Reducing Plasmodium falciparum malaria transmission in Africa: a model-based evaluation of intervention strategies
Over the past decade malaria intervention coverage has been scaled up across Africa. However, it remains unclear what overall reduction in transmission is achievable using currently available tools. We developed an individual-based simulation model for Plasmodium falciparum transmission in an Africa...
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| Veröffentlicht in: | PLoS medicine 2010-08, Vol.7 (8), p.e1000324 |
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| creator | Griffin, Jamie T Hollingsworth, T Deirdre Okell, Lucy C Churcher, Thomas S White, Michael Hinsley, Wes Bousema, Teun Drakeley, Chris J Ferguson, Neil M Basáñez, María-Gloria Ghani, Azra C |
| description | Over the past decade malaria intervention coverage has been scaled up across Africa. However, it remains unclear what overall reduction in transmission is achievable using currently available tools.
We developed an individual-based simulation model for Plasmodium falciparum transmission in an African context incorporating the three major vector species (Anopheles gambiae s.s., An. arabiensis, and An. funestus) with parameters obtained by fitting to parasite prevalence data from 34 transmission settings across Africa. We incorporated the effect of the switch to artemisinin-combination therapy (ACT) and increasing coverage of long-lasting insecticide treated nets (LLINs) from the year 2000 onwards. We then explored the impact on transmission of continued roll-out of LLINs, additional rounds of indoor residual spraying (IRS), mass screening and treatment (MSAT), and a future RTS,S/AS01 vaccine in six representative settings with varying transmission intensity (as summarized by the annual entomological inoculation rate, EIR: 1 setting with low, 3 with moderate, and 2 with high EIRs), vector-species combinations, and patterns of seasonality. In all settings we considered a realistic target of 80% coverage of interventions. In the low-transmission setting (EIR approximately 3 ibppy [infectious bites per person per year]), LLINs have the potential to reduce malaria transmission to low levels (90%) or novel tools and/or substantial social improvements will be required, although considerable reductions in prevalence can be achieved with existing tools and realistic coverage levels.
Interventions using current tools can result in major reductions in P. falciparum malaria transmission and the associated disease burden in Africa. Reduction to the 1% parasite prevalence threshold is possible in low- to moderate-transmission settings when vectors are primarily endophilic (indoor-resting), provided a comprehensive and sustained intervention program is achie |
| doi_str_mv | 10.1371/journal.pmed.1000324 |
| format | Article |
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We developed an individual-based simulation model for Plasmodium falciparum transmission in an African context incorporating the three major vector species (Anopheles gambiae s.s., An. arabiensis, and An. funestus) with parameters obtained by fitting to parasite prevalence data from 34 transmission settings across Africa. We incorporated the effect of the switch to artemisinin-combination therapy (ACT) and increasing coverage of long-lasting insecticide treated nets (LLINs) from the year 2000 onwards. We then explored the impact on transmission of continued roll-out of LLINs, additional rounds of indoor residual spraying (IRS), mass screening and treatment (MSAT), and a future RTS,S/AS01 vaccine in six representative settings with varying transmission intensity (as summarized by the annual entomological inoculation rate, EIR: 1 setting with low, 3 with moderate, and 2 with high EIRs), vector-species combinations, and patterns of seasonality. In all settings we considered a realistic target of 80% coverage of interventions. In the low-transmission setting (EIR approximately 3 ibppy [infectious bites per person per year]), LLINs have the potential to reduce malaria transmission to low levels (<1% parasite prevalence in all age-groups) provided usage levels are high and sustained. In two of the moderate-transmission settings (EIR approximately 43 and 81 ibppy), additional rounds of IRS with DDT coupled with MSAT could drive parasite prevalence below a 1% threshold. However, in the third (EIR = 46) with An. arabiensis prevailing, these interventions are insufficient to reach this threshold. In both high-transmission settings (EIR approximately 586 and 675 ibppy), either unrealistically high coverage levels (>90%) or novel tools and/or substantial social improvements will be required, although considerable reductions in prevalence can be achieved with existing tools and realistic coverage levels.
Interventions using current tools can result in major reductions in P. falciparum malaria transmission and the associated disease burden in Africa. Reduction to the 1% parasite prevalence threshold is possible in low- to moderate-transmission settings when vectors are primarily endophilic (indoor-resting), provided a comprehensive and sustained intervention program is achieved through roll-out of interventions. In high-transmission settings and those in which vectors are mainly exophilic (outdoor-resting), additional new tools that target exophagic (outdoor-biting), exophilic, and partly zoophagic mosquitoes will be required.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1000324</identifier><identifier>PMID: 20711482</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Africa - epidemiology ; Animals ; Anopheles ; Anopheles - drug effects ; Anopheles - parasitology ; Anopheles gambiae ; Artemisinins - pharmacology ; Artemisinins - therapeutic use ; Control ; Disease transmission ; Distribution ; Health aspects ; Humans ; Infectious Diseases/Epidemiology and Control of Infectious Diseases ; Insect Vectors - drug effects ; Insect Vectors - parasitology ; Insecticides ; Malaria ; Malaria, Falciparum - prevention & control ; Malaria, Falciparum - transmission ; Medical research ; Models, Theoretical ; Mosquito Control - standards ; Mosquitoes ; Parasites ; Plasmodium falciparum ; Plasmodium falciparum - drug effects ; Prevention ; Risk factors ; Studies</subject><ispartof>PLoS medicine, 2010-08, Vol.7 (8), p.e1000324</ispartof><rights>COPYRIGHT 2010 Public Library of Science</rights><rights>Griffin et al. 2010</rights><rights>2010 Griffin et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Griffin JT, Hollingsworth TD, Okell LC, Churcher TS, White M, et al. (2010) Reducing Plasmodium falciparum Malaria Transmission in Africa: A Model-Based Evaluation of Intervention Strategies. PLoS Med 7(8): e1000324. doi:10.1371/journal.pmed.1000324</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c767t-7d8bcb08055497868f86bd6617098719722be3a46f3bb5ba82a1310a0311a5773</citedby><cites>FETCH-LOGICAL-c767t-7d8bcb08055497868f86bd6617098719722be3a46f3bb5ba82a1310a0311a5773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919425/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919425/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20711482$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Griffin, Jamie T</creatorcontrib><creatorcontrib>Hollingsworth, T Deirdre</creatorcontrib><creatorcontrib>Okell, Lucy C</creatorcontrib><creatorcontrib>Churcher, Thomas S</creatorcontrib><creatorcontrib>White, Michael</creatorcontrib><creatorcontrib>Hinsley, Wes</creatorcontrib><creatorcontrib>Bousema, Teun</creatorcontrib><creatorcontrib>Drakeley, Chris J</creatorcontrib><creatorcontrib>Ferguson, Neil M</creatorcontrib><creatorcontrib>Basáñez, María-Gloria</creatorcontrib><creatorcontrib>Ghani, Azra C</creatorcontrib><title>Reducing Plasmodium falciparum malaria transmission in Africa: a model-based evaluation of intervention strategies</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Over the past decade malaria intervention coverage has been scaled up across Africa. However, it remains unclear what overall reduction in transmission is achievable using currently available tools.
We developed an individual-based simulation model for Plasmodium falciparum transmission in an African context incorporating the three major vector species (Anopheles gambiae s.s., An. arabiensis, and An. funestus) with parameters obtained by fitting to parasite prevalence data from 34 transmission settings across Africa. We incorporated the effect of the switch to artemisinin-combination therapy (ACT) and increasing coverage of long-lasting insecticide treated nets (LLINs) from the year 2000 onwards. We then explored the impact on transmission of continued roll-out of LLINs, additional rounds of indoor residual spraying (IRS), mass screening and treatment (MSAT), and a future RTS,S/AS01 vaccine in six representative settings with varying transmission intensity (as summarized by the annual entomological inoculation rate, EIR: 1 setting with low, 3 with moderate, and 2 with high EIRs), vector-species combinations, and patterns of seasonality. In all settings we considered a realistic target of 80% coverage of interventions. In the low-transmission setting (EIR approximately 3 ibppy [infectious bites per person per year]), LLINs have the potential to reduce malaria transmission to low levels (<1% parasite prevalence in all age-groups) provided usage levels are high and sustained. In two of the moderate-transmission settings (EIR approximately 43 and 81 ibppy), additional rounds of IRS with DDT coupled with MSAT could drive parasite prevalence below a 1% threshold. However, in the third (EIR = 46) with An. arabiensis prevailing, these interventions are insufficient to reach this threshold. In both high-transmission settings (EIR approximately 586 and 675 ibppy), either unrealistically high coverage levels (>90%) or novel tools and/or substantial social improvements will be required, although considerable reductions in prevalence can be achieved with existing tools and realistic coverage levels.
Interventions using current tools can result in major reductions in P. falciparum malaria transmission and the associated disease burden in Africa. Reduction to the 1% parasite prevalence threshold is possible in low- to moderate-transmission settings when vectors are primarily endophilic (indoor-resting), provided a comprehensive and sustained intervention program is achieved through roll-out of interventions. In high-transmission settings and those in which vectors are mainly exophilic (outdoor-resting), additional new tools that target exophagic (outdoor-biting), exophilic, and partly zoophagic mosquitoes will be required.</description><subject>Africa - epidemiology</subject><subject>Animals</subject><subject>Anopheles</subject><subject>Anopheles - drug effects</subject><subject>Anopheles - parasitology</subject><subject>Anopheles gambiae</subject><subject>Artemisinins - pharmacology</subject><subject>Artemisinins - therapeutic use</subject><subject>Control</subject><subject>Disease transmission</subject><subject>Distribution</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Infectious Diseases/Epidemiology and Control of Infectious Diseases</subject><subject>Insect Vectors - drug effects</subject><subject>Insect Vectors - parasitology</subject><subject>Insecticides</subject><subject>Malaria</subject><subject>Malaria, Falciparum - prevention & control</subject><subject>Malaria, Falciparum - transmission</subject><subject>Medical research</subject><subject>Models, Theoretical</subject><subject>Mosquito Control - standards</subject><subject>Mosquitoes</subject><subject>Parasites</subject><subject>Plasmodium falciparum</subject><subject>Plasmodium falciparum - drug effects</subject><subject>Prevention</subject><subject>Risk factors</subject><subject>Studies</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>DOA</sourceid><recordid>eNqVk12L1DAUhoso7rr6D0QLguJFx3y0TeKFMCx-DCyurB-34bRNOxnSZEzaQf-96c7sMoUFlVw0TZ_3PT055yTJU4wWmDL8ZuNGb8Estr1qFhghREl-LznFRS4yXLLy_tH-JHkUwgYhIpBAD5MTghjGOSenib9SzVhr26VfDITeNXrs0xZMrbfg47YHA15DOniwodchaGdTbdNl63UNb1NIo0aZrIKgmlTtwIwwTIxrIzYov1P2-j1Eh0F1WoXHyYMYIKgnh-dZ8v3D-2_nn7KLy4-r8-VFVrOSDRlreFVXiKMiZsF4yVteVk1ZYoYEZ1gwQipFIS9bWlVFBZwAphgBohhDwRg9S57vfbfGBXm4riAx4RyJoqAiEqs90TjYyK3XPfjf0oGW1wfOdxL8oGujZFG1ceUYKJC8bQRQzkRbAihUNoAger07RBurWJE6pu3BzEznX6xey87tJBFY5KSIBq8OBt79HFUYZLzuWhkDVrkxSE4woznn4q8ky3nMj5OJfLEnO4g5aNu6GLqeaLkktBSxHYo8UtkdVKesiv_prGp1PJ7xizv4uBrV6_pOweuZIDKD-jV0MIYgV1-v_oP9_O_s5Y85-_KIXSswwzo4M07NGeZgvgdr70Lwqr2tIUZymrybVpLT5MnD5EXZs-P634puRo3-Ac0MKUI</recordid><startdate>20100801</startdate><enddate>20100801</enddate><creator>Griffin, Jamie T</creator><creator>Hollingsworth, T Deirdre</creator><creator>Okell, Lucy C</creator><creator>Churcher, Thomas S</creator><creator>White, Michael</creator><creator>Hinsley, Wes</creator><creator>Bousema, Teun</creator><creator>Drakeley, Chris J</creator><creator>Ferguson, Neil M</creator><creator>Basáñez, María-Gloria</creator><creator>Ghani, Azra C</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>7X8</scope><scope>7SS</scope><scope>C1K</scope><scope>F1W</scope><scope>H95</scope><scope>H97</scope><scope>L.G</scope><scope>M7N</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope></search><sort><creationdate>20100801</creationdate><title>Reducing Plasmodium falciparum malaria transmission in Africa: a model-based evaluation of intervention strategies</title><author>Griffin, Jamie T ; Hollingsworth, T Deirdre ; Okell, Lucy C ; Churcher, Thomas S ; White, Michael ; Hinsley, Wes ; Bousema, Teun ; Drakeley, Chris J ; Ferguson, Neil M ; Basáñez, María-Gloria ; Ghani, Azra C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c767t-7d8bcb08055497868f86bd6617098719722be3a46f3bb5ba82a1310a0311a5773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Africa - epidemiology</topic><topic>Animals</topic><topic>Anopheles</topic><topic>Anopheles - drug effects</topic><topic>Anopheles - parasitology</topic><topic>Anopheles gambiae</topic><topic>Artemisinins - pharmacology</topic><topic>Artemisinins - therapeutic use</topic><topic>Control</topic><topic>Disease transmission</topic><topic>Distribution</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Infectious Diseases/Epidemiology and Control of Infectious Diseases</topic><topic>Insect Vectors - drug effects</topic><topic>Insect Vectors - parasitology</topic><topic>Insecticides</topic><topic>Malaria</topic><topic>Malaria, Falciparum - prevention & control</topic><topic>Malaria, Falciparum - transmission</topic><topic>Medical research</topic><topic>Models, Theoretical</topic><topic>Mosquito Control - standards</topic><topic>Mosquitoes</topic><topic>Parasites</topic><topic>Plasmodium falciparum</topic><topic>Plasmodium falciparum - drug effects</topic><topic>Prevention</topic><topic>Risk factors</topic><topic>Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Griffin, Jamie T</creatorcontrib><creatorcontrib>Hollingsworth, T Deirdre</creatorcontrib><creatorcontrib>Okell, Lucy C</creatorcontrib><creatorcontrib>Churcher, Thomas S</creatorcontrib><creatorcontrib>White, Michael</creatorcontrib><creatorcontrib>Hinsley, Wes</creatorcontrib><creatorcontrib>Bousema, Teun</creatorcontrib><creatorcontrib>Drakeley, Chris J</creatorcontrib><creatorcontrib>Ferguson, Neil M</creatorcontrib><creatorcontrib>Basáñez, María-Gloria</creatorcontrib><creatorcontrib>Ghani, Azra C</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>MEDLINE - Academic</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ASFA: Aquatic Sciences and Fisheries Abstracts</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 1: Biological Sciences & Living Resources</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 3: Aquatic Pollution & Environmental Quality</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) Professional</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Griffin, Jamie T</au><au>Hollingsworth, T Deirdre</au><au>Okell, Lucy C</au><au>Churcher, Thomas S</au><au>White, Michael</au><au>Hinsley, Wes</au><au>Bousema, Teun</au><au>Drakeley, Chris J</au><au>Ferguson, Neil M</au><au>Basáñez, María-Gloria</au><au>Ghani, Azra C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reducing Plasmodium falciparum malaria transmission in Africa: a model-based evaluation of intervention strategies</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2010-08-01</date><risdate>2010</risdate><volume>7</volume><issue>8</issue><spage>e1000324</spage><pages>e1000324-</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Over the past decade malaria intervention coverage has been scaled up across Africa. However, it remains unclear what overall reduction in transmission is achievable using currently available tools.
We developed an individual-based simulation model for Plasmodium falciparum transmission in an African context incorporating the three major vector species (Anopheles gambiae s.s., An. arabiensis, and An. funestus) with parameters obtained by fitting to parasite prevalence data from 34 transmission settings across Africa. We incorporated the effect of the switch to artemisinin-combination therapy (ACT) and increasing coverage of long-lasting insecticide treated nets (LLINs) from the year 2000 onwards. We then explored the impact on transmission of continued roll-out of LLINs, additional rounds of indoor residual spraying (IRS), mass screening and treatment (MSAT), and a future RTS,S/AS01 vaccine in six representative settings with varying transmission intensity (as summarized by the annual entomological inoculation rate, EIR: 1 setting with low, 3 with moderate, and 2 with high EIRs), vector-species combinations, and patterns of seasonality. In all settings we considered a realistic target of 80% coverage of interventions. In the low-transmission setting (EIR approximately 3 ibppy [infectious bites per person per year]), LLINs have the potential to reduce malaria transmission to low levels (<1% parasite prevalence in all age-groups) provided usage levels are high and sustained. In two of the moderate-transmission settings (EIR approximately 43 and 81 ibppy), additional rounds of IRS with DDT coupled with MSAT could drive parasite prevalence below a 1% threshold. However, in the third (EIR = 46) with An. arabiensis prevailing, these interventions are insufficient to reach this threshold. In both high-transmission settings (EIR approximately 586 and 675 ibppy), either unrealistically high coverage levels (>90%) or novel tools and/or substantial social improvements will be required, although considerable reductions in prevalence can be achieved with existing tools and realistic coverage levels.
Interventions using current tools can result in major reductions in P. falciparum malaria transmission and the associated disease burden in Africa. Reduction to the 1% parasite prevalence threshold is possible in low- to moderate-transmission settings when vectors are primarily endophilic (indoor-resting), provided a comprehensive and sustained intervention program is achieved through roll-out of interventions. In high-transmission settings and those in which vectors are mainly exophilic (outdoor-resting), additional new tools that target exophagic (outdoor-biting), exophilic, and partly zoophagic mosquitoes will be required.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>20711482</pmid><doi>10.1371/journal.pmed.1000324</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Public Library of Science (PLoS) |
| subjects | Africa - epidemiology Animals Anopheles Anopheles - drug effects Anopheles - parasitology Anopheles gambiae Artemisinins - pharmacology Artemisinins - therapeutic use Control Disease transmission Distribution Health aspects Humans Infectious Diseases/Epidemiology and Control of Infectious Diseases Insect Vectors - drug effects Insect Vectors - parasitology Insecticides Malaria Malaria, Falciparum - prevention & control Malaria, Falciparum - transmission Medical research Models, Theoretical Mosquito Control - standards Mosquitoes Parasites Plasmodium falciparum Plasmodium falciparum - drug effects Prevention Risk factors Studies |
| title | Reducing Plasmodium falciparum malaria transmission in Africa: a model-based evaluation of intervention strategies |
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