Francesco Pizzitutti1, Carlos F Mena2, Beth Feingold3, William K Pan4. 1. Duke Global Health Institute, 310 Trent Dr., Duke University, Durham, NC, 27708, USA. 2. Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador. 3. Environmental Health Sciences, University at Albany - SUNY, One University Place, Rensselaer, NY, 12144, USA. 4. Duke Global Health Institute and Nicholas School of Environment, 310 Trent Dr., Duke University, Durham, NC, 27708, USA. Electronic address: william.pan@duke.edu.
Abstract
BACKGROUND: Despite relatively successful control campaigns, malaria remains a relevant public health problem in the Peruvian Amazon. Several studies suggest that malaria persistence in the area can be connected with a high prevalence of asymptomatic infections, which were subsequently shown to be connected with work-related exposure in areas of hyperendemic transmission. In this study, we tested the hypothesis that the infection reservoir represented by asymptomatic carriers in the northern Peruvian Amazon, combined with circular human movement to and from hyperendemic working areas, can capture the observed hypoendemic malaria transmission. METHODS: We designed a set of agent-based models that represent local-scale malaria transmission in a typical riverine community in the northern Peruvian Amazon. The models include asymptomatic individuals as well as a full representation of human movements within the community and between the community and external hyperendemic working places. Several theoretical scenarios are explored to verify if and how malaria clinical immunity prevalence and human work-related movements influence the malaria morbidity registered in the community. RESULTS: Agent-based simulations suggest that malaria incidence observed through passive case detection can be reproduced as exclusively generated by the asymptomatic infection reservoir. Scenarios analysis also show that, even if asymptomatic infections are completely eliminated, human movements to and from hyperendemic working areas generate a flow of imported cases that is enough to permit the persistence of transmission in the community. Simulation results were verified over a wide range of clinical immunity prevalence values and over a wide range of percentages of people working in remote hyperendemic areas. This context of unstable malaria transmission is observed to be vulnerable to severe outbreaks. CONCLUSIONS: Asymptomatic malaria infection and occupational circular human movement to hyperendemic transmission areas are designated by agent-based models as possible exclusive causes of residual hypoendemic malaria transmission observed in the Peruvian Amazon. Control strategies are proposed to decrease asymptomatic infection prevalence and to block transmission from asymptomatic individuals to the malaria susceptible population.
BACKGROUND: Despite relatively successful control campaigns, malaria remains a relevant public health problem in the Peruvian Amazon. Several studies suggest that malaria persistence in the area can be connected with a high prevalence of asymptomatic infections, which were subsequently shown to be connected with work-related exposure in areas of hyperendemic transmission. In this study, we tested the hypothesis that the infection reservoir represented by asymptomatic carriers in the northern Peruvian Amazon, combined with circular human movement to and from hyperendemic working areas, can capture the observed hypoendemic malaria transmission. METHODS: We designed a set of agent-based models that represent local-scale malaria transmission in a typical riverine community in the northern Peruvian Amazon. The models include asymptomatic individuals as well as a full representation of human movements within the community and between the community and external hyperendemic working places. Several theoretical scenarios are explored to verify if and how malaria clinical immunity prevalence and human work-related movements influence the malaria morbidity registered in the community. RESULTS: Agent-based simulations suggest that malaria incidence observed through passive case detection can be reproduced as exclusively generated by the asymptomatic infection reservoir. Scenarios analysis also show that, even if asymptomatic infections are completely eliminated, human movements to and from hyperendemic working areas generate a flow of imported cases that is enough to permit the persistence of transmission in the community. Simulation results were verified over a wide range of clinical immunity prevalence values and over a wide range of percentages of people working in remote hyperendemic areas. This context of unstable malaria transmission is observed to be vulnerable to severe outbreaks. CONCLUSIONS: Asymptomatic malaria infection and occupational circular human movement to hyperendemic transmission areas are designated by agent-based models as possible exclusive causes of residual hypoendemic malaria transmission observed in the Peruvian Amazon. Control strategies are proposed to decrease asymptomatic infection prevalence and to block transmission from asymptomatic individuals to the malaria susceptible population.
Authors: Annika K Gunderson; Rani E Kumar; Cristina Recalde-Coronel; Luis E Vasco; Andree Valle-Campos; Carlos F Mena; Benjamin F Zaitchik; Andres G Lescano; William K Pan; Mark M Janko Journal: Int J Environ Res Public Health Date: 2020-10-13 Impact factor: 3.390
Authors: Gabriel Carrasco-Escobar; Kimberly Fornace; Daniel Wong; Pierre G Padilla-Huamantinco; Jose A Saldaña-Lopez; Ober E Castillo-Meza; Armando E Caballero-Andrade; Edgar Manrique; Jorge Ruiz-Cabrejos; Jose Luis Barboza; Hugo Rodriguez; German Henostroza; Dionicia Gamboa; Marcia C Castro; Joseph M Vinetz; Alejandro Llanos-Cuentas Journal: Front Public Health Date: 2020-09-24