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      Operational strategies to achieve and maintain malaria elimination


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          Present elimination strategies are based on recommendations derived during the Global Malaria Eradication Program of the 1960s. However, many countries considering elimination nowadays have high intrinsic transmission potential and, without the support of a regional campaign, have to deal with the constant threat of imported cases of the disease, emphasising the need to revisit the strategies on which contemporary elimination programmes are based. To eliminate malaria, programmes need to concentrate on identification and elimination of foci of infections through both passive and active methods of case detection. This approach needs appropriate treatment of both clinical cases and asymptomatic infections, combined with targeted vector control. Draining of infectious pools entirely will not be sufficient since they could be replenished by imported malaria. Elimination will thus additionally need identification and treatment of incoming infections before they lead to transmission, or, more realistically, embarking on regional initiatives to dry up importation at its source.

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          Most cited references104

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          Guidelines for the treatment of malaria

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            The entomological inoculation rate and Plasmodium falciparum infection in African children.

            Malaria is an important cause of global morbidity and mortality. The fact that some people are bitten more often than others has a large effect on the relationship between risk factors and prevalence of vector-borne diseases. Here we develop a mathematical framework that allows us to estimate the heterogeneity of infection rates from the relationship between rates of infectious bites and community prevalence. We apply this framework to a large, published data set that combines malaria measurements from more than 90 communities. We find strong evidence that heterogeneous biting or heterogeneous susceptibility to infection are important and pervasive factors determining the prevalence of infection: 20% of people receive 80% of all infections. We also find that individual infections last about six months on average, per infectious bite, and children who clear infections are not immune to new infections. The results have important implications for public health interventions: the success of malaria control will depend heavily on whether efforts are targeted at those who are most at risk of infection.
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              Serology: a robust indicator of malaria transmission intensity?

              To estimate the burden of malarial disease, and evaluate the likely effects of control strategies, requires reliable predictions of malaria transmission intensity. It has long been suggested that antimalarial antibody prevalences could provide a more accurate estimate of transmission intensity than traditional measures such as parasite prevalence or entomological inoculation rates, but there has been no systematic evaluation of this approach. Now, the availability of well characterized malarial antigens allows us to test whether serological measurements provide a practical method for estimating transmission. Here we present a suggested methodology, highlight the advantages and shortcomings of serological measurements of malaria transmission and identify areas in which further work is desirable.

                Author and article information

                Lancet Publishing Group
                6 November 2010
                6 November 2010
                : 376
                : 9752
                : 1592-1603
                [a ]Clinton Health Access Initiative, Nairobi, Kenya
                [b ]Global Health Group, University of California, San Francisco, San Francisco, CA, USA
                [c ]Clinton Health Access Initiative, Boston, MA, USA
                [d ]Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute, Nairobi, Kenya
                [e ]Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
                [f ]Centers for Disease Control and Prevention, Atlanta, GA, USA
                [g ]Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
                [h ]Emerging Pathogens Institute and Department of Biology, University of Florida, Gainesville, FL, USA
                [i ]Anti-Malaria Campaign, Ministry of Health, Colombo, Sri Lanka
                [j ]National Institute of Public Health, Cuernavaca, Morelos, Mexico
                [k ]Medical Research Council, Durban, KwaZulu-Natal, South Africa
                [l ]Swiss Tropical and Public Health Institute, Basel, Switzerland
                [m ]University of Basel, Basel, Switzerland
                Author notes
                [* ]Correspondence to: Dr Bruno Moonen, Clinton Health Access Initiative, Timau Plaza, 3rd Floor, Argwings Kodhek Road, PO Box 2011-00100, Nairobi, Kenya bmoonen@ 123456clintonhealthaccess.org
                © 2010 Elsevier Ltd. All rights reserved.

                This document may be redistributed and reused, subject to certain conditions.




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