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BMC Medicine
Published in: BMC Medicine 1/2022

Open Access 01-12-2022 | Falciparum Malaria | Research article

The potential impact of Anopheles stephensi establishment on the transmission of Plasmodium falciparum in Ethiopia and prospective control measures

Authors: Arran Hamlet, Dereje Dengela, J. Eric Tongren, Fitsum G. Tadesse, Teun Bousema, Marianne Sinka, Aklilu Seyoum, Seth R. Irish, Jennifer S. Armistead, Thomas Churcher

Published in: BMC Medicine | Issue 1/2022

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Abstract

Background

Sub-Saharan Africa has seen substantial reductions in cases and deaths due to malaria over the past two decades. While this reduction is primarily due to an increasing expansion of interventions, urbanisation has played its part as urban areas typically experience substantially less malaria transmission than rural areas. However, this may be partially lost with the invasion and establishment of Anopheles stephensi. A. stephensi, the primary urban malaria vector in Asia, was first detected in Africa in 2012 in Djibouti and was subsequently identified in Ethiopia in 2016, and later in Sudan and Somalia. In Djibouti, malaria cases have increased 30-fold from 2012 to 2019 though the impact in the wider region remains unclear.

Methods

Here, we have adapted an existing model of mechanistic malaria transmission to estimate the increase in vector density required to explain the trends in malaria cases seen in Djibouti. To account for the observed plasticity in An. stephensi behaviour, and the unknowns of how it will establish in a novel environment, we sample behavioural parameters in order to account for a wide range of uncertainty. This quantification is then applied to Ethiopia, considering temperature-dependent extrinsic incubation periods, pre-existing vector-control interventions and Plasmodium falciparum prevalence in order to assess the potential impact of An. stephensi establishment on P. falciparum transmission. Following this, we estimate the potential impact of scaling up ITN (insecticide-treated nets)/IRS (indoor residual spraying) and implementing piperonyl butoxide (PBO) ITNs and larval source management, as well as their economic costs.

Results

We estimate that annual P. falciparum malaria cases could increase by 50% (95% CI 14–90) if no additional interventions are implemented. The implementation of sufficient control measures to reduce malaria transmission to pre-stephensi levels will cost hundreds of millions of USD.

Conclusions

Substantial heterogeneity across the country is predicted and large increases in vector control interventions could be needed to prevent a major public health emergency.
Appendix
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Metadata
Title
The potential impact of Anopheles stephensi establishment on the transmission of Plasmodium falciparum in Ethiopia and prospective control measures
Authors
Arran Hamlet
Dereje Dengela
J. Eric Tongren
Fitsum G. Tadesse
Teun Bousema
Marianne Sinka
Aklilu Seyoum
Seth R. Irish
Jennifer S. Armistead
Thomas Churcher
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2022
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-022-02324-1

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