Eduardo Massad1, Gabriel Zorello Laporta2, Jan Evelyn Conn3, Leonardo Suveges Chaves4, Eduardo Sterlino Bergo5, Elder Augusto Guimarães Figueira6, Francisco Antonio Bezerra Coutinho7, Luis Fernandez Lopez7, Claudio Struchiner1, Maria Anice Mureb Sallum8. 1. Escola de Matemática Aplicada, Fundação Getúlio Vargas, Rio de Janeiro, Brazil. 2. Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC, Fundação do ABC, Santo André, SP, Brazil. 3. Wadsworth Center, New York State Department of Health, Albany, NY, USA. 4. Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil. 5. Superintendência de Controle de Endemias, Secretaria de Estado da Saúde de São Paulo, Araraquara, SP, Brazil. 6. Fundação de Vigilância em Saúde do Amazonas, Manaus, AM, Brazil. 7. Faculdade de Medicina, Universidade de São Paulo e LIM01-HCFMUSP, SP, Brazil. 8. Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: masallum@usp.br.
Abstract
BACKGROUND: Human mobility between malaria endemic and malaria-free areas can hinder control and elimination efforts in the Amazon basin, maintaining Plasmodium circulation and introduction to new areas. METHODS: The analysis begins by estimating the incidence of malaria in areas of interest. Then, the risk of infection as a function of the duration of stay after t0 was calculated as the number of infected travelers over the number of arrived travelers. Differential equations were employed to estimate the risk of nonimmune travelers acquiring malaria in Amazonian municipalities. Risk was calculated as a result of the force of the infection in terms of local dynamics per time of arrival and duration of visit. RESULTS: Maximum risk occurred at the peak or at the end of the rainy season and it was nonlinearly (exponentially) correlated with the fraction of infected mosquitoes. Relationship between the risk of malaria and duration of visit was linear and positively correlated. Relationship between the risk of malaria and the time of arrival in the municipality was dependent on local effects of seasonality. CONCLUSIONS: The risk of nonimmune travelers acquiring malaria is not negligible and can maintain regional circulation of parasites, propagating introductions in areas where malaria has been eliminated.
BACKGROUND:Human mobility between malaria endemic and malaria-free areas can hinder control and elimination efforts in the Amazon basin, maintaining Plasmodium circulation and introduction to new areas. METHODS: The analysis begins by estimating the incidence of malaria in areas of interest. Then, the risk of infection as a function of the duration of stay after t0 was calculated as the number of infected travelers over the number of arrived travelers. Differential equations were employed to estimate the risk of nonimmune travelers acquiring malaria in Amazonian municipalities. Risk was calculated as a result of the force of the infection in terms of local dynamics per time of arrival and duration of visit. RESULTS: Maximum risk occurred at the peak or at the end of the rainy season and it was nonlinearly (exponentially) correlated with the fraction of infected mosquitoes. Relationship between the risk of malaria and duration of visit was linear and positively correlated. Relationship between the risk of malaria and the time of arrival in the municipality was dependent on local effects of seasonality. CONCLUSIONS: The risk of nonimmune travelers acquiring malaria is not negligible and can maintain regional circulation of parasites, propagating introductions in areas where malaria has been eliminated.
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