Malaria Transmission Rates Research Articles

Understanding the link between malaria risk and climate

The incubation period for malaria parasites within the mosquito is exquisitely temperature-sensitive, so that temperature is a major determinant of malaria risk. Epidemiological models are increasingly used to guide allocation of disease control resources and to assess the likely impact of climate change on global malaria burdens. Temperature-based malaria transmission is generally incorporated into these models using mean monthly temperatures, yet temperatures fluctuate throughout the diurnal cycle. Here we use a thermodynamic malaria development model to demonstrate that temperature fluctuation can substantially alter the incubation period of the parasite, and hence malaria transmission rates. We find that, in general, temperature fluctuation reduces the impact of increases in mean temperature. Diurnal temperature fluctuation around means >21 degrees C slows parasite development compared with constant temperatures, whereas fluctuation around <21 degrees C speeds development. Consequently, models which ignore diurnal variation overestimate malaria risk in warmer environments and underestimate risk in cooler environments. To illustrate the implications further, we explore the influence of diurnal temperature fluctuation on malaria transmission at a site in the Kenyan Highlands. Based on local meteorological data, we find that the annual epidemics of malaria at this site cannot be explained without invoking the influence of diurnal temperature fluctuation. Moreover, while temperature fluctuation reduces the relative influence of a subtle warming trend apparent over the last 20 years, it nonetheless makes the effects biologically more significant. Such effects of short-term temperature fluctuations have not previously been considered but are central to understanding current malaria transmission and the consequences of climate change.

Rapid Diagnostic Tests for Malaria at Sites of Varying Transmission Intensity in Uganda

In Africa, fever is often treated presumptively as malaria, resulting in misdiagnosis and the overuse of antimalarial drugs. Rapid diagnostic tests (RDTs) for malaria may allow improved fever management. We compared RDTs based on histidine-rich protein 2 (HRP2) and RDTs based on Plasmodium lactate dehydrogenase (pLDH) with expert microscopy and PCR-corrected microscopy for 7000 patients at sites of varying malaria transmission intensity across Uganda. When all sites were considered, the sensitivity of the HRP2-based test was 97% when compared with microscopy and 98% when corrected by PCR; the sensitivity of the pLDH-based test was 88% when compared with microscopy and 77% when corrected by PCR. The specificity of the HRP2-based test was 71% when compared with microscopy and 88% when corrected by PCR; the specificity of the pLDH-based test was 92% when compared with microscopy and >98% when corrected by PCR. Based on Plasmodium falciparum PCR-corrected microscopy, the positive predictive value (PPV) of the HRP2-based test was high (93%) at all but the site with the lowest transmission rate; the pLDH-based test and expert microscopy offered excellent PPVs (98%) for all sites. The negative predictive value (NPV) of the HRP2-based test was consistently high (>97%); in contrast, the NPV for the pLDH-based test dropped significantly (from 98% to 66%) as transmission intensity increased, and the NPV for expert microscopy decreased significantly (99% to 54%) because of increasing failure to detect subpatent parasitemia. Based on the high PPV and NPV, HRP2-based RDTs are likely to be the best diagnostic choice for areas with medium-to-high malaria transmission rates in Africa.

Effect of Rice Cultivation on Malaria Transmission in Central Kenya

A 12-month field study was conducted between April 2004 and March 2005 to determine the association between irrigated rice cultivation and malaria transmission in Mwea, Kenya. Adult mosquitoes were collected indoors twice per month in three villages representing non-irrigated, planned, and unplanned rice agro-ecosystems and screened for blood meal sources and Plasmodium falciparum circumsporozoite proteins. Anopheles arabiensis Patton and An. funestus Giles comprised 98.0% and 1.9%, respectively, of the 39,609 female anophelines collected. Other species including An. pharoensis Theobald, An. maculipalpis Giles, An. pretoriensis Theobald, An. coustani Laveran, and An. rufipes Gough comprised the remaining 0.1%. The density of An. arabiensis was highest in the planned rice village and lowest in the non-irrigated village and that of An. funestus was significantly higher in the non-irrigated village than in irrigated ones. The human blood index (HBI) for An. arabiensis was significantly higher in the non-irrigated village compared with irrigated villages. For An. funestus, the HBI for each village differed significantly from the others, being highest in the non-irrigated village and lowest in the planned rice village. The sporozoite rate and annual entomologic inoculation rate (EIR) for An. arabiensis was 1.1% and 3.0 infective bites per person, respectively with no significant difference among villages. Sporozoite positive An. funestus were detected only in planned rice and non-irrigated villages. Overall, 3.0% of An. funestus samples tested positive for Plasmodium falciparum sporozoites. The annual EIR of 2.21 for this species in the non-irrigated village was significantly higher than 0.08 for the planned rice village. We conclude that at least in Mwea Kenya, irrigated rice cultivation may reduce the risk of malaria transmission by An. funestus but has no effect on malaria transmission by An. arabiensis. The zoophilic tendency of malaria vectors in irrigated areas accounts partly for low malaria transmission rates despite the presence of higher vector densities, highlighting the potential of zooprophylaxis in malaria control.

Fetal Responses during Placental Malaria Modify the Risk of Low Birth Weight

Inflammation during placental malaria (PM) is associated with low birth weight (LBW), especially during the first pregnancy, but the relative contribution of maternal or fetal factors that mediate this effect remains unclear and the role of gamma interferon (IFN-gamma) has been controversial. We examined the relationship of maternal and cord plasma levels of IFN-gamma, tumor necrosis factor alpha, interleukin-10, ferritin, and leptin to birth weight for Tanzanian women delivering in an area where there is a high rate of malaria transmission. The placental levels of inflammatory cytokines, including IFN-gamma, increased significantly during PM in primigravid and multigravid women but not in secundigravid women. PM also increased maternal peripheral levels of all inflammatory markers except IFN-gamma but had strikingly little effect on cord levels of these proteins. In a multivariate analysis, placental IFN-gamma was negatively associated (P = 0.01) and cord ferritin was positively associated (P < 0.0001) with birth weight in infected (PM-positive [PM+]) first-time mothers. This relationship was not observed in other mothers, consistent with the epidemiology of PM and disease. Cord leptin had a strong positive relationship with birth weight in offspring of PM-negative women (P = 0.02 to P < 0.0001) but not in offspring of PM+ women (all differences were not significant) in the three gravidity groups. The results confirmed that placental IFN-gamma is related to LBW due to PM during first pregnancies and suggest that fetal ferritin plays a protective role. Because fetal cells are a source of placental IFN-gamma and cord ferritin, the fetal response to PM may modify the risk of LBW.

Extensive heterozygosity at four microsatellite loci flanking Plasmodium vivax dihydrofolate reductase gene

Only limited but contrasting reports are available on microsatellites based population structure of Plasmodium vivax. Further, there is complete lack of information on microsatellites in the flanking regions of the P. vivax drug resistance genes to trace the origin and spread of the drug resistant vivax malaria. Therefore, we scanned ±300 kb flanking sequences of the P. vivax dihydrofolate reductase ( pvdhfr) gene for di-nucleotide microsatellite repeats with minimum of 8 unit array length. Only 13 such repeats were detected in this region as compared to 738 di-nucleotide repeats present in ±300 kb flanking region of P. falciparum dhfr gene. We have analyzed here the nucleotide sequence of 110 Indian P. vivax isolates for four of these di-nucleotide microsatellites (two in the nearest regions at −38.83 kb and +6.15 kb, and two in the farthest regions at −230.54 kb and +283.28 kb). All the four microsatellites were found to be highly polymorphic in the population where number of alleles varied from 4 to 10 with the median values of 9–11 at these loci. The expected heterozygosity ( He) at these loci ranged from 0.50 to 0.82. We did not find any association between pvdhfr mutations and the flanking microsatellite alleles. There was a regional variation in the microsatellites polymorphism which was not associated with the reported prevalent rates of drug resistance or malaria transmission. In conclusion, the level of microsatellite polymorphism in P. vivax is as high as in P. falciparum. These results will be valuable in understanding the evolutionary history of the pvdhfr alleles as well as for designing the malaria control strategies.

URBAN MALARIA IN DAKAR, SENEGAL: CHEMOSUSCEPTIBILITY AND GENETIC DIVERSITY OF PLASMODIUM FALCIPARUM ISOLATES

The chemosusceptibility and genetic polymorphism of Plasmodium falciparum populations from 48 patients hospitalized for malaria at the Hospital Principal in Dakar, Senegal were investigated during the 2002 malaria transmission season. Sixty-two percent of the isolates collected were from patients with severe malaria and 38% were from patients with mild malaria. In vitro activities of chloroquine, quinine, cycloguanil, atovaquone, mefloquine, halofantrine, and artesunate were evaluated. The prevalence of mutations in the Plasmodium falciparum dihydrofolate reductase (dhfr) and dihyropteroate synthetase (dhps) genes and the P. falciparum chloroquine resistance transporter (Pfcrt) gene associated with cycloguanil, pyrimethamine, sulfadoxine, and chloroquine resistance were estimated. The genetic polymorphism of the parasite populations was evaluated by analysis of the highly polymorphic regions of merozoite surface protein 1 (msp1) block 2 and msp2. Seventy percent of the isolates were assessed by an in vitro assay. Fifty-two percent of the isolates were chloroquine resistant, 45% were cycloguanil resistant, and 24% were atovaquone resistant. Four percent had low susceptibility to quinine. The Pfcrt and dhfr mutations were associated with in vitro chloroquine- and antimetabolic drug-resistant isolates, respectively. Approximately 70% of the isolates contained two or more clones. Genetic diversity of P. falciparum was high. The prevalence of allelic family K1 of msp1 was 68%. Isolates of P. falciparum were highly resistant to chloroquine, cycloguanil and atovaquone. The transmission rate of malaria in Dakar is low but a high degree of genetic polymorphism can increase severe malaria, as shown by persons coming to Dakar from areas highly endemic for malaria. Areas with urban malaria should use vector control measures and efficient chemoprophylaxis for non-immune populations.

Frequency of malaria and glucose-6-phosphate dehydrogenase deficiency in Tajikistan

BackgroundDuring the Soviet era, malaria was close to eradication in Tajikistan. Since the early 1990s, the disease has been on the rise and has become endemic in large areas of southern and western Tajikistan. The standard national treatment for Plasmodium vivax is based on primaquine. This entails the risk of severe haemolysis for patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Seasonal and geographical distribution patterns as well as G6PD deficiency frequency were analysed with a view to improve understanding of the current malaria situation in Tajikistan.MethodsSpatial and seasonal distribution was analysed, applying a risk model that included key environmental factors such as temperature and the availability of mosquito breeding sites. The frequency of G6PD deficiency was studied at the health service level, including a cross-sectional sample of 382 adult men.ResultsAnalysis revealed high rates of malaria transmission in most districts of the southern province of Khatlon, as well as in some zones in the northern province of Sughd. Three categories of risk areas were identified: (i) zones at relatively high malaria risk with high current incidence rates, where malaria control and prevention measures should be taken at all stages of the transmission cycle; (ii) zones at relatively high malaria risk with low current incidence rates, where malaria prevention measures are recommended; and (iii) zones at intermediate or low malaria risk with low current incidence rates where no particular measures appear necessary. The average prevalence of G6PD deficiency was 2.1% with apparent differences between ethnic groups and geographical regions.ConclusionThe study clearly indicates that malaria is a serious health issue in specific regions of Tajikistan. Transmission is mainly determined by temperature. Consequently, locations at lower altitude are more malaria-prone. G6PD deficiency frequency is too moderate to require fundamental changes in standard national treatment of cases of P. vivax.

Rodent malaria parasites Plasmodium chabaudi and P. vinckei do not increase their rates of gametocytogenesis in response to mosquito probing

Several vector-borne infectious agents facultatively alter their life history strategies in response to local vector densities. Some evidence suggests that malaria parasites invest more heavily in transmission stage production (gametocytogenesis) when vectors are present. Such a strategy could rapidly increase malaria transmission rates, particularly when adult mosquitoes begin to appear after dry seasons. However, in contrast to a recent experiment with a rodent malaria (Plasmodium chabaudi), we found no change in gametocytogenesis in either P. chabaudi or in another rodent malaria, P. vinckei, when their mouse hosts were exposed to mosquitoes. Positive results in the earlier study may have been because mosquito-feeding caused anaemia in hosts, a known promoter of gametocytogenesis. The substantial evidence that malaria and a variety of other parasites facultatively alter transmission strategies in response to a variety of environmental influences makes our results surprising.

Long-term use of insecticide treated bed nets reduces malaria transmission and death rates in children

SummaryQuestionWhat is the effect of long-term use of insecticide-treated bed nets on malaria transmission and death rates in children?Study DesignCommunity randomised controlled trial.Main ResultsAll-cause mortality rates in infants (aged 1 to 11 months) were lower in villages with higher bed net use, compared with control villages (HR: 0.78, 95% CI 0.67 to 0.90). Despite much reduced exposure to malaria (and therefore the risk of reduced immunity), there was no difference in death rates of children born in intervention and control households after 6 years of bed-net use (HR during phase 1: 1.01, 95% CI 0.86 to 1.19; HR after phase 1: 0.97, 95% CI 0.61 to 1.52). Overall, the number of Anopheles mosquitoes per house was lower in houses with bed nets (reduction during phase 1:72%; RR: 0.28, 95% CI 0.16 to 0.51; reduction after 3 to 4 years: 77%, RR: 0.23, 95% CI 0.15 to 0.35). When bed nets were available, young children (aged 0–5 years) increasingly used them over time (65.9% in phase 1 v 82.5% in phase 2; p<0.001).Authors’ conclusionsLong-term use of insecticide treated bed nets significantly reduces malaria transmission and malaria-related mortality. There was no increase in all-cause mortality in children who had used bed-nets from birth.

Long-term use of insecticide treated bed nets reduces malaria transmission and death rates in children☆

SummaryQuestionWhat is the effect of long-term use of insecticide-treated bed nets on malaria transmission and death rates in children?Study DesignCommunity randomised controlled trial.Main ResultsAll-cause mortality rates in infants (aged 1 to 11 months) were lower in villages with higher bed net use, compared with control villages (HR: 0.78, 95% CI 0.67 to 0.90). Despite much reduced exposure to malaria (and therefore the risk of reduced immunity), there was no difference in death rates of children born in intervention and control households after 6 years of bed-net use (HR during phase 1: 1.01, 95% CI 0.86 to 1.19; HR after phase 1: 0.97, 95% CI 0.61 to 1.52). Overall, the number of Anopheles mosquitoes per house was lower in houses with bed nets (reduction during phase 1:72%; RR: 0.28, 95% CI 0.16 to 0.51; reduction after 3 to 4 years: 77%, RR: 0.23, 95% CI 0.15 to 0.35). When bed nets were available, young children (aged 0–5 years) increasingly used them over time (65.9% in phase 1 v 82.5% in phase 2; p<0.001).Authors’ conclusionsLong-term use of insecticide treated bed nets significantly reduces malaria transmission and malaria-related mortality. There was no increase in all-cause mortality in children who had used bed-nets from birth.

In vivo assessment of drug efficacy against Plasmodium falciparum malaria: duration of follow-up.

To determine the optimum duration of follow-up for the assessment of drug efficacy against Plasmodium falciparum malaria, 96 trial arms from randomized controlled trials (RCTs) with follow-up of 28 days or longer that were conducted between 1990 and 2003 were analyzed. These trials enrolled 13,772 patients, and participating patients comprised 23% of all patients enrolled in RCTs over the past 40 years; 61 (64%) trial arms were conducted in areas where the rate of malaria transmission was low, and 58 (50%) trial arms were supported by parasite genotyping to distinguish true recrudescences from reinfections. The median overall failure rate reported was 10% (range, 0 to 47%). The widely used day 14 assessment had a sensitivity of between 0 and 37% in identifying treatment failures and had no predictive value. Assessment at day 28 had a sensitivity of 66% overall (28 to 100% in individual trials) but could be used to predict the true failure rate if either parasite genotyping was performed (r(2) = 0.94) or if the entomological inoculation rate was known. In the assessment of drug efficacy against falciparum malaria, 28 days should be the minimum period of follow-up.

EPIDEMIOLOGY OF MALARIA TRANSMISSION AND DEVELOPMENT OF NATURAL IMMUNITY IN A MALARIA-ENDEMIC VILLAGE, SAN DULAKUDAR, IN ORISSA STATE, INDIA

We describe the epidemiology of malaria in San Dulakudar, a village in Sundargarh District in the state of Orissa in eastern India. Malaria transmission is perennial with Plasmodium falciparum, accounting for greater than 80% of malaria cases. Transmission intensity varies with season with high transmission after the monsoon rains in autumn and winter, low transmission in summer, and intermediate transmission in spring. The anthropophagic mosquito Anopheles fluviatilis was identified as the main vector for malaria transmission. Based on observations of spleen rates and supported by data on malaria parasite prevalence and malaria incidence, San Dulakudar can be classified as a hyperendemic area for P. falciparum malaria. Parasite prevalence and malaria incidence rates decrease with age, suggesting that residents of San Dulakudar develop immunity to malaria. The study demonstrates the presence of regions in the Indian subcontinent such as Sundargarh District where P. falciparum is the primary cause of malaria and where malaria transmission rates are comparable to those found in many parts of Africa.

Impact of cattle keeping on human biting rate of anopheline mosquitoes and malaria transmission around Ziway, Ethiopia.

To assess the impact of livestock keeping on the human biting rate (HBR) of anopheline mosquitoes and malaria transmission around Ziway in the middle course of the Ethiopian Rift Valley. As a passive experiment, man landing captures were done in homesteads with mixed dwelling, separate cattle shed and without livestock; and as an active experiment, captures were in experimental tukuls (huts) of cattle, goats, and without livestock. Parasite and spleen rates of children were compared among those residents under variable living conditions mentioned for passive experiment. For entomological study, human-baits were used for man-landing captures of mosquitoes. Study subjects for parasitological and clinical studies were children below 10 years old. Human-biting rate (HBR) of anopheline mosquitoes; and the parasite and spleen rates of the study subjects in different living conditions. In the passive experiment, the mean HBR of Anopheles arabiensis in mixed dwelling, separate cattle shed and without livestock was 8.45, 4.64 and 5.97, respectively. Similarly, the HBR of An. pharoensis was 2.88, 1.79 and 1.61, respectively. In the active experiment, the mean HBR of An. arabiensis in tukuls with cattle, goats, and without livestock was 3.50, 3.38 and 1.43 respectively; while that of An. pharoensis was 0.37, 0.70 and 0.55 respectively. Parasitologically, mean parasite rates of 26.67%, 15.05% and 23.85% were, respectively, recorded from children living under the above conditions stated for passive experiment. Similarly, the mean spleen rates of 50.0%, 26.9%, and 47.37% were recorded, respectively. These observations in the present study indicate that the presence of cattle in homesteads tends to increase the man biting rate of An. arabiensis, although differences in the mean HBR of vector mosquitoes were not statistically significant for all groups. In contrast, cattle keeping in separate cattle sheds outside of the human dwellings tends to reduce the man biting rate of An. arabiensis and malaria transmission in the study area.

Inland valley rice production systems and malaria infection and disease in the savannah of Côte d'Ivoire.

In sub-Saharan Africa, lowlands developed for rice cultivation favour the development of Anopheles gambiae s. l. populations. However, the epidemiological impact is not clearly determined. The importance of malaria was compared in terms of prevalence and parasite density of infections as well as in terms of disease incidence between three agroecosystems: (i) uncultivated lowlands, 'R0', (ii) lowlands with one annual rice cultivation in the rainy season, 'R1' and (iii) developed lowlands with two annual rice cultivation cycles, 'R2'. We clinically monitored 2000 people of all age groups, selected randomly in each agroecosystem, for 40 days (in eight periods of five consecutive days scheduled every 6 weeks for 1 year). During each survey, a systematic blood sample was taken from every sick and asymptomatic person. The three agroecosystems presented a high endemic situation with a malaria transmission rate of 139-158 infective bites per person per year. The age-standardized annual malaria incidence reached 0.9 malaria episodes per person in R0, 0.6 in R1 and 0.8 in R2. Children from 0 to 9-year-old in R0 and R2 had two malarial attacks annually, but this was less in R1 (1.4 malaria episodes per child per year). Malaria incidence varied with season and agroecosystem. In parallel with transmission, a high malaria risk occurs temporarily at the beginning of the dry season in R2, but not in R0 and R1. Development of areas for rice cultivation does not modify the annual incidence of malarial attacks despite their seasonal influence on malaria risk. However, the lower malaria morbidity rate in R1 could be explained by socio-economic and cultural factors.

Plasmodium falciparum infection elicits both variant-specific and cross-reactive antibodies against variant surface antigens.

Naturally acquired antibodies to Plasmodium falciparum erythrocyte membrane protein-1 (PfEMP-1), the variant surface antigens expressed on the surface of infected erythrocytes, are thought to play a role in protection against P. falciparum malaria. Here, we have studied the development of antibodies to PfEMP-1 in adult malaria patients living in Rourkela, India, an area with a low malaria transmission rate, and prevalence of antibodies to PfEMP-1 in residents of San Dulakudar, India, a village in which P. falciparum malaria is hyperendemic. Convalescent-phase sera from adult malaria patients from Rourkela agglutinate homologous P. falciparum isolates as well as some heterologous isolates, suggesting that they develop partially cross-reactive antibodies to PfEMP-1 following infection. Adult sera from San Dulakudar agglutinate diverse P. falciparum isolates, suggesting that they have antibodies with wide recognition of diverse PfEMP-1. Mixed-agglutination assays using pairs of P. falciparum isolates confirm the presence of both variant-specific and partially cross-reactive antibodies in convalescent-phase sera from Rourkela and adult sera from San Dulakudar. Analysis of PfEMP-1 sequences suggests a molecular basis for the observed cross-reactivity.

Assessment of Mercury Exposure and Malaria in a Brazilian Amazon Riverine Community

Small-scale gold mining in the Brazilian Amazon occurs in areas with high rates of malaria transmission. Amazonian populations can be exposed to mercury through direct contact with the mining process and/or through fish consumption. Because of data from experimental studies, we examined the potential for mercury to affect host response to malaria. A cross-sectional survey was done in Jacareacanga, a riverine community in Para state, in a region of intense alluvial gold mining. A sample of 205 persons was selected by cluster sampling from the total population of approximately 2000. A brief medical history and exam were conducted, malaria slides were obtained, and hair samples were taken to measure mercury levels. The average hair mercury level was 8.6 μg/g, ranging from 0.3 to 83.2 μg/g. The most important predictors of elevated mercury levels were high fish consumption and low income. Although there was no prevalent malaria, the odds of reporting a past malaria infection was four times higher for those also reporting a history of working with mercury.

Cost-effectiveness of sulfadoxine-pyrimethamine for the prevention of malaria-associated low birth weight.

Prevention of placental malaria through administration of antimalarial medications to pregnant women in disease-endemic areas decreases the risk of delivery of low birth weight (LBW) infants. In areas of high Plasmodium falciparum transmission, two intermittent presumptive treatment doses of sulfadoxine-pyrimethamine (SP) during the second and third trimesters of pregnancy are effective in decreasing the prevalence of placental malaria in human immunodeficiency virus (HlV)-negative women, while HIV-positive women may require a monthly SP regimen to reduce their prevalence of placental parasitemia. A decision-analysis model was used to compare the cost-effectiveness of three different presumptive SP treatment regimens with febrile case management with SP in terms of incremental cost per case LBW prevented. Factors considered included HIV seroprevalence, placental malaria prevalence, LBW incidence, the cost of SP, medical care for LBW infants, and HIV testing. For a hypothetical cohort of 10,000 pregnant women, the monthly SP regimen would always be the most effective strategy for reducing LBW associated with malaria. The two-dose SP and monthly SP regimens would prevent 172 and 229 cases of LBW, respectively, compared with the case management approach. At HIV seroprevalence rates greater than 10%, the monthly SP regimen is the least expensive strategy. At HIV seroprevalence rates less than 10%, the two-dose SP regimen would be the less expensive option. When only antenatal clinic costs are considered, the two-dose and monthly SP strategies cost US $11 and $14, respectively, well within the range considered cost effective. Presumptive treatment regimens to prevent LBW associated with malaria and the subsequent increased risk of mortality during the first year of life are effective and cost effective strategies in areas with both elevated HIV prevalence and malaria transmission rates.

Child mortality and malaria transmission intensity in Africa.

The desirability of controlling malaria transmission in the areas of highest endemicity of Plasmodium falciparum has long been debated. Most recently, it has been claimed that rates of malaria morbidity are no higher in areas of very high transmission in Africa than they are in places with lower inoculation rates. We now review the literature on the relationship of morbidity and mortality to malaria transmission intensity, and have linked published child mortality and malaria transmission rates to examine how age-specific mortality actually varies with the inoculation rate of P. falciparum.

The neglected burden of Plasmodium vivax malaria.

We estimate that the global burden of malaria due to Plasmodium vivax is approximately 70-80 million cases annually. Probably approximately 10-20% of the world's cases of P. vivax infection occur in Africa, south of the Sahara. In eastern and southern Africa, P. vivax represents around 10% of malaria cases but < 1% of cases in western and central Africa. Outside of African, P. vivax accounts for > 50% of all malaria cases. About 80-90% of P. vivax outside of Africa occurs in the Middle East, Asia, and the Western Pacific, mainly in the most tropical regions, and 10-15% in Central and South America. Because malaria transmission rates are low in most regions where P. vivax is prevalent, the human populations affected achieve little immunity to this parasite; as a result, in these regions, P. vivax infections affect people of all ages. Although the effects of repeated attacks of P. vivax through childhood and adult life are only rarely directly lethal, they can have major deleterious effects on personal well-being, growth, and development, and on the economic performance at the individual, family, community, and national levels. Features of the transmission biology of P. vivax give this species greater resilience than the less robust Plasmodiumfalciparum in the face of conditions adverse to the transmission of the parasites. Therefore, as control measures become more effective, the residual malaria burden is likely increasingly to become that of P. vivax.

Effects of available sugar on the reproductive fitness and vectorial capacity of the malaria vector Anopheles gambiae (Diptera: Culicidae).

Although females of most mosquito species are known to use sugar as a necessary source of energy, female Anopheles gambiae Giles sensu stricto are thought to use it facultatively or not at all. However, field evidence of sugar-free living is inconclusive, and the implications for reproductive fitness and vectorial capacity are unknown. To evaluate the role that sugar may play in the ecology of these mosquitoes, mated female An. gambiae in the laboratory were given access to either no food (water only), 10% sucrose, human blood, or human blood + 10% sucrose, and comparisons of daily mortality, fecundity, and biting frequency were made. The effect of sugar availability on vectorial capacity and the intrinsic rate of increase, a measure of fitness, then were determined. Females (pooled and individual) given blood + sugar lived significantly longer than did those on the other diets. Daily fecundity was higher for females given blood alone than for those fed blood + sugar (13 versus 9 eggs per female daily). However, total fecundity and intrinsic rate of increase were not affected by sugar availability. Biting frequency was significantly higher (0.41 versus 0.26 bites per female per day) for females given blood alone. Despite the reduced survivorship, exclusive blood-feeding led to a theoretically higher vectorial capacity for Plasmodium falciparum at 27 degrees C. These data indicate that female An. gambiae could replace sugar with increased blood feeding without suppressing reproductive fitness. Increased blood feeding could, in turn, increase the rate of malaria transmission and may explain the unusual efficiency of this vector.