as the world moves toward malaria eradication. Through the lens of a mathematical model, we show how, for a given malaria prevalence, the relative infectivity of chronic individuals determines what intervention tools are predicted be the most effective. Crucially, in a large part of the parameter space where elimination is theoretically possible, it can be achieved solely through improved case management. However, there are a significant number of settings where malaria elimination requires not only good vector control but also a mass drug administration campaign. Quantifying the relative infectiousness of chronic malaria across a range of epidemiological settings would provide essential information for the design of effective malaria elimination strategies. Given the difficulties obtaining this information, we also provide a set of epidemiological metrics that can be used to guide policy in the absence of such data.
Highlights
Accepting that clinical malaria infections are, on average, considerably shorter in duration owing to treatment, and that chronic infections can extend up to several months, it is evident that, if clinical and chronic infections had similar infectivity, chronic infections would be the main contributors to overall malaria transmission
We have focused on the potential impact of elimination strategies consisting of 2 annual mass drug administration (MDA) campaigns of 3 artemisinin combination therapy (ACT) rounds each and vector control intervention packages consisting of annual insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS) campaigns (Figure 3)
We chose parameters sets that illustrate the 3 possible outcomes of elimination driven intervention strategies: successful elimination with the 2 annual MDA campaigns or 3 years of sustained vector control; failure to eliminate where elimination is theoretically possible because the intervention effort was halted too soon, with resurgence following after a few years; and elimination impossible, with malaria returning to baseline prevalence levels soon after the intervention stops
Summary
Accepting that clinical malaria infections are, on average, considerably shorter in duration owing to treatment, and that chronic infections can extend up to several months, it is evident that, if clinical and chronic infections had similar infectivity, chronic infections would be the main contributors to overall malaria transmission. We have focused on the potential impact of elimination strategies consisting of 2 annual MDA campaigns of 3 artemisinin combination therapy (ACT) rounds each and vector control intervention packages consisting of annual ITN and IRS campaigns (Figure 3).
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