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INFECTIOUSNESS OF MALARIA-ENDEMIC HUMAN POPULATIONS TO VECTORS
GERRY F. KILLEEN
GERRY F. KILLEEN
Ifakara Health Research and Development Center, Ifakara, Tanzania; Swiss Tropical Institute, Basel, Switzerland
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AMANDA ROSS
AMANDA ROSS
Ifakara Health Research and Development Center, Ifakara, Tanzania; Swiss Tropical Institute, Basel, Switzerland
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THOMAS SMITH
THOMAS SMITH
Ifakara Health Research and Development Center, Ifakara, Tanzania; Swiss Tropical Institute, Basel, Switzerland
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Despite its key role in determining the stability and intensity of malaria transmission, the infectiousness of human populations to mosquitoes has rarely been estimated. Field-based analyses of malaria transmission have frequently relied on the prevalence of asexual parasites or gametocytes as proxies for infectiousness. We now summarize empirical data on human infectiousness from Africa and Papua New Guinea. Over a wide range of transmission intensities there is little relationship between the infectiousness of human populations to vector mosquitoes and mosquito-to-human transmission intensity. We compare these data with the predictions of a stochastic simulation model of Plasmodium falciparum epidemiology. This model predicted little variation in the infectiousness of the human population for entomologic inoculation rates (EIRs) greater than approximately 10 infectious bites per year, demonstrating that the lack of relationship between the EIR and the infectious reservoir can be explained without invoking any effects of acquired transmission-blocking immunity. The near absence of field data from areas with an EIR < 10 per year precluded validation of the model predictions for low EIR values. These results suggest that interventions reducing mosquito-to-human transmission will have little or no effect on human infectiousness at the levels of transmission found in most rural areas of sub-Saharan Africa. Unless very large reductions in transmission can be achieved, measures to prevent mosquito-to-human transmission need to be complemented with interventions that reduce the density or infectiousness of blood stage parasites.
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1
Saul A, 1996. Transmission dynamics of Plasmodium falciparum. Parasitol Today 12 :74–79.
-
2
Molineaux L, Gramiccia G, 1980. The Garki Project. Geneva: World Health Organization
-
3
Lengeler C, 2003. Insecticide-treated bednets and curtains for preventing malaria. Cochrane Database Syst Rev 2004; (2): CD000363.
-
4
Smith T, Leuenberger R, Lengeler C, 2001. Child mortality and malaria transmission intensity in Africa. Trends Parasitol 17 :145–149.
-
5
Killeen G, Fillinger U, Kiche I, Gouagna L, Knols B, 2002. Eradication of Anopheles gambiae from Brazil: lessons for malaria control in Africa? Lancet Infect Dis 2 :618–627.
-
6
Mabaso ML, Sharp B, Lengeler C, 2004. Historical review of malarial control in southern African with emphasis on the use of indoor residual house-spraying. Trop Med Int Health 9 :846–856.
-
7
Utzinger J, Tozan Y, Singer B, 2001. Efficacy and cost-effectiveness of environmental management for malaria control. Trop Med Int Health 6 :677–687.
-
8
Curtis CF, Mnzava AE, 2000. Comparison of house spraying and insecticide-treated nets for malaria control. Bull World Health Organ 78 :1389–1400.
-
9
Sama W, Killeen G, Smith T, 2004. Estimating the duration of Plasmodium falciparum infection from trials of indoor residual spraying. Am J Trop Med Hyg 70 :625–634.
-
10
Macdonald G, 1956. Theory of the eradication of malaria. Bull World Health Organ 15 :369–387
-
11
Binka F, Indome F, Smith T, 1998. Impact of spatial distribution of permethrin-impregnated bed nets on child mortality in rural northern Ghana. Am J Trop Med Hyg 59 :80–85.
-
12
Howard SC, Omumbo J, Nevill C, Some ES, Donnelly CA, Snow R, 2000. Evidence for a mass community effect of insecticide-treated bednets on the incidence of malaria on the Kenyan coast. Trans R Soc Trop Med Hyg 94 :357–360.
-
13
Hawley WA, Phillips-Howard P, ter Kuile F, Terlouw DJ, Vulule JM, Ombok M, Nahlen B, Gimnig JE, Kariuki SK, Kolczak MS, Hightower AW, 2003. Community-wide effects of permethrin-treated bed nets on child mortality and malaria morbidity in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):121–127.
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