Anopheline breeding in river bed pools below major dams in Sri Lanka

Modelled and observed mean and seasonal relationships between climate, population density and malaria indicators in Cameroon

Background

A major health burden in Cameroon is malaria, a disease that is sensitive to climate, environment and socio-economic conditions, but whose precise relationship with these drivers is still uncertain. An improved understanding of the relationship between the disease and its drivers, and the ability to represent these relationships in dynamic disease models, would allow such models to contribute to health mitigation and adaptation planning. This work collects surveys of malaria parasite ratio and entomological inoculation rate and examines their relationship with temperature, rainfall, population density in Cameroon and uses this analysis to evaluate a climate sensitive mathematical model of malaria transmission.

Methods

Co-located, climate and population data is compared to the results of 103 surveys of parasite ratio (PR) covering 18,011 people in Cameroon. A limited set of campaigns which collected year-long field-surveys of the entomological inoculation rate (EIR) are examined to determine the seasonality of disease transmission, three of the study locations are close to the Sanaga and Mefou rivers while others are not close to any permanent water feature. Climate-driven simulations of the VECTRI malaria model are evaluated with this analysis.

Results

The analysis of the model results shows the PR peaking at temperatures of approximately 22 °C to 26 °C, in line with recent work that has suggested a cooler peak temperature relative to the established literature, and at precipitation rates at 7 mm day⁻¹, somewhat higher than earlier estimates. The malaria model is able to reproduce this broad behaviour, although the peak occurs at slightly higher temperatures than observed, while the PR peaks at a much lower rainfall rate of 2 mm day⁻¹. Transmission tends to be high in rural and peri-urban relative to urban centres in both model and observations, although the model is oversensitive to population which could be due to the neglect of population movements, and differences in hydrological conditions, housing quality and access to healthcare. The EIR follows the seasonal rainfall with a lag of 1 to 2 months, and is well reproduced by the model, while in three locations near permanent rivers the annual cycle of malaria transmission is out of phase with rainfall and the model fails.

Conclusion

Malaria prevalence is maximum at temperatures of 24 to 26 °C in Cameroon and rainfall rates of approximately 4 to 6 mm day⁻¹. The broad relationships are reproduced in a malaria model although prevalence is highest at a lower rainfall maximum of 2 mm day⁻¹. In locations far from water bodies malaria transmission seasonality closely follows that of rainfall with a lag of 1 to 2 months, also reproduced by the model, but in locations close to a seasonal river the seasonality of malaria transmission is reversed due to pooling in the transmission to the dry season, which the model fails to capture.

Diagnostic challenges and case management of the first imported case of Plasmodium knowlesi in Sri Lanka

Background

Sri Lanka has achieved ‘malaria-free’ status and is now in the phase of prevention of re-introduction of malaria. Imported malaria remains a challenge to resurgence of the disease. The diagnostic challenges encountered and the rapid response initiated to manage a Plasmodium infection, which was later confirmed as Plasmodium knowlesi, the first reported case from Sri Lanka, is discussed.

Case presentation

An army officer who returned from Malaysia in October 2016 was found to be positive for Plasmodium both by microscopy and rapid diagnostic test (RDT) by the Anti Malaria Campaign Sri Lanka (AMC) during his third visit to a health care provider. Microscopy findings were suspicious of P. knowlesi infection as the smears showed parasite stages similar to both Plasmodium malariae and Plasmodium falciparum. Nested PCR at AMC confirmed Plasmodium genus, but not the species. In the absence of species confirmation, the patient was treated as a case of P. falciparum. The presence of P. knowlesi was later confirmed by a semi-nested PCR assay performed at the Environmental Health Institute, National Environmental Agency in Singapore. The parasite strain was also characterized by sequencing the circumsporozoite gene. Extensive case investigation including parasitological and entomological surveillance was carried out.

Conclusions

Plasmodium knowlesi should be suspected in patients returning from countries in the South Asian region where the parasite is prevalent and when blood smear results are inconclusive.

Species composition and population dynamics of malaria vectors in three previously ignored aquatic systems in Sri Lanka

BACKGROUND

In 2015 alone there were an estimated 214 million new cases of malaria across the globe and 438,000 deaths were reported. Although indigenous malaria has not been reported in Sri Lanka since 2012, to date 247 imported cases of malaria have been identified. Knowledge of the locations, behaviour and vectorial capacity of potential malarial vectors is therefore needed to prevent future outbreaks. Attention is now being focused on some previously ignored habitats.

METHODS

Active and abandoned granite and clay quarry pits, located in wet and intermediate zones, and agro wells located in the dry zone of Sri Lanka were mapped and sampled for 1 year, as potential mosquito breeding sites. Species composition and spatio-temporal variation in both malarial and other mosquito larvae were recorded.

RESULTS

A total of 18 species of mosquito larvae were identified. Other than Anopheles culicifacies, the primary malaria vector, five species of potential malaria vectors (Anopheles vagus, Anopheles varuna, Anopheles nigerrimus, Anopheles peditaeniatus and Anopheles barbirostris) were found in all three aquatic systems. Additionally, Anopheles annularis was found in granite quarries and Anopheles subpictus and Anopheles pallidus in both types of quarry, but only during the initial sampling. Apart from potential malaria vectors, mosquito larvae such as Anopheles jamesii, Culex tritaeniorhynchus, Culex infula and Culex malayi were found in all three habitats at least once during the sampling period. Apart from potential malaria vectors and other mosquito larvae common to all three aquatic systems, Culex gelidus, Culex mimulus and Culex pseudo vishnui were detected in agro wells. Culex gelidus was also detected in granite quarry pits. Culex mimulus, Culex lutzia and Culex fuscocephala were detected in clay quarry pits. Accordingly, a total of 14, 13 and 15 mosquito species were identified in agro wells, granite and clay quarry pits, respectively.

CONCLUSIONS

Although zero occurrence of indigenous malaria has been achieved in Sri Lanka, the current study emphasizes the potential for future epidemics. The presence of native flora and fauna in abandoned granite and clay quarry pits and the need to extract drinking water from agro wells demand bio-sensitive control methods in these three aquatic systems.

Species Composition and Diversity of Malaria Vector Breeding Habitats in Trincomalee District of Sri Lanka

Introduction. Mosquito larval ecology is important in determining larval densities and species assemblage. This in turn influences malaria transmission in an area. Therefore, understanding larval habitat ecology is important in designing malaria control programs. Method. Larval surveys were conducted in 20 localities under five sentinel sites (Padavisiripura, Gomarankadawala, Thoppur, Mollipothana, and Ichchallampaththu) in Trincomalee District, Eastern Province of Sri Lanka, between June 2010 and July 2013. The relationship between seven abiotic variables (temperature, pH, conductivity, Total Dissolved Solid (TDS), turbidity, Dissolved Oxygen (DO), and salinity) was measured. Results. A total of 21,347 anophelines were recorded representing 15 species. Anopheles subpictus 24.72% (5,278/21,347) was the predominant species, followed by 24.67% (5,267/21,347) of An. nigerrimus and 14.56% (3,109/21,347) of An. peditaeniatus. A total of 9,430 breeding habitats under twenty-one categories were identified. An. culcicifacies was noted to be highest from built wells (20.5%) with high salinity (1102.3 ± 81.8 mg/L), followed by waste water collections (20.2%) having low DO levels (2.85 ± 0.03 mg/L) and high TDS (1,654 ± 140 mg/L). Conclusion. This study opens an avenue to explore new breeding habitats of malaria vectors in the country and reemphasizes the requirement of conducting entomological surveillance to detect potential transmission of malaria in Sri Lanka under the current malaria elimination programme.

On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs

Malaria is one of the most important tropical diseases that has caused devastation throughout the history of mankind. Malaria eradication programmes in the past have had many positive effects but failed to wipe out malaria from most tropical countries, including Sri Lanka. Encouraged by the impressive levels of reduction in malaria case numbers during the past decade, Sri Lanka has launched a programme to eliminate malaria by year 2014. This article reviews the historical milestones associated with the malaria eradication programme that failed subsequently and the events that led to the launch of the ongoing malaria elimination plans at national-level and its strategies that are operational across the entire country. The existing gaps in knowledge are also discussed together with the priority areas for research to fill in these gaps that are posing as challenges to the envisaged goal of wiping out malaria from this island nation.

Recent advances and perspectives on tropical diseases: Malaria

Malaria remains a major health problem in the world. It is a neglected disease because it occurs almost exclusively in poor developing countries, which offer negligible marketable and profitable opportunities. Malaria (together with Tuberculosis), is responsible for an unprecedented global health crisis with devastating effects in developing countries. The 2011 Word Malaria Report indicated that 106 countries showed endemic malaria. Malaria control depends mainly on drug treatment, which is increasingly difficult due to the spread of drug resistant parasites and requires expensive drug combinations. Part of the inability to combat this disease is attributed to an incomplete understanding of its pathogenesis and pathophysiology. Improving the knowledge of the underlying pathogenic mechanisms of malaria transmission and of the exclusive metabolic pathways of the parasites (protozoa of the genus Plasmodium), should promote efficient treatment of disease and help the identification of novel targets for potential therapeutic interventions. Moreover, the elucidation of determinants involved in the spread of malaria will provide important information for efficient planning of strategies for targeted control.

The dominant Anopheles vectors of human malaria in the Asia-Pacific region: occurrence data, distribution maps and bionomic précis

BACKGROUND

The final article in a series of three publications examining the global distribution of 41 dominant vector species (DVS) of malaria is presented here. The first publication examined the DVS from the Americas, with the second covering those species present in Africa, Europe and the Middle East. Here we discuss the 19 DVS of the Asian-Pacific region. This region experiences a high diversity of vector species, many occurring sympatrically, which, combined with the occurrence of a high number of species complexes and suspected species complexes, and behavioural plasticity of many of these major vectors, adds a level of entomological complexity not comparable elsewhere globally. To try and untangle the intricacy of the vectors of this region and to increase the effectiveness of vector control interventions, an understanding of the contemporary distribution of each species, combined with a synthesis of the current knowledge of their behaviour and ecology is needed.

RESULTS

Expert opinion (EO) range maps, created with the most up-to-date expert knowledge of each DVS distribution, were combined with a contemporary database of occurrence data and a suite of open access, environmental and climatic variables. Using the Boosted Regression Tree (BRT) modelling method, distribution maps of each DVS were produced. The occurrence data were abstracted from the formal, published literature, plus other relevant sources, resulting in the collation of DVS occurrence at 10116 locations across 31 countries, of which 8853 were successfully geo-referenced and 7430 were resolved to spatial areas that could be included in the BRT model. A detailed summary of the information on the bionomics of each species and species complex is also presented.

CONCLUSIONS

This article concludes a project aimed to establish the contemporary global distribution of the DVS of malaria. The three articles produced are intended as a detailed reference for scientists continuing research into the aspects of taxonomy, biology and ecology relevant to species-specific vector control. This research is particularly relevant to help unravel the complicated taxonomic status, ecology and epidemiology of the vectors of the Asia-Pacific region. All the occurrence data, predictive maps and EO-shape files generated during the production of these publications will be made available in the public domain. We hope that this will encourage data sharing to improve future iterations of the distribution maps.

The role of climate variability in the spread of malaria in Bangladeshi highlands

Background

Malaria is a major public health problem in Bangladesh, frequently occurring as epidemics since the 1990s. Many factors affect increases in malaria cases, including changes in land use, drug resistance, malaria control programs, socioeconomic issues, and climatic factors. No study has examined the relationship between malaria epidemics and climatic factors in Bangladesh. Here, we investigate the relationship between climatic parameters [rainfall, temperature, humidity, sea surface temperature (SST), El Niño-Southern Oscillation (ENSO), the normalized difference vegetation index (NDVI)], and malaria cases over the last 20 years in the malaria endemic district of Chittagong Hill Tracts (CHT).

Methods and Principal Findings

Monthly malaria case data from January 1989 to December 2008, monthly rainfall, temperature, humidity sea surface temperature in the Bay of Bengal and ENSO index at the Niño Region 3 (NIÑO3) were used. A generalized linear negative binomial regression model was developed using the number of monthly malaria cases and each of the climatic parameters. After adjusting for potential mutual confounding between climatic factors there was no evidence for any association between the number of malaria cases and temperature, rainfall and humidity. Only a low NDVI was associated with an increase in the number of malaria cases. There was no evidence of an association between malaria cases and SST in the Bay of Bengal and NIÑO3.

Conclusion and Significance

It seems counterintuitive that a low NDVI, an indicator of low vegetation greenness, is associated with increases in malaria cases, since the primary vectors in Bangladesh, such as An. dirus, are associated with forests. This relationship can be explained by the drying up of rivers and streams creating suitable breeding sites for the vector fauna. Bangladesh has very high vector species diversity and vectors suited to these habitats may be responsible for the observed results.

Costs and effectiveness of application of Poecilia reticulata (guppy) and temephos in anopheline mosquito control in river basins below the major dams of Sri Lanka

In this study we examined the costs and effectiveness of using larvivorous fish, Poecilia reticulata, and a chemical larvicide, temephos, in anopheline mosquito control in the riverbeds below the major dams in Sri Lanka. Five riverbeds below the dams, namely Laxapana, Kotmale 1, Kotmale 2, Nilambe, Rantembe and Victoria, were selected. Riverbed pools in Laxapana and Kotmale 1 were treated with P. reticulata; Rantembe and Victoria were treated with temephos; and Kotmale 2 and Nilambe were kept as controls. In each area, the anopheline larval density, before and after application of fish/temephos, was estimated. The cost of application of fish/temephos was estimated by activities involved for each treatment. After intervention, there was a significant reduction in anopheline larval density in the fish-treated areas compared with the temephos-treated and control areas. Application of P. reticulata was 2.67 times less costly than that of temephos. The cost of fish application can be further reduced if the community is involved in the application.

Larvivorous Potential of the Guppy, Poecilia reticulata, in Anopheline Mosquito Control in Riverbed Pools Below the Kotmale Dam, Sri Lanka

The larvivorous potential of Poecilia reticulata was studied in the laboratory and in the field. In the laboratory, the number of anopheline larvae consumed per fish per day and the number of larvae in fecal matter per fish were determined. In the field study, 29 of 60 selected riverbed pools in Kotmale oya, below the Kotmale dam, were stocked with P reticulata, whereas the rest served as controls. Anopheline larval surveys were carried out starting from 1 day prior to stocking of fish and on selected days subsequently. P. reticulata consumed an average of 117 ± 32.33 larvae per fish per day. Fecal matter of P. reticulata contained an average of 2.7 ± 2.68 larvae per fish . There was a significant reduction in the number of pools positive for anopheline larvae ( P < .001) after stocking fish and the number of larvae per pool ( P < .001) and per 100 dips ( P < .001) as compared with controls.