bims-mosdis 2020-09-27 papers

bims-mosdis

Biomed News

on Mosquito distribution and disease

Issue of 2020–09–27
twenty-one papers selected by
Richard Halfpenny, Staffordshire University

Diversity of mosquito (Diptera: Culicidae) vectors in a heterogeneous landscape endemic for arboviruses.
Surveillance of Aedes aegypti populations in the city of Praia, Cape Verde: Zika virus infection, insecticide resistance and genetic diversity.
Larval ecology and infestation indices of two major arbovirus vectors, Aedes aegypti and Aedes albopictus (Diptera: Culicidae), in Brazzaville, the capital city of the Republic of the Congo.
Impact of sugarcane irrigation on malaria vector Anopheles mosquito fauna, abundance and seasonality in Arjo-Didessa, Ethiopia.
Integrating statistical and mechanistic approaches with biotic and environmental variables improves model predictions of the impact of climate and land-use changes on future mosquito-vector abundance, diversity and distributions in Australia.
Evaluating effectiveness of screening house eaves as a potential intervention for reducing indoor vector densities and malaria prevalence in Nyabondo, western Kenya.
A decade of arbovirus emergence in the temperate southern cone of South America: dengue, Aedes aegypti and climate dynamics in Córdoba, Argentina.
Land cover affects microclimate and temperature suitability for arbovirus transmission in an urban landscape.
Possible non-sylvatic transmission of yellow fever between non-human primates in São Paulo city, Brazil, 2017-2018.
Spatial and temporal distribution of Anopheles mosquito's larvae and its determinants in two urban sites in Tanzania with different malaria transmission levels.
Dengue and Zika Viruses: Epidemiological History, Potential Therapies, and Promising Vaccines.
Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico.
Quantifying species traits related to oviposition behavior and offspring survival in two important disease vectors.
Community-level impacts of spatial repellents for control of diseases vectored by Aedes aegypti mosquitoes.
Rapid reduction of malaria transmission following the introduction of indoor residual spraying in previously unsprayed districts: an observational analysis of Mopti Region, Mali, in 2017.
Assessing Insecticide Resistance in Adult Mosquitoes: Perspectives on Current Methods.
Vector-borne Viruses in Turkey: A Systematic Review and Bibliography.
Spatio-temporal dynamics of Aedes aegypti and Aedes albopictus oviposition in an urban area of northeastern Brazil.
Neurological disease in adults with Zika and chikungunya virus infection in Northeast Brazil: a prospective observational study.
Clinical, Virological, and Immunological Profiles of DENV, ZIKV, and/or CHIKV-Infected Brazilian Patients.
Will More of the Same Achieve Malaria Elimination? Results from an Integrated Macroeconomic Epidemiological Demographic Model.

Acta Trop. 2020 Sep 21. pii: S0001-706X(20)30950-5. [Epub ahead of print] 105715

Diversity of mosquito (Diptera: Culicidae) vectors in a heterogeneous landscape endemic for arboviruses.

Daniel Cardoso Portela Câmara, Célio da Silva Pinel, Gláucio Pereira Rocha, Claudia Torres Codeço, Nildimar Alves Honório.

   BACKGROUND: In Brazil and several countries in the Americas, where dengue, chikungunya and Zika are cocirculating, there is a need to understand how different mosquito species relate to landscape and humans. Mosquito ecology and distribution, especially at finer spatial scales, are key factors to study since the relationship of mosquito communities to their habitats might have important consequences in the risk of disease transmission to humans. The aim of this study was to evaluate the diversity of resident culicids along heterogeneous landscapes in different endemic cities for dengue, chikungunya and Zika.
METHODS: Fourteen collection sites were randomly selected in six landscapes characterized as urban, periurban and rural along two endemic metropolitan cities in Rio de Janeiro, Brazil: Itaboraí and Cachoeiras de Macacu, Rio de Janeiro. In each site, adult mosquito collections were performed using different traps and backpack aspiration. Collections took place during the rainy and dry seasons of 2015 and 2016. To measure diversity in each landscape, we generated species accumulation curves and used different indexes: rarefied species richness, Chao1-bc and ACE-1. Mosquito habitat segregation along different land use types was measured with a partial canonical correspondence analysis (pCCA). Generalized linear mixed models (GLMM) were used to model the probability of occurrence of the most abundant species along an Urban-Forest gradient.
RESULTS: A total of 13,462 adult mosquitoes from 10 genera and 41 species were collected. The most abundant species were Culex quinquefasciatus Say, 1823, Aedes aegypti (Linnaeus, 1762) and Aedes albopictus (Skuse, 1895). There was a significant association between rarefied species richness and landscape, with higher richness in the Rural landscape. The number of observed species was matched only in the Urban landscape. Most species showed segregation along an Urban-Forest gradient, and the great majority were associated with forested habitats. We were able to fit prediction models for six mosquito species.
DISCUSSION: The paper discusses the impact of human activities on landscape and its effects on mosquito populations, focusing on the segregation of different known vector species and their proximity to human altered environments. Most of these species are known arbovirus vectors and knowledge of their distribution are key elements that health authorities should take into account when planning arbovirus surveillance and vector control activities.

Keywords:  Arboviruses; Heterogeneous landscape; Mosquito diversity; Mosquito vectors; Spatial distribution

DOI:  https://doi.org/10.1016/j.actatropica.2020.105715
Parasit Vectors. 2020 Sep 21. 13(1): 481

Surveillance of Aedes aegypti populations in the city of Praia, Cape Verde: Zika virus infection, insecticide resistance and genetic diversity.

Monica Campos, Daniel Ward, Raika Francesca Morales, Ana Rita Gomes, Keily Silva, Nuno Sepúlveda, Lara Ferrero Gomez, Taane G Clark, Susana Campino.

   BACKGROUND: Aedes spp. are responsible for the transmission of many arboviruses, which contribute to rising human morbidity and mortality worldwide. The Aedes aegypti mosquito is a main vector for chikungunya, dengue and yellow fever infections, whose incidence have been increasing and distribution expanding. This vector has also driven the emergence of the Zika virus (ZIKV), first reported in Africa which spread rapidly to Asia and more recently across the Americas. During the outbreak in the Americas, Cape Verde became the first African country declaring a Zika epidemic, with confirmed cases of microcephaly. Here we investigate the prevalence of ZIKV and dengue (DENV) infected Ae. aegypti mosquitoes in the weeks following the outbreak in Cape Verde, and the presence of insecticide resistance in the circulating vector population. Genetic diversity in the mosquito population was also analysed.
METHODS: From August to October 2016, 816 Ae. aegypti mosquitoes were collected in several locations across Praia, Cape Verde, the major hot spot of reported ZIKV cases in the country. All mosquitoes were screened by reverse transcription PCR for ZIKV and DENV, and a subset (n = 220) were screened for knockdown insecticide resistance associated mutations in the voltage gated sodium channel (VGSC) gene by capillary sequencing. The mitochondrial NADH dehydrogenase subunit 4 (nad4) gene was sequenced in 100 mosquitoes. These data were compared to 977 global sequences in a haplotype network and a phylogenetic tree analysis.
RESULTS: Two Ae. aegypti mosquitoes were ZIKV positive (0.25%). There were no SNP mutations found in the VGSC gene associated with insecticide resistance. Analysis of the nad4 gene revealed 11 haplotypes in the Cape Verdean samples, with 5 being singletons. Seven haplotypes were exclusive to Cape Verde. Several of the remaining haplotypes were frequent in the global dataset, being present in several countries (including Cape Verde) across five different continents. The most common haplotype in Cape Verde (50.6 %) was also found in Africa and South America.
CONCLUSIONS: There was low-level Zika virus circulation in mosquitoes from Praia shortly after the outbreak. The Ae. aegypti population did not appear to have the kdr mutations associated with pyrethroid resistance. Furthermore, haplotype and phylogenetic analyses revealed that Cape Verde Ae. aegypti mosquitoes are most closely related to those from other countries in Africa and South America.

Keywords:  Aedes aegypti; Cape Verde; Zika; kdr; nad4

DOI:  https://doi.org/10.1186/s13071-020-04356-z
Parasit Vectors. 2020 Sep 25. 13(1): 492

Larval ecology and infestation indices of two major arbovirus vectors, Aedes aegypti and Aedes albopictus (Diptera: Culicidae), in Brazzaville, the capital city of the Republic of the Congo.

Theodel A Wilson-Bahun, Basile Kamgang, Arsène Lenga, Charles S Wondji.

   BACKGROUND: Invasive mosquito species, such as Aedes albopictus in Congo can affect the distribution of native species, changing the vector composition and pattern of disease transmission. Here, we comparatively establish the geographical distribution and larval habitat preference of Ae. aegypti and Ae. albopictus and the risk of arbovirus disease outbreaks using Stegomyia indices in the city of Brazzaville, the capital of the Republic of the Congo.
METHODS: Human dwelling surveys of water-holding containers for immature stages of Aedes was carried out in December 2017 in Brazzaville through a random cluster sampling method. A total of 268 human dwellings distributed in 9 boroughs and 27 neighbourhoods were surveyed across the city.
RESULTS: Overall, 455 potential larval habitats were surveyed. Both Ae. aegypti and Ae. albopictus were collected across the city with an overall high prevalence of Ae. aegypti (53.1%) compared to Ae. albopictus (46.9%). Geographical distribution analysis showed that Ae. aegypti was more abundant (mean = 6.6 ± 1.4) in neighbourhoods located in downtown, while the abundance of Ae. albopictus was low (mean = 3.5 ± 0.6) in suburbs. Peridomestic containers, especially discarded tanks, were the most strongly colonized productive larval habitat for both mosquito species with the prevalence of 56.4% and 53.1% for Ae. aegypti and Ae. albopictus, respectively. Globally, the house index (HI), Breteau index (BI) and container index (CI) were high for Ae. aegypti (26.6%, 38.4% and 22.6%) and Ae. albopictus (33.3%, 49.6% and 26.6%) compared to the transmission risk threshold (5%, 5% and 20%) established by the WHO/PAHO. Overall, pupae-based indices (the pupae index and the pupae per person index) were not significantly different between Ae. aegypti (273.4% and 23.2%) and Ae. albopictus (228.8% and 19.5%).
CONCLUSIONS: The findings of this study suggest a high risk for transmission of arbovirus diseases in Brazzaville and call for an urgent need to implement vector control strategies against these vectors in the Republic of the Congo.

Keywords:  Aedes aegypti; Aedes albopictus; Larval ecology; Republic of the Congo; Transmission risk

DOI:  https://doi.org/10.1186/s13071-020-04374-x
Malar J. 2020 Sep 22. 19(1): 344

Impact of sugarcane irrigation on malaria vector Anopheles mosquito fauna, abundance and seasonality in Arjo-Didessa, Ethiopia.

Assalif Demissew, Dawit Hawaria, Solomon Kibret, Abebe Animut, Arega Tsegaye, Ming-Cheih Lee, Guiyun Yan, Delenasaw Yewhalaw.

   BACKGROUND: Despite extensive irrigation development in Ethiopia, limited studies assessed the impact of irrigation on malaria vector mosquito composition, abundance and seasonality. This study aimed to evaluate the impact of sugarcane irrigation on species composition, abundance and seasonality of malaria vectors.
METHODS: Adult Anopheles mosquitoes were collected using CDC light traps from three irrigated and three non-irrigated clusters in and around Arjo-Didessa sugarcane irrigation scheme in southwestern Ethiopia. Mosquitoes were surveyed in four seasons: two wet and two dry, in 2018 and 2019. Mosquito species composition, abundance and seasonality were compared between irrigated and non-irrigated clusters. Anopheles mosquitoes were sorted out to species using morphological keys and molecular techniques. Chi square was used to test the relationships between Anopheles species occurrence, and environmental and seasonal parameters.
RESULTS: Overall, 2108 female Anopheles mosquitoes comprising of six species were collected. Of these, 92.7% (n = 1954) were from irrigated clusters and 7.3% (n = 154) from the non-irrigated. The Anopheles gambiae complex was the most abundant (67.3%) followed by Anopheles coustani complex (25.3%) and Anopheles pharoensis (5.7%). PCR-based identification revealed that 74.7% (n = 168) of the An. gambiae complex were Anopheles arabiensis and 22.7% (n = 51) Anopheles amharicus. The density of An. gambiae complex (both indoor and outdoor) was higher in irrigated than non-irrigated clusters. The overall anopheline mosquito abundance during the wet seasons (87.2%; n = 1837) was higher than the dry seasons (12.8%; n = 271).
CONCLUSION: The ongoing sugarcane irrigation activities in Arjo-Didessa created conditions suitable for malaria transmitting Anopheles species diversity and abundance. This could drive malaria transmission in Arjo-Didessa and its environs in both dry and wet seasons. Currently practiced malaria vector interventions need to be strengthened by including larval source management to reduce vector abundance in the irrigated areas.

Keywords:  Anopheles amharicus; Anopheles mosquitoes; Ethiopia; Irrigation; Malaria; Vector density

DOI:  https://doi.org/10.1186/s12936-020-03416-0
Parasit Vectors. 2020 Sep 23. 13(1): 484

Integrating statistical and mechanistic approaches with biotic and environmental variables improves model predictions of the impact of climate and land-use changes on future mosquito-vector abundance, diversity and distributions in Australia.

Eugene T Madzokere, Willow Hallgren, Oz Sahin, Julie A Webster, Cameron E Webb, Brendan Mackey, Lara J Herrero.

  Changes to Australia's climate and land-use patterns could result in expanded spatial and temporal distributions of endemic mosquito vectors including Aedes and Culex species that transmit medically important arboviruses. Climate and land-use changes greatly influence the suitability of habitats for mosquitoes and their behaviors such as mating, feeding and oviposition. Changes in these behaviors in turn determine future species-specific mosquito diversity, distribution and abundance. In this review, we discuss climate and land-use change factors that influence shifts in mosquito distribution ranges. We also discuss the predictive and epidemiological merits of incorporating these factors into a novel integrated statistical (SSDM) and mechanistic species distribution modelling (MSDM) framework. One potentially significant merit of integrated modelling is an improvement in the future surveillance and control of medically relevant endemic mosquito vectors such as Aedes vigilax and Culex annulirostris, implicated in the transmission of many arboviruses such as Ross River virus and Barmah Forest virus, and exotic mosquito vectors such as Aedes aegypti and Aedes albopictus. We conducted a focused literature search to explore the merits of integrating SSDMs and MSDMs with biotic and environmental variables to better predict the future range of endemic mosquito vectors. We show that an integrated framework utilising both SSDMs and MSDMs can improve future mosquito-vector species distribution projections in Australia. We recommend consideration of climate and environmental change projections in the process of developing land-use plans as this directly impacts mosquito-vector distribution and larvae abundance. We also urge laboratory, field-based researchers and modellers to combine these modelling approaches. Having many different variations of integrated (SDM) modelling frameworks could help to enhance the management of endemic mosquitoes in Australia. Enhanced mosquito management measures could in turn lead to lower arbovirus spread and disease notification rates.

Keywords:  Climate and land-use change; Distribution; Integrated modelling; Mosquito

DOI:  https://doi.org/10.1186/s13071-020-04360-3
Malar J. 2020 Sep 19. 19(1): 341

Evaluating effectiveness of screening house eaves as a potential intervention for reducing indoor vector densities and malaria prevalence in Nyabondo, western Kenya.

Peter Njoroge Ng'ang'a, Collins Okoyo, Charles Mbogo, Clifford Maina Mutero.

   BACKGROUND: Mosquito-proofing of houses using wire mesh screens is gaining greater recognition as a practical intervention for reducing exposure to malaria transmitting mosquitoes. Screening potentially protects all persons sleeping inside the house against transmission of mosquito-borne diseases indoors. The study assessed the effectiveness of house eaves screening in reducing indoor vector densities and malaria prevalence in Nyabondo, western Kenya.
METHODS: 160 houses were selected for the study, with half of them randomly chosen for eaves screening with fibre-glass coated wire mesh (experimental group) and the other half left without screening (control group). Randomization was carried out by use of computer-generated list in permuted blocks of ten houses and 16 village blocks, with half of them allocated treatment in a ratio of 1:1. Cross-sectional baseline entomological and parasitological data were collected before eave screening. After baseline data collection, series of sampling of indoor adult mosquitoes were conducted once a month in each village using CDC light traps. Three cross-sectional malaria parasitological surveys were conducted at three month intervals after installation of the screens. The primary outcome measures were indoor Anopheles mosquito density and malaria parasite prevalence.
RESULTS: A total of 15,286 mosquitoes were collected over the two year period using CDC light traps in 160 houses distributed over 16 study villages (mean mosquitoes = 4.35, SD = 11.48). Of all mosquitoes collected, 2,872 (18.8%) were anophelines (2,869 Anopheles gambiae sensu lato, 1 Anopheles funestus and 2 other Anopheles spp). Overall, among An. gambiae collected, 92.6% were non-blood fed, 3.57% were blood fed and the remaining 0.47% were composed of gravid and half gravid females. More indoor adult mosquitoes were collected in the control than experimental arms of the study. Results from cross-sectional parasitological surveys showed that screened houses recorded relatively low malaria parasite prevalence rates compared to the control houses. Overall, malaria prevalence was 5.6% (95% CI: 4.2-7.5) n = 1,918, with baseline prevalence rate of 6.1% (95% CI: 3.9-9.4), n = 481 and 3rd follow-up survey prevalence of 3.6% (95% CI: 2.0-6.8) n = 494. At all the three parasitological follow-up survey points, house screening significantly reduced the malaria prevalence by 100% (p < 0.001), 63.6% (p = 0.026), and 100% (p < 0.001) in the 1st, 2nd and 3rd follow-up surveys respectively.
CONCLUSIONS: The study demonstrated that house eave screening has potential to reduce indoor vector densities and malaria prevalence in high transmission areas.

Keywords:  Anopheles gambiae; Eaves; Malaria; Mosquitoes; Prevalence; Screening; Vector control

DOI:  https://doi.org/10.1186/s12936-020-03413-3
Heliyon. 2020 Sep;6(9): e04858

A decade of arbovirus emergence in the temperate southern cone of South America: dengue, Aedes aegypti and climate dynamics in Córdoba, Argentina.

Elizabet L Estallo, Rachel Sippy, Anna M Stewart-Ibarra, Marta G Grech, Elisabet M Benitez, Francisco F Ludueña-Almeida, Mariela Ainete, María Frias-Cespedes, Michael Robert, Moory M Romero, Walter R Almirón.

   Background: Argentina is located at the southern temperate range of arboviral transmission by the mosquito Aedes aegypti and has experienced a rapid increase in disease transmission in recent years. Here we present findings from an entomological surveillance study that began in Córdoba, Argentina, following the emergence of dengue in 2009.
Methods: From 2009 to 2017, larval surveys were conducted monthly, from November to May, in 600 randomly selected households distributed across the city. From 2009 to 2013, ovitraps (n = 177) were sampled weekly to monitor the oviposition activity of Ae. aegypti. We explored seasonal and interannual dynamics of entomological variables and dengue transmission. Cross correlation analysis was used to identify significant lag periods.
Results: Aedes aegypti were detected over the entire study period, and abundance peaked during the summer months (January to March). We identified a considerable increase in the proportion of homes with juvenile Ae. aegypti over the study period (from 5.7% of homes in 2009-10 to 15.4% of homes in 2016-17). Aedes aegypti eggs per ovitrap and larval abundance were positively associated with temperature in the same month. Autochthonous dengue transmission peaked in April, following a peak in imported dengue cases in March; autochthonous dengue was not positively associated with vector or climate variables.
Conclusions: This longitudinal study provides insights into the complex dynamics of arbovirus transmission and vector populations in a temperate region of arbovirus emergence. Our findings suggest that Córdoba is well suited for arbovirus disease transmission, given the stable and abundant vector populations. Further studies are needed to better understand the role of regional human movement.

Keywords:  Aedes aegypti; Argentina; Climate; Dengue; Environmental analysis; Environmental science; Epidemiology; Infectious disease; Larval surveys; Ovitrap; Surveillance; Zoology

DOI:  https://doi.org/10.1016/j.heliyon.2020.e04858
PLoS Negl Trop Dis. 2020 Sep 21. 14(9): e0008614

Land cover affects microclimate and temperature suitability for arbovirus transmission in an urban landscape.

Michael C Wimberly, Justin K Davis, Michelle V Evans, Andrea Hess, Philip M Newberry, Nicole Solano-Asamoah, Courtney C Murdock.

The emergence of mosquito-transmitted viruses poses a global threat to human health. Combining mechanistic epidemiological models based on temperature-trait relationships with climatological data is a powerful technique for environmental risk assessment. However, a limitation of this approach is that the local microclimates experienced by mosquitoes can differ substantially from macroclimate measurements, particularly in heterogeneous urban environments. To address this scaling mismatch, we modeled spatial variation in microclimate temperatures and the thermal potential for dengue transmission by Aedes albopictus across an urban-to-rural gradient in Athens-Clarke County GA. Microclimate data were collected across gradients of tree cover and impervious surface cover. We developed statistical models to predict daily minimum and maximum microclimate temperatures using coarse-resolution gridded macroclimate data (4000 m) and high-resolution land cover data (30 m). The resulting high-resolution microclimate maps were integrated with temperature-dependent mosquito abundance and vectorial capacity models to generate monthly predictions for the summer and early fall of 2018. The highest vectorial capacities were predicted for patches of trees in urban areas with high cover of impervious surfaces. Vectorial capacity was most sensitive to tree cover during the summer and became more sensitive to impervious surfaces in the early fall. Predictions from the same models using temperature data from a local meteorological station consistently over-predicted vectorial capacity compared to the microclimate-based estimates. This work demonstrates that it is feasible to model variation in mosquito microenvironments across an urban-to-rural gradient using satellite Earth observations. Epidemiological models applied to the microclimate maps revealed localized patterns of temperature suitability for disease transmission that would not be detectable using macroclimate data. Incorporating microclimate data into disease transmission models has the potential to yield more spatially precise and ecologically interpretable metrics of mosquito-borne disease transmission risk in urban landscapes.

DOI: https://doi.org/10.1371/journal.pntd.0008614
Sci Rep. 2020 Sep 25. 10(1): 15751

Possible non-sylvatic transmission of yellow fever between non-human primates in São Paulo city, Brazil, 2017-2018.

Mariana Sequetin Cunha, Rosa Maria Tubaki, Regiane Maria Tironi de Menezes, Mariza Pereira, Giovana Santos Caleiro, Esmenia Coelho, Leila Del Castillo Saad, Natalia Coelho Couto de Azevedo Fernandes, Juliana Mariotti Guerra, Juliana Silva Nogueira, Juliana Laurito Summa, Amanda Aparecida Cardoso Coimbra, Ticiana Zwarg, Steven S Witkin, Luís Filipe Mucci, Maria do Carmo Sampaio Tavares Timenetsky, Ester Cerdeira Sabino, Juliana Telles de Deus.

Yellow Fever (YF) is a severe disease caused by Yellow Fever Virus (YFV), endemic in some parts of Africa and America. In Brazil, YFV is maintained by a sylvatic transmission cycle involving non-human primates (NHP) and forest canopy-dwelling mosquitoes, mainly Haemagogus-spp and Sabethes-spp. Beginning in 2016, Brazil faced one of the largest Yellow Fever (YF) outbreaks in recent decades, mainly in the southeastern region. In São Paulo city, YFV was detected in October 2017 in Aloutta monkeys in an Atlantic Forest area. From 542 NHP, a total of 162 NHP were YFV positive by RT-qPCR and/or immunohistochemistry, being 22 Callithrix-spp. most from urban areas. Entomological collections executed did not detect the presence of strictly sylvatic mosquitoes. Three mosquito pools were positive for YFV, 2 Haemagogus leucocelaenus, and 1 Aedes scapularis. In summary, YFV in the São Paulo urban area was detected mainly in resident marmosets, and synanthropic mosquitoes were likely involved in viral transmission.

DOI: https://doi.org/10.1038/s41598-020-72794-x
Parasite Epidemiol Control. 2020 Nov;11 e00179

Spatial and temporal distribution of Anopheles mosquito's larvae and its determinants in two urban sites in Tanzania with different malaria transmission levels.

Mary Mathew Mathania, David Zadock Munisi, Richard S Silayo.

   Background: In order to be able to design and implement control measures directed to the mosquito larva stages an understanding of the spatial and temporal distribution and its determinants in different malaria transmission settings is important. This study therefore, intended to determine the spatial and temporal distribution of Anopheles mosquito's larvae and its determinants in two urban sites with different transmission levels, in Tanzania.
Methodology: This study was conducted in Dodoma and Morogoro regions in Tanzania. The study was an ecological study of repeated cross-sectional type. Searching for water bodies in the selected wards was done by going around all streets. Potential breeding sites were given unique identification numbers and larval sampling was done using the standard dipping method with a 350 ml mosquito scoop and a calibrated pipette. Visual identification of presence of larvae and its abundance in each sampling were used to describe the larvae density. A sample of Anopheles mosquitoes which emerged from collected larvae, were processed for species identification using PCR. Descriptive statistics were arrived at by calculating different proportions for the variables. The overall impact of the variables on the density of Anopheles larvae was tested using multiple logistic regression. Variables with p-value less than 0.05 were regarded as significant.
Results: A total of 724 water bodies out of which, 576 (79.6%) potential breeding sites were analyzed. It was found that, most (96.2%) of the potential breeding sites were manmade and most (59.5%) were less than 5 m in diameter and 87.2% were within 100 m from human settlement. Out of all the potential breeding sites, 69.8% and 30.2% were in Morogoro and Dodoma respectively, out of which 72.2% and 68.4% respectively, were found during rainy season. Habitats with clean water, at a distance of 10-100 m from the house, in natural, shaded and partial sunlight habitats had higher odds of having high density of mosquito larvae than their counterparts (p < .05). The PCR analysis showed that 72.5% were An. arabiensis, 4.5% An. gambiaes.s, 0.5% An.coustaniand 20% An. quadrianulatuswhile 2.5% of the samples could not be identified because DNA was not amplified.
Conclusion and recommendation: Type of water, distance from the breeding site to human settlement, light intensity and habitat origin were significant predictors of variation on the spatial and temporal distribution of Anopheles mosquito breeding sites. With increased global emphasis on control measures that targets mosquito immature stages; we recommend that larval control measures should be developed while considering the findings from this study.

Keywords:  Anopheles arabiensis; Larva; Mosquito breeding sites

DOI:  https://doi.org/10.1016/j.parepi.2020.e00179
Trop Med Infect Dis. 2020 Sep 23. pii: E150. [Epub ahead of print]5(4):

Dengue and Zika Viruses: Epidemiological History, Potential Therapies, and Promising Vaccines.

Nelly M Silva, Nuno C Santos, Ivo C Martins.

  Dengue virus (DENV), which can lead to fatal hemorrhagic fever, affects 390 million people worldwide. The closely related Zika virus (ZIKV) causes microcephaly in newborns and Guillain-Barré syndrome in adults. Both viruses are mostly transmitted by Aedes albopictus and Aedes aegypti mosquitoes, which, due to globalization of trade and travel alongside climate change, are spreading worldwide, paving the way to DENV and ZIKV transmission and the occurrence of new epidemics. Local outbreaks have already occurred in temperate climates, even in Europe. As there are no specific treatments, these viruses are an international public health concern. Here, we analyze and discuss DENV and ZIKV outbreaks history, clinical and pathogenesis features, and modes of transmission, supplementing with information on advances on potential therapies and restraining measures. Taking advantage of the knowledge of the structure and biological function of the capsid (C) protein, a relatively conserved protein among flaviviruses, within a genus that includes DENV and ZIKV, we designed and patented a new drug lead, pep14-23 (WO2008/028939A1). It was demonstrated that it inhibits the interaction of DENV C protein with the host lipid system, a process essential for viral replication. Such an approach can be used to develop new therapies for related viruses, such as ZIKV.

Keywords:  Aedes; Flavivirus; Zika; dengue; epidemiology

DOI:  https://doi.org/10.3390/tropicalmed5040150
PLoS Negl Trop Dis. 2020 Sep 21. 14(9): e0008532

Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico.

Tyler M Sharp, Talia M Quandelacy, Laura E Adams, Jomil Torres Aponte, Matthew J Lozier, Kyle Ryff, Mitchelle Flores, Aidsa Rivera, Gilberto A Santiago, Jorge L Muñoz-Jordán, Luisa I Alvarado, Vanessa Rivera-Amill, Myriam Garcia-Negrón, Stephen H Waterman, Gabriela Paz-Bailey, Michael A Johansson, Brenda Rivera-Garcia.

BACKGROUND: After Zika virus (ZIKV) emerged in the Americas, laboratory-based surveillance for arboviral diseases in Puerto Rico was adapted to include ZIKV disease.
METHODS AND FINDINGS: Suspected cases of arboviral disease reported to Puerto Rico Department of Health were tested for evidence of infection with Zika, dengue, and chikungunya viruses by RT-PCR and IgM ELISA. To describe spatiotemporal trends among confirmed ZIKV disease cases, we analyzed the relationship between municipality-level socio-demographic, climatic, and spatial factors, and both time to detection of the first ZIKV disease case and the midpoint of the outbreak. During November 2015-December 2016, a total of 71,618 suspected arboviral disease cases were reported, of which 39,717 (55.5%; 1.1 cases per 100 residents) tested positive for ZIKV infection. The epidemic peaked in August 2016, when 71.5% of arboviral disease cases reported weekly tested positive for ZIKV infection. Incidence of ZIKV disease was highest among 20-29-year-olds (1.6 cases per 100 residents), and most (62.3%) cases were female. The most frequently reported symptoms were rash (83.0%), headache (64.6%), and myalgia (63.3%). Few patients were hospitalized (1.2%), and 13 (<0.1%) died. Early detection of ZIKV disease cases was associated with increased population size (log hazard ratio [HR]: -0.22 [95% confidence interval -0.29, -0.14]), eastern longitude (log HR: -1.04 [-1.17, -0.91]), and proximity to a city (spline estimated degrees of freedom [edf] = 2.0). Earlier midpoints of the outbreak were associated with northern latitude (log HR: -0.30 [-0.32, -0.29]), eastern longitude (spline edf = 6.5), and higher mean monthly temperature (log HR: -0.04 [-0.05, -0.03]). Higher incidence of ZIKV disease was associated with lower mean precipitation, but not socioeconomic factors.
CONCLUSIONS: During the ZIKV epidemic in Puerto Rico, 1% of residents were reported to public health authorities and had laboratory evidence of ZIKV disease. Transmission was first detected in urban areas of eastern Puerto Rico, where transmission also peaked earlier. These trends suggest that ZIKV was first introduced to Puerto Rico in the east before disseminating throughout the island.

DOI: https://doi.org/10.1371/journal.pntd.0008532
PLoS One. 2020 ;15(9): e0239636

Quantifying species traits related to oviposition behavior and offspring survival in two important disease vectors.

Donald A Yee, William C Glasgow, Nnaemeka F Ezeakacha.

Animals with complex life cycles have traits related to oviposition and juvenile survival that can respond to environmental factors in similar or dissimilar ways. We examined the preference-performance hypothesis (PPH), which states that females lacking parental care select juvenile habitats that maximize fitness, for two ubiquitous mosquito species, Aedes albopictus and Culex quinquefasciatus. Specifically, we examined if environmental factors known to affect larval abundance patterns in the field played a role in the PPH for these species. We first identified important environmental factors from a field survey that predicted larvae across different spatial scales. We then performed two experiments, the first testing the independent responses of oviposition and larval survival to these environmental factors, followed by a combined experiment where initial oviposition decisions were allowed to affect larval life history measures. We used path analysis for this last experiment to determine important links among factors in explaining egg numbers, larval mass, development time, and survival. For separate trials, Aedes albopictus displayed congruence between oviposition and larval survival, however C. quinquefasciatus did not. For the combined experiment path analysis suggested neither species completely fit predictions of the PPH, with density dependent effects of initial egg number on juvenile performance in A. albopictus. For these species the consequences of female oviposition choices on larval performance do not appear to fit expectations of the PPH.

DOI: https://doi.org/10.1371/journal.pone.0239636
PLoS Comput Biol. 2020 Sep 25. 16(9): e1008190

Community-level impacts of spatial repellents for control of diseases vectored by Aedes aegypti mosquitoes.

Quirine A Ten Bosch, Joseph M Wagman, Fanny Castro-Llanos, Nicole L Achee, John P Grieco, T Alex Perkins.

Spatial repellents (SRs) reduce human-mosquito contact by preventing mosquito entrance into human-occupied spaces and interfering with host-seeking and blood-feeding. A new model to synthesize experimental data on the effects of transfluthrin on Aedes aegypti explores how SR effects interact to impact the epidemiology of diseases vectored by these mosquitoes. Our results indicate that the greatest impact on force of infection is expected to derive from the chemical's lethal effect but delayed biting and the negative effect this may have on the mosquito population could elicit substantial impact in the absence of lethality. The relative contributions of these effects depend on coverage, chemical dose, and housing density. We also demonstrate that, through an increase in the number of potentially mosquito bites, increased partial blood-feeding and reduced exiting may elicit adverse impacts, which could offset gains achieved by other effects. Our analysis demonstrates how small-scale experimental data can be leveraged to derive expectations of epidemiological impact of SRs deployed at larger scales.

DOI: https://doi.org/10.1371/journal.pcbi.1008190
Malar J. 2020 Sep 19. 19(1): 340

Rapid reduction of malaria transmission following the introduction of indoor residual spraying in previously unsprayed districts: an observational analysis of Mopti Region, Mali, in 2017.

Joseph Wagman, Idrissa Cissé, Diakalkia Kone, Seydou Fomba, Erin Eckert, Jules Mihigo, Elie Bankineza, Mamadou Bah, Diadier Diallo, Christelle Gogue, Kenzie Tynuv, Andrew Saibu, Jason H Richardson, Christen Fornadel, Laurence Slutsker, Molly Robertson.

   BACKGROUND: The National Malaria Control Programme (NMCP) of Mali has had recent success decreasing malaria transmission using 3rd generation indoor residual spraying (IRS) products in areas with pyrethroid resistance, primarily in Ségou and Koulikoro Regions. In 2015, national survey data showed that Mopti Region had the highest under 5-year-old (u5) malaria prevalence at 54%-nearly twice the national average-despite having high access to long-lasting insecticidal nets (LLINs) and seasonal malaria chemoprevention (SMC). Accordingly, in 2016 the NMCP and other stakeholders shifted IRS activities from Ségou to Mopti. Here, the results of a series of observational analyses utilizing routine malaria indicators to evaluate the impact of this switch are presented.
METHODS: A set of retrospective, eco-observational time-series analyses were performed using monthly incidence rates of rapid diagnostic test (RDT)-confirmed malaria cases reported in the District Health Information System 2 (DHIS2) from January 2016 until February 2018. Comparisons of case incidence rates were made between health facility catchments from the same region that differed in IRS status (IRS vs. no-IRS) to describe the general impact of the 2016 and 2017 IRS campaigns, and a difference-in-differences approach comparing changes in incidence from year-to-year was used to describe the effect of suspending IRS operations in Ségou and introducing IRS operations in Mopti in 2017.
RESULTS: Compared to communities with no IRS, cumulative case incidence rates in IRS communities were reduced 16% in Ségou Region during the 6 months following the 2016 campaign and 31% in Mopti Region during the 6 months following the 2017 campaign, likely averting a total of more than 22,000 cases of malaria that otherwise would have been expected during peak transmission months. Across all comparator health facilities (HFs) where there was no IRS in either year, peak malaria case incidence rates fell by an average of 22% (CI95 18-30%) from 2016 to 2017. At HFs in communities of Mopti where IRS was introduced in 2017, peak incidence fell by an average of 42% (CI95 31-63%) between these years, a significantly greater decrease (p = 0.040) almost double what was seen in the comparator HFCAs. The opposite effect was observed in Ségou Region, where peak incidence at those HFs where IRS was withdrawn after the 2016 campaign increased by an average of 106% (CI95 63-150%) from year to year, also a significant difference-in-differences compared to the comparator no-IRS HFs (p < 0.0001).
CONCLUSION: Annual IRS campaigns continue to make dramatic contributions to the seasonal reduction of malaria transmission in communities across central Mali, where IRS campaigns were timed in advance of peak seasonal transmission and utilized a micro-encapsulated product with an active ingredient that was of a different class than the one found on the LLINs used throughout the region and to which local malaria vectors were shown to be susceptible. Strategies to help mitigate the resurgence of malaria cases that can be expected should be prioritized whenever the suspension of IRS activities in a particular region is considered.

Keywords:  Indoor residual spraying; Malaria incidence; Next-generation IRS; Observational impact analysis

DOI:  https://doi.org/10.1186/s12936-020-03414-2
Environ Health Insights. 2020 ;14 1178630220952790

Assessing Insecticide Resistance in Adult Mosquitoes: Perspectives on Current Methods.

Stephanie L Richards, Brian D Byrd, Michael H Reiskind, Avian V White.

  Mosquito insecticide resistance (IR) is a growing global issue that must be addressed to protect public health. Vector control programs (VCPs) should regularly monitor local mosquito populations for IR and plan control measures accordingly. In some cases, state/federal resources financially support this testing with expertise and/or training programs. Standardization of methods (eg, Centers for Disease Control and Prevention bottle bioassay, World Health Organization tube testing, dose-mortality bioassay) for monitoring IR must be prioritized. One solution is regional hubs of IR monitoring at the state or other level. Training programs on methodology and interpretation of results should be developed and routinely offered to local VCPs conducting IR testing in mosquitoes. Here, current methods for assessing mosquito IR are discussed and insights into a variety of questions from VCPs are considered. It is critical that methods for IR monitoring and data interpretation are standardized through routine training, with the goal of evidence-driven decision making to improve control of mosquitoes and mosquito-borne disease.

Keywords:  CDC bottle bioassay; insecticide resistance; mosquito

DOI:  https://doi.org/10.1177/1178630220952790
Antiviral Res. 2020 Sep 16. pii: S0166-3542(20)30348-X. [Epub ahead of print] 104934

Vector-borne Viruses in Turkey: A Systematic Review and Bibliography.

Koray Ergünay, Ceylan Polat, Aykut Özkul.

  Turkey serves as a natural hub for the dissemination of vector-borne viruses and provides many suitable habitats with diverse ecologies for introduction and establishment of new pathogens. This manuscipt provides an updated systematic review and meta-analysis of the vector-borne viruses documented in Turkey. Following web-based identification, screening and eligibility evaluation, 291 published reports were reviewed. The publications were categorized and listed as a supplementary bibliography accompanying the manuscript. In brief, Crimean-Congo hemorrhagic fever virus (CCHFV) and West Nile virus (WNV) are currently documented as prominent tick and mosquito-borne viral pathogens in Turkey. CCHFV produces a significant number of infections annually, with severe outcome or death in a portion of cases. WNV gained attention following the clustering of cases in 2010. Exposure and infections with sandfly-borne phleboviruses, such as Toscana virus, are indigenous and widespread. Epidemiology, risk factors, symptomatic infections in susceptible hosts, vectors and reservoirs for these pathogens have been explored in detail. Detection of novel viruses in mosquitoes, sandflies and ticks from several regions is of particular interest, despite scarce information on their epidemiology and pathogenicity in vertebrates. Introduction and emergence of viruses transmitted by invasive Aedes mosquitoes constitute a threat, albeit only imported infections have so far been documented. Detection of Rift valley fever virus exposure is also of concern, due to its detrimental effects on livestock and spillover infections in humans. Vigilance to identify and diagnose probable cases as well as vector surveillance for established and potential pathogens is therefore, imperative.

Keywords:  Anatolia; Turkey; Vector; mosquito; sandfly; tick; virus

DOI:  https://doi.org/10.1016/j.antiviral.2020.104934
Trop Med Int Health. 2020 Sep 22.

Spatio-temporal dynamics of Aedes aegypti and Aedes albopictus oviposition in an urban area of northeastern Brazil.

Márcia Cristina Bernardo de Melo Moura, Josinaldo Vidal de Oliveira, Rodrigo Moreira Pedreira, Alessandre de Medeiros Tavares, Talita Araujo de Souza, Kenio Costa de Lima, Isabelle Ribeiro Barbosa.

   OBJECTIVE: The objective of this study was to analyze abundance and spatial distribution of Aedes aegypti and Aedes albopictus oviposition in the city of Natal-RN, 2016 to 2018.
METHODS: 307 oviposition traps were installed across the whole city and monitored weekly from January 2016 to December 2018. To verify the abundance of the vector based on its location, the formation of oviposition clusters was studied using the Kernel statistics. Egg Density Index (EDI) and Oviposition Positivity Index (OPI) values were calculated.
RESULTS: Temperature and humidity presented a weak and very weak correlation, respectively, with the oviposition indicators. The median of oviposition positivity index (OPI) was 60.5% and the egg density index (EDI) was 45.4 eggs/trap. The OPI (71.1%) was higher in the second quarter of the year. The areas with the most persistent oviposition are located in a continuous strip that extends from the extreme of the northern district and extends along the western district of the city. Also noteworthy is the proximity to the strategic points.
CONCLUSIONS: The spatiotemporal distribution of oviposition revealed that there is spatial segregation and marked seasonality. Therefore, this study highlights the importance of maintaining surveillance targeting and control strategies focused on these areas, especially during the most important period of the year.

Keywords:  Aedes; oviposition; seasonality; spatial analysis

DOI:  https://doi.org/10.1111/tmi.13491
Lancet Neurol. 2020 10;pii: S1474-4422(20)30232-5. [Epub ahead of print]19(10): 826-839

Neurological disease in adults with Zika and chikungunya virus infection in Northeast Brazil: a prospective observational study.

Maria Lúcia Brito Ferreira, Maria de Fatima Pessoa Militão de Albuquerque, Carlos Alexandre Antunes de Brito, Rafael Freitas de Oliveira França, Álvaro José Porto Moreira, Maria Íris de Morais Machado, Roberta da Paz Melo, Raquel Medialdea-Carrera, Solange Dornelas Mesquita, Marcela Lopes Santos, Ravi Mehta, Rafael Ramos E Silva, Sonja E Leonhard, Mark Ellul, Anna Rosala-Hallas, Girvan Burnside, Lance Turtle, Michael J Griffiths, Bart C Jacobs, Maneesh Bhojak, Hugh J Willison, Lindomar José Pena, Carlos A Pardo, Ricardo A A Ximenes, Celina Maria Turchi Martelli, David W G Brown, Marli Tenório Cordeiro, Suzannah Lant, Tom Solomon.

BACKGROUND: Since 2015, the arthropod-borne viruses (arboviruses) Zika and chikungunya have spread across the Americas causing outbreaks, accompanied by increases in immune-mediated and infectious neurological disease. The spectrum of neurological manifestations linked to these viruses, and the importance of dual infection, are not known fully. We aimed to investigate whether neurological presentations differed according to the infecting arbovirus, and whether patients with dual infection had a different disease spectrum or severity.
METHODS: We report a prospective observational study done during epidemics of Zika and chikungunya viruses in Recife, Pernambuco, a dengue-endemic area of Brazil. We recruited adults aged 18 years or older referred to Hospital da Restauração, a secondary-level and tertiary-level hospital, with suspected acute neurological disease and a history of suspected arboviral infection. We looked for evidence of Zika, chikungunya, or dengue infection by viral RNA or specific IgM antibodies in serum or CSF. We grouped patients according to their arbovirus laboratory diagnosis and then compared demographic and clinical characteristics.
FINDINGS: Between Dec 4, 2014, and Dec 4, 2016, 1410 patients were admitted to the hospital neurology service; 201 (14%) had symptoms consistent with arbovirus infection and sufficient samples for diagnostic testing and were included in the study. The median age was 48 years (IQR 34-60), and 106 (53%) were women. 148 (74%) of 201 patients had laboratory evidence of arboviral infection. 98 (49%) of them had a single viral infection (41 [20%] had Zika, 55 [27%] had chikungunya, and two [1%] had dengue infection), whereas 50 (25%) had evidence of dual infection, mostly with Zika and chikungunya viruses (46 [23%] patients). Patients positive for arbovirus infection presented with a broad range of CNS and peripheral nervous system (PNS) disease. Chikungunya infection was more often associated with CNS disease (26 [47%] of 55 patients with chikungunya infection vs six [15%] of 41 with Zika infection; p=0·0008), especially myelitis (12 [22%] patients). Zika infection was more often associated with PNS disease (26 [63%] of 41 patients with Zika infection vs nine [16%] of 55 with chikungunya infection; p≤0·0001), particularly Guillain-Barré syndrome (25 [61%] patients). Patients with Guillain-Barré syndrome who had Zika and chikungunya dual infection had more aggressive disease, requiring intensive care support and longer hospital stays, than those with mono-infection (median 24 days [IQR 20-30] vs 17 days [10-20]; p=0·0028). Eight (17%) of 46 patients with Zika and chikungunya dual infection had a stroke or transient ischaemic attack, compared with five (6%) of 96 patients with Zika or chikungunya mono-infection (p=0·047).
INTERPRETATION: There is a wide and overlapping spectrum of neurological manifestations caused by Zika or chikungunya mono-infection and by dual infections. The possible increased risk of acute cerebrovascular disease in patients with dual infection merits further investigation.
FUNDING: Fundação do Amparo a Ciência e Tecnologia de Pernambuco (FACEPE), EU's Horizon 2020 research and innovation programme, National Institute for Health Research.
TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

DOI: https://doi.org/10.1016/S1474-4422(20)30232-5
Intervirology. 2020 Sep 23. 1-13

Clinical, Virological, and Immunological Profiles of DENV, ZIKV, and/or CHIKV-Infected Brazilian Patients.

Juan Camilo Sánchez-Arcila, Jessica Badolato-Correa, Thiara Manuele Alves de Souza, Iury Amâncio Paiva, Luciana Santos Barbosa, Priscila Conrado Guerra Nunes, Monique da Rocha Queiroz Lima, Flavia Barrento Dos Santos, Paulo Vieira Damasco, Rivaldo Venancio da Cunha, Elzinandes Leal de Azeredo, Luzia Maria de Oliveira-Pinto.

   BACKGROUND: Arboviruses co-circulating within a population that are transmitted by the same vector have the potential to cause coinfections. Coinfections with dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV) have been occurring in Brazil, but it is not well-understood how human responses vary during mono- or coinfections and whether they play different roles in pathogenesis.
METHODS: We investigated the clinical, virological, and immunological status during patients' acute infections, focusing on the CCL/CXC chemokines, proinflammatory, as well as anti-inflammatory cytokines levels quantified by ELISAs. Viral load was determined by qRT-PCR in serum samples from 116 acute DENV, ZIKV, CHIKV, DENV/ZIKV, and CHIKV/ZIKV-infected adult patients from Brazil.
RESULTS: Most of the acute patients displayed fever, headache, prostration, and myalgia, regardless of the type of arbovirus infection. Zika viral load was higher in CHIKV/ZIKV coinfected patients compared with ZIKV or DENV/ZIKV infections. All infected individuals presented increased concentrations of C-X-C motif chemokine ligand 10/interferon protein-10 (CXCL10/IP-10), C-C motif chemokine ligand 2/monocyte chemoattractant protein-1 (CCL2/MCP-1), and tumor necrosis factor alpha (TNF-α) compared to healthy donors. Interestingly, the ZIKV group separated from CHIKV/ZIKV due to higher levels of interleukin-10 (IL-10) and lower levels of TNF-α. While DENV/ZIKV differentiated from CHIKV due to their higher levels of CCL2/MCP-1, in CHIKV- and CHIKV/ZIKV-infected patients, levels of CXC10/IP-10, CCL2/MCP-1, and migration inhibitory factor (MIF) were associated with CHIKV viral load. By contrast, in DENV/ZIKV- and CHIKV/ZIKV-infected patients, levels of CXCL10/IP-10, CCL2/MCP-1, and TNF-α showed a significant inverse correlation with ZIKV viral load.
CONCLUSIONS: From all the circulating mediators measured, we detected differences of IL-10, TNF-α, and CCL2/MCP-1 between arbovirus groups. We hypothesize that CXC10/IP-10, CCL2/MCP-1, and MIF in the CHIKV-infected group could regulate the CHIKV viral load, while CXC10/IP-10, CCL2/MCP-1, and TNF-α in DENV/ZIKV, and CHIKV/ZIKV groups, could regulate ZIKV viral load.

Keywords:  Chikungunya virus; Coinfection; Cytokines and chemokines; Dengue virus; Zika virus

DOI:  https://doi.org/10.1159/000510223
Am J Trop Med Hyg. 2020 Sep 21.

Will More of the Same Achieve Malaria Elimination? Results from an Integrated Macroeconomic Epidemiological Demographic Model.

Richard D Smith, Marcus R Keogh-Brown, R Matthew Chico, Michael T Bretscher, Chris Drakeley, Henning Tarp Jensen.

Historic levels of funding have reduced the global burden of malaria in recent years. Questions remain, however, as to whether scaling up interventions, in parallel with economic growth, has made malaria elimination more likely today than previously. The consequences of "trying but failing" to eliminate malaria are also uncertain. Reduced malaria exposure decreases the acquisition of semi-immunity during childhood, a necessary phase of the immunological transition that occurs on the pathway to malaria elimination. During this transitional period, the risk of malaria resurgence increases as proportionately more individuals across all age-groups are less able to manage infections by immune response alone. We developed a robust model that integrates the effects of malaria transmission, demography, and macroeconomics in the context of Plasmodium falciparum malaria within a hyperendemic environment. We analyzed the potential for existing interventions, alongside economic development, to achieve malaria elimination. Simulation results indicate that a 2% increase in future economic growth will increase the US$5.1 billion cumulative economic burden of malaria in Ghana to US$7.2 billion, although increasing regional insecticide-treated net coverage rates by 25% will lower malaria reproduction numbers by just 9%, reduce population-wide morbidity by -0.1%, and reduce prevalence from 54% to 46% by 2034. As scaling up current malaria control tools, combined with economic growth, will be insufficient to interrupt malaria transmission in Ghana, high levels of malaria control should be maintained and investment in research and development should be increased to maintain the gains of the past decade and to minimize the risk of resurgence, as transmission drops.

DOI: https://doi.org/10.4269/ajtmh.19-0472