Abstract
Eliminating malaria from highly endemic settings will require unprecedented levels of vector control. To suppress mosquito populations, vector control products targeting their blood hosts must attain high biological coverage of all available sources, rather than merely high demographic coverage of a targeted resource subset, such as humans while asleep indoors. Beyond defining biological coverage in a measurable way, the proportion of blood meals obtained from humans and the proportion of bites upon unprotected humans occurring indoors also suggest optimal target product profiles for delivering insecticides to humans or livestock. For vectors that feed only occasionally upon humans, preferred animal hosts may be optimal targets for mosquito-toxic insecticides, and vapour-phase insecticides optimized to maximize repellency, rather than toxicity, may be ideal for directly protecting people against indoor and outdoor exposure. However, for vectors that primarily feed upon people, repellent vapour-phase insecticides may be inferior to toxic ones and may undermine the impact of contact insecticides applied to human sleeping spaces, houses or clothing if combined in the same time and place. These concepts are also applicable to other mosquito-borne anthroponoses so that diverse target species could be simultaneously controlled with integrated vector management programmes. Measurements of these two crucial mosquito behavioural parameters should now be integrated into programmatically funded, longitudinal, national-scale entomological monitoring systems to inform selection of available technologies and investment in developing new ones.
Highlights
While anti-parasitic drugs and vaccines will be essential for the final stages of malaria elimination, their effectiveness as transmission control interventions will rely heavily upon first achieving unprecedented levels of vector control in settings with historically high levels of endemicity [1,2,3,4]
The most important malaria parasites of humans are entirely dependent on people as their only secondary, mammalian hosts, so the most potent vector mosquito species are those with highly specialized behaviour adapted to feeding upon humans indoors at
A simple conceptual framework based on mathematical models is described that allows new and existing tools for controlling adult malaria vectors to be prioritized and optimized for specific contexts, by predicting their relative merits based on only two field-measurable behavioural parameters of local mosquito populations and two fieldmeasurable indicators of how those mosquitoes interact with specific vector control products
Summary
While anti-parasitic drugs and vaccines will be essential for the final stages of malaria elimination, their effectiveness as transmission control interventions will rely heavily upon first achieving unprecedented levels of vector control in settings with historically high levels of endemicity [1,2,3,4]. The proportions of human exposure which occur indoors and outdoors are important and dynamic indicators of vector behaviour that malaria control programmes should survey on a routine basis [6,8,12,13,38] so that they can manage malaria transmission in the same integrated, evidence-based, locally tailored and adaptive manner as agricultural pests [51] While these indicators are ideal for LLINs, field measurements of the maximum proportion of human exposure which is directly preventable (πh) by other personal protection interventions will require more careful consideration, especially for insecticidal clothing or repellent products with usage patterns that are more difficult to survey because they are portable, used outdoors, or require frequent re-application.
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