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Background Over a decade of vector control by indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) distribution on mainland and only LLINs on islands, has had minimal impact on disease burden in Nchelenge district, northern Zambia. Anopheles funestus and An. gambiae are vectors known only from the mainland. Understanding vector bionomics in the district is necessary for planning and targeting effective vector control. This study aimed to provide information on malaria vectors’ abundance, seasonality and Plasmodium falciparum sporozoite infectivity in Nchelenge including islands.Methods Mosquitoes were collected in 192 CDC indoor light traps set in 56 households between January 2015 and January 2016. Morphological and molecular species identifications, and P. falciparum circumsporoites by ELISA were performed. Mosquito counts and relative abundances from the islands and mainland were compared and household factors associated with vector counts determined.Results A total of 5888 anophelines were collected during the study. Of these 5,704 were female An. funestus s.l. and 248 female An. gambiae s.l. The highest proportion of An. funestus (n = 4030) was from Chisenga Island and that of An. gambiae (n = 174) was from Kilwa Island. The dorminance of An. funestus s.l. over An. gambiae s.l. was significant on Chisenga island (z = 6.66, p p p = 0.052). Highest counts of An. funestus were associated with dry season (p An. gambiae was associated with rainy season (p = 0.404). At household level vector counts were associated with high household occupancy and high bed net use. The highest estimated annual entomological inoculation rate was from Chisenga island with 136.51ib/p/y followed by Kilwa island with 55.05 ib/p/yr then Mainland with 30.31ib/p/yr.Conclusions There was varied species abundance and malaria transmission risk across sites and seasons. Risk for malaria transmission was perennial and higher on the islands. The minimal impact of vector control efforts on mainland was evident but limited overall. Vector control intervention coverage with effective tools need to be extended to the islands to effectively control malaria transmission in Nchelenge district.

The global malaria burden has decreased substantially, but gains have been uneven both within and between countries. In Zambia, the malaria burden remains high in northern and eastern regions of the country. To effectively reduce malaria transmission in these areas, evidence-based intervention strategies are needed. Zambia’s National Malaria Control Centre conducted targeted indoor residual spraying (IRS) in 40 high-burden districts from 2014 to 2016 using the novel organophosphate insecticide pirimiphos-methyl. The Southern and Central Africa International Centers of Excellence for Malaria Research conducted an evaluation of the impact of the IRS campaign on household vector abundance in Nchelenge District, Luapula Province. From April 2012 to July 2017, field teams conducted indoor overnight vector collections from 25 to 30 households per month using Centers for Disease Control light traps. Changes in indoor anopheline counts before versus after IRS were assessed by species using negative binomial regression models with robust standard errors, controlling for geographic and climatological covariates. Counts of Anopheles funestus declined by approximately 50% in the study area and within areas targeted for IRS, and counts of Anopheles gambiae declined by approximately 40%. Within targeted areas, An. funestus counts declined more in sprayed households than in unsprayed households; however, this relationship was not observed for An. gambiae. The moderate decrease in indoor vector abundance indicates that IRS with pirimiphos-methyl is an effective vector control measure, but a more comprehensive package of interventions is needed with sufficient coverage to effectively reduce the malaria burden in this setting.

BackgroundNchelenge District in northern Zambia suffers from holoendemic malaria transmission despite a decade of yearly indoor residual spraying (IRS) and insecticide treated net (ITN) distributions. One hypothesis for this lack of impact is that some vectors in the area may forage in the early evening or outdoors. Anopheles gibbinsi specimens were identified in early evening mosquito collections performed in this study area, and we gleaned further insight into this taxon, including characterizing its genetic identity, feeding preferences, and potential role as a malaria vector.MethodsMosquitoes were collected in July and August 2019 by CDC light traps in Nchelenge District in indoor sitting rooms, outdoor gathering spaces, and animal pens from 16:00-22:00. Host detection by PCR, COI and ITS2 PCR, and circumsporozoite (CSP) ELISA were performed on all samples morphologically identified as An. gibbinsi, and a subset of specimens were selected for COI and ITS2 sequencing. To determine risk factors for increased abundance of An. gibbinsi, a negative binomial generalized linear mixed-effects model was performed with household-level variables of interest.ResultsComparison of COI and ITS2 An. gibbinsi reference sequences to the NCBI database revealed >99% identity to “An. sp. 6” from Kenya. More than 97% of specimens were morphologically and molecularly consistent with An. gibbinsi. Specimens were primarily collected in animal pen traps (59.2%), followed by traps outdoors near where humans gather (24.3%), and traps set indoors (16.5%). Host DNA detection revealed a high propensity for goats, but 5% of specimens with detected host DNA had fed on humans. No specimens were positive for Plasmodium falciparum sporozoites. Animal pens and inland households >3 km from Lake Mweru were both associated with increased An. gibbinsi abundance. ConclusionsThis is the first report of An. gibbinsi in Nchelenge District, Zambia. This study provided a species identity for unknown “An. sp. 6” in the NCBI database, which has been implicated in malaria transmission in Kenya. Composite data suggest that this species is largely zoophilic and exophilic, but comes into contact with humans and the malaria parasites they carry. This species should continue to be monitored in Zambia and neighboring countries as a potential malaria vector.

For a decade, the Southern and Central Africa International Center of Excellence for Malaria Research has operated with local partners across study sites in Zambia and Zimbabwe that range from hypo- to holoendemic and vary ecologically and entomologically. The burden of malaria and the impact of control measures were assessed in longitudinal cohorts, cross-sectional surveys, passive and reactive case detection, and other observational designs that incorporated multidisciplinary scientific approaches: classical epidemiology, geospatial science, serosurveillance, parasite and mosquito genetics, and vector bionomics. Findings to date have helped elaborate the patterns and possible causes of sustained low-to-moderate transmission in southern Zambia and eastern Zimbabwe and recalcitrant high transmission and fatality in northern Zambia. Cryptic and novel mosquito vectors, asymptomatic parasite reservoirs in older children, residual parasitemia and gametocytemia after treatment, indoor residual spraying timed dyssynchronously to vector abundance, and stockouts of essential malaria commodities, all in the context of intractable rural poverty, appear to explain the persistent malaria burden despite current interventions. Ongoing studies of high-resolution transmission chains, parasite population structures, long-term malaria periodicity, and molecular entomology are further helping to lay new avenues for malaria control in southern and central Africa and similar settings.

Residual vector populations that do not come in contact with the most frequently utilized indoor-directed interventions present major challenges to global malaria eradication. Many of these residual populations are mosquito species about which little is known. As part of a study to assess the threat of outdoor exposure to malaria mosquitoes within the Southern and Central Africa International Centers of Excellence for Malaria Research, foraging female anophelines were collected outside households in Nchelenge District, northern Zambia. These anophelines proved to be more diverse than had previously been reported in the area. In order to further characterize the anopheline species, sequencing and phylogenetic approaches were utilized. Anopheline mosquitoes were collected from outdoor light traps, morphologically identified, and sent to Johns Hopkins Bloomberg School of Public Health for sequencing. Sanger sequencing from 115 field-derived samples yielded mitochondrial COI sequences, which were aligned with a homologous 488 bp gene segment from known anophelines (n = 140) retrieved from NCBI. Nuclear ITS2 sequences (n = 57) for at least one individual from each unique COI clade were generated and compared against NCBI’s nucleotide BLAST database to provide additional evidence for taxonomical identity and structure. Molecular and morphological data were combined for assignment of species or higher taxonomy. Twelve phylogenetic groups were characterized from the COI and ITS2 sequence data, including the primary vector species Anopheles funestus s.s. and An. gambiae s.s. An unexpectedly large proportion of the field collections were identified as An. coustani and An. sp. 6. Six phylogenetic groups remain unidentified to species-level. Outdoor collections of anopheline mosquitoes in areas frequented by people in Nchelenge, northern Zambia, proved to be extremely diverse. Morphological misidentification and underrepresentation of some anopheline species in sequence databases confound efforts to confirm identity of potential malaria vector species. The large number of unidentified anophelines could compromise the malaria vector surveillance and malaria control efforts not only in northern Zambia but other places where surveillance and control are focused on indoor-foraging and resting anophelines. Therefore, it is critical to continue development of methodologies that allow better identification of these populations and revisiting and cleaning current genomic databases.

The mosquito Anopheles gambiae s.s. is distributed across most of sub-Saharan Africa and is of major scientific and public health interest for being an African malaria vector. Here we present population genomic analyses of 111 specimens sampled from west to east Africa, including the first whole genome sequences from oceanic islands, the Comoros. Genetic distances between populations of A. gambiae are discordant with geographic distances but are consistent with a stepwise migration scenario in which the species increases its range from west to east Africa through consecutive founder events over the last ~200,000 years. Geological barriers like the Congo River basin and the East African rift seem to play an important role in shaping this process. Moreover, we find a high degree of genetic isolation of populations on the Comoros, confirming the potential of these islands as candidate sites for potential field trials of genetically engineered mosquitoes for malaria control.

Despite ongoing malaria control efforts implemented throughout sub-Saharan Africa, malaria remains an enormous public health concern. Current interventions such as indoor residual spraying with insecticides and use of insecticide-treated bed nets are aimed at targeting the key malaria vectors that are primarily endophagic and endophilic. Anopheles coustani s.l., an understudied vector of malaria, is a species previously thought to exhibit mostly zoophilic behavior. Like many of these understudied species, An. coustani has greater anthropophilic tendencies than previously appreciated, is often both endophagic and exophagic, and carries Plasmodium falciparum sporozoites. The aim of this study was to explore genetic variation of An. coustani mosquitoes and the potential of this species to contribute to malaria parasite transmission in high transmission settings in Zambia and the Democratic Republic of the Congo (DRC). Morphologically identified An. coustani specimens that were trapped outdoors in these study sites were analyzed by PCR and sequencing for species identification and bloodmeal sources, and malaria parasite infection was determined by ELISA and qPCR. Fifty An. coustani s.s. specimens were confirmed by analysis of mitochondrial DNA cytochrome c oxidase subunit I (COI) and ribosomal internal transcribed spacer region 2 (ITS2). Maximum likelihood phylogenetic analysis of COI and ITS2 sequences revealed two distinct phylogenetic groups within this relatively small regional collection. Our findings indicate that both An. coustani groups have anthropophilic and exophagic habits and come into frequent contact with P. falciparum, suggesting that this potential alternative malaria vector might elude current vector control measures in northern Zambia and southern DRC.

Despite ongoing malaria control efforts implemented throughout sub-Saharan Africa, malaria remains an enormous public health concern. Current interventions such as indoor residual spraying with insecticides and use of insecticide-treated bed nets are aimed at targeting the key malaria vectors that are primarily endophagic and endophilic. While these control measures have resulted in a substantial decline in malaria cases and continue to impact indoor transmission, the importance of alternative vectors for malaria transmission has been largely neglected. Anopheles coustani, an understudied vector of malaria, is a species previously thought to exhibit mostly zoophilic behavior. However, recent studies from across Africa bring to light the contribution of this and ecologically similar anopheline species to human malaria transmission. Like many of these understudied species, An. coustani has greater anthropophilic tendencies than previously appreciated, is often both endophagic and exophagic, and carries Plasmodium falciparum sporozoites. These recent developments highlight the need for more studies throughout the geographic range of this species and the potential need to control this vector. The aim of this study was to explore the genetic variation of An. coustani mosquitoes and the potential of this Anopheles species to contribute to malaria parasite transmission in high transmission settings in Nchelenge District, Zambia, and the Kashobwe and Kilwa Health Zones in Haut-Katanga Province, the Democratic Republic of the Congo (DRC). Morphologically identified An. coustani specimens that were trapped outdoors in these study sites were analyzed by PCR and sequencing for species identification and blood meal sources, and malaria parasite infection was determined by ELISA and qPCR. Fifty specimens were confirmed to be An. coustani by the analysis of mitochondrial DNA cytochrome c oxidase subunit I (COI) and ribosomal internal transcribed spacer region 2 (ITS2). Further, maximum likelihood phylogenetic analysis of COI and ITS2 sequences revealed two distinct phylogenetic groups within this relatively small regional collection. Our findings indicate that both An. coustani groups have anthropophilic and exophagic habits and come into frequent contact with P. falciparum, suggesting that this potential alternative malaria vector might elude current vector controls in Northern Zambia and Southern DRC. This study sets the groundwork for more thorough investigations of bionomic characteristics and genetic diversity of An. coustani and its contribution to malaria transmission in these regions.

Severe malaria, caused by the protozoan Plasmodium, is the leading parasitic cause of mortality worldwide. Plasmodium falciparum, the most lethal among human malaria parasites, predominates in sub-Saharan Africa where it causes a disconcerting 1,200 child deaths per day concentrated in regions where malaria has proven recalcitrant to control measures or where control measures are tenuous or absent.1,2 In Zambia, there were an estimated 3.1 million cases of malaria (severe and uncomplicated) in 2016 among its population of 16.7 million and it was most prevalent in northern Zambia where it persists year round despite the recent scale-up of vector control efforts.2,3 Severe malaria can feature one or more of severe anemia (hemoglobin < 5 g/dL), cerebral edema, lactic acidosis, respiratory failure, or shock. In high-transmission, resource-limited settings, malaria evades easy case definition and is often clinically indistinguishable from bacterial meningitis, pneumonia, bacteremia, and other febrile diseases which can conflate or confuse diagnosis.4 Only a small proportion (∼2%) of P. falciparum infections progress to severe malaria, but in highly malarious regions where children may experience several infections a year, the absolute number of cases is large.5 Prompt initiation of treatment is vital. Rapid disease progression is fueled by an exponential expansion of parasites and an exuberant host immune response, and hospital deaths occur most often within 24 hours of admission.5,6 The preferred treatment is intravenous artesunate and supportive care as indicated (e.g., fluid resuscitation, blood transfusion, anticonvulsants, and ventilator and vasopressor support), but even with appropriate care, mortality can reach 20%.5 Delayed presentation to allopathic health providers on account of logistical constraints or health-seeking behaviors compounds the danger.7 Distinguishing factors that contribute to poor outcomes for children with malaria can inform clinical and programmatic strategies to lessen its toll. However, research is limited by the inherent challenges of conducting intrahospital epidemiologic studies in rural centers where malaria prevalence is greatest. We present results of a retrospective, time-matched, case-control study of hospitalized children with malaria who died (cases) and those who survived (controls) at a rural, district-level hospital in a high-transmission region of northern Zambia to identify and evaluate demographic and clinical factors associated with increased risk of death.

BackgroundAnopheles funestus(s.s.) is a primary vector of the malaria parasitePlasmodium falciparumin Africa, a human pathogen that causes almost half a million deaths each year. The population structure ofAn. funestuswas examined in samples from Uganda and the southern African countries of Malawi, Mozambique, Zambia and Zimbabwe.MethodsTwelve microsatellites were used to estimate the genetic diversity and differentiation ofAn. funestusfrom 13 representative locations across five countries. These were comprised of four sites from Uganda, three from Malawi and two each from Mozambique, Zambia and Zimbabwe.ResultsAll loci were highly polymorphic across the populations with high allelic richness and heterozygosity. A high genetic diversity was observed with 2–19 alleles per locus and an average number of seven alleles. Overall, expected heterozygosity (He) ranged from 0.65 to 0.79. When samples were pooled three of the 12 microsatellite loci showed Hardy–Weinberg equilibrium. Unsupervised Bayesian clustering analysis of microsatellite data revealed two clusters withAn. funestussamples from Mozambique, Uganda and Zambia falling into one group and Malawi and Zimbabwe into another. The overall genetic differentiation between the populations was moderate (FST = 0.116). Pairwise differentiation between the pairs was low but significant. A weak but significant correlation was established between genetic and geographical distance for most populations.ConclusionsHigh genetic diversity revealed by the loci with low to moderate differentiation, identified two clusters among theAn. funestuspopulations. Further research on the population dynamics ofAn. funestusin east and southern Africa is essential to understand the implications of this structuring and what effect it may have on the efficient implementation of mosquito vector control strategies.

Additional file 1: Table S1. Population comparisons, HW proportions and independence of loci (significant values recorded in bold).

The mosquito Anopheles gambiae s.s. is distributed across most of sub-Saharan Africa and is of major scientific and public health interest for being an African malaria vector. Here we present population genomic analyses of 111 specimens sampled from west to east Africa, including the first whole genome sequences from oceanic islands, the Comoros. Genetic distances between populations of A. gambiae are discordant with geographic distances but are consistent with a stepwise migration scenario in which the species increases its range from west to east Africa through consecutive founder events over the last ~200,000 years. Geological barriers like the Congo River basin and the East African rift seem to play an important role in shaping this process. Moreover, we find a high degree of genetic isolation of populations on the Comoros, confirming the potential of these islands as candidate sites for potential field trials of genetically engineered mosquitoes for malaria control., Schmidt et al. present population genomic analyses of 111 mosquito Anopheles gambiae specimens sampled from west to east Africa. This study suggests a high degree of genetic isolation of populations on the Comoros, highlighting the importance of physical barriers to gene flow in this African malaria vector species.

Malaria transmission is dependent on the density and distribution of mosquito vectors, but drivers of vector abundance have not been adequately studied across a range of transmission settings. To inform intervention strategies for high-burden areas, further investigation is needed to identify predictors of vector abundance. Active household (HH) surveillance was conducted in Nchelenge district, Luapula Province, northern Zambia, a high-transmission setting with limited impact of malaria control. Between April 2012 and July 2017, mosquitoes were collected indoors during HH visits using CDC light traps. Demographic, environmental, and climatological correlates of vector abundance were identified using log-binomial regression models with robust standard errors. The primary malaria vectors in this setting were Anopheles funestus sensu stricto (s.s.) and Anopheles gambiae s.s. Anopheles funestus predominated in both seasons, with a peak in the dry season. Anopheles gambiae peaked at lower numbers in the rainy season. Environmental, climatic, and demographic factors were correlated with HH vector abundance. Higher vector counts were found in rural areas with low population density and among HHs close to roads and small streams. Vector counts were lower with increasing elevation and slope. Anopheles funestus was negatively associated with rainfall at lags of 2-6 weeks, and An. gambiae was positively associated with rainfall at lags of 3-10 weeks. Both vectors had varying relationships with temperature. These results suggest that malaria vector control in Nchelenge district should occur throughout the year, with an increased focus on dry-season transmission and rural areas.

Country-wide planning and coordination can improve sustainability of vectorborne disease control., Arthropod vectors transmit organisms that cause many emerging and reemerging diseases, and their control is reliant mainly on the use of chemical insecticides. Only a few classes of insecticides are available for public health use, and the increased spread of insecticide resistance is a major threat to sustainable disease control. The primary strategy for mitigating the detrimental effects of insecticide resistance is the development of an insecticide resistance management plan. However, few examples exist to show how to implement such plans programmatically. We describe the formulation and implementation of a resistance management plan for mosquito vectors of human disease in Zambia. We also discuss challenges, steps taken to address the challenges, and directions for the future.

Malaria transmission in northern Zambia has increased in the past decade, despite malaria control activities. Evidence-based intervention strategies are needed to effectively reduce malaria transmission. Zambia’s National Malaria Control Centre conducted targeted indoor residual spraying (IRS) in Nchelenge District, Luapula Province, from 2014 to 2016 using the organophosphate insecticide pirimiphos-methyl. An evaluation of the IRS campaign was conducted by the Southern Africa International Centers of Excellence for Malaria Research using actively detected malaria cases in bimonthly household surveys carried out from April 2012 to July 2017. Changes in malaria parasite prevalence after IRS were assessed by season using Poisson regression models with robust standard errors, controlling for clustering of participants in households and demographic, geographical, and climatological covariates. In targeted areas, parasite prevalence declined approximately 25% during the rainy season following IRS with pirimiphos-methyl but did not decline during the dry season or in the overall study area. Within targeted areas, parasite prevalence declined in unsprayed households, suggesting both direct and indirect effects of IRS. The moderate decrease in parasite prevalence within sprayed areas indicates that IRS with pirimiphos-methyl is an effective malaria control measure, but a more comprehensive package of interventions is needed to effectively reduce the malaria burden in this setting.

Background Anopheles funestus has been recognized as a major malaria vector in Africa for over 100 years, but knowledge on many aspects of the biology of this species is still lacking. Anopheles funestus, as with most other anophelines, mate through swarming. A key event that is crucial for the An. funestus male to mate is genitalia rotation. This involves the 135° to 180° rotation of claspers, which are tipped with claws. This physical change then enables the male to grasp the female during copulation. The aim of this investigation was to molecularly characterize wild An. funestus swarms from Zambia and examine the degree of genitalia rotation within the swarm. Methods Anopheles funestus swarms were collected from Nchelenge, northern Zambia, during dusk periods in May 2016. All the adults from the swarm were analysed morphologically and identified to species level using a multiplex PCR assay. Anopheles funestus s.s. specimens were molecularly characterized by restriction fragment length polymorphism type and Clade type assays. The different stages of genitalia rotation were examined in the adult males. Results A total of six swarms were observed during the study period and between 6 and 26 mosquitoes were caught from each swarm. Species analysis revealed that 90% of the males from the swarms were An. funestus s.s. MW-type, with 84% belonging to clade I compared to 14% clade II and 2% failed to amplify. Very few specimens (3.4%) were identified as Anopheles gambiae s.s. Eighty percent of the males from the swarm had complete genitalia rotation. Conclusions This is the first time that An. funestus swarms have been molecularly identified to species level. Anopheles funestus swarms appear to be species-specific with no evidence of clade-type differentiation within these swarms. The An. funestus swarms consist mainly of males with fully rotated genitalia, which strongly suggests that swarming behaviour is triggered primarily when males have matured.

To determine the distribution of yellow fever (YF) vectors species in Northwestern and Western of Zambia, which sampled mosquitoes inside and outside houses in rural, urban, peri-urban and forest areas.Back-pack aspirators spray catches and CDC light traps collected adult mosquitoes including 405 Aedes, 518 Anopheles, 471 Culex and 71 Mansonia. Morphological vector identification and PCR viral determination were done at a WHO Regional Reference Centre (Institute Pasteur Dakar), Senegal.The two main YF vectors were Aedes (Stegomyia) aegypti (Ae. aegypti) and Aedes (Stegomyia) africanus. The first was collected in peri-urban areas and the later was in forest areas, both sparsely distributed in Northwestern Province, where the 0.43 Breteau and 1.92 container indexes, respectively implied low risk to YF. Aedes (Aedimorphus) mutilus; Aedes (Aedimorphus) minutus and Aedes (Finlaya) wellmani were also found in Northwestern, not in Western Province. No Aedes were collected from rural peri-domestic areas. Significantly more Aedes species (90.7%, n=398) than Anopheles (9.1%, n=40) were collected in forest areas (P0.001) or Culex species (0.2%, n=2) (P0.001). Ae. aegypti was found only in a discarded container but not in flower pots, old tyres, plant axils, discarded shallow wells, disused container bottles and canoes inspected.Ae. aegypti and Aedes africanus YF vectors were found in the study sites in the Northwestern Province of Zambia, where densities were low and distribution was sparse. The low Breteau index suggests low risk of YF in the Northwestern Province. The presence of Aedes in Northwestern Province and its absence in the Western Province could be due to differing ecological factors in the sampled areas. Universal coverage of vector control interventions could help to reduce YF vector population and the risk to arthropod-borne virus infections.

Background A commonly used measure of malaria transmission intensity is the entomological inoculation rate (EIR), defined as the product of the human biting rate (HBR) and sporozoite infection rate (SIR). The EIR excludes molecular parameters that may influence vector control and surveillance strategies. The purpose of this study was to investigate Anopheles multiple blood feeding behavior (MBF) and Plasmodium falciparum multiplicity of infection (MOI) within the mosquito host in Nchelenge District, northern Zambia. Mosquitoes were collected from light traps and pyrethroid spray catch in Nchelenge in the 2013 wet season. All anophelines were tested for blood meal host, P. falciparum, and MOI using PCR. Circumsporozoite (CSP) ELISA and microsatellite analysis were performed to detect parasites in the mosquito and MBF, respectively. Statistical analyses used regression models to assess MBF and MOI and exact binomial test for human sex bias. Both MBF and MOI can enhance our understanding of malaria transmission dynamics beyond what is currently understood through conventional EIR estimates alone. Results The dominant malaria vectors collected in Nchelenge were Anopheles funestus (sensu stricto) and An. gambiae (s.s.) The EIRs of An. funestus (s.s.) and An. gambiae (s.s.) were 39.6 infectious bites/person/6 months (ib/p/6mo) and 5.9 ib/p/6mo, respectively, and took multiple human blood meals at high rates, 23.2 and 25.7% respectively. There was no bias in human host sex preference in the blood meals. The SIR was further characterized for parasite genetic diversity. The overall P. falciparum MOI was 6.4 in infected vectors, exceeding previously reported average MOIs in humans in Africa. Conclusions Both Anopheles MBF rates and P. falciparum MOI in Nchelenge were among some of the highest reported in sub-Saharan Africa. The results suggest an underestimation of the EIR and large numbers of circulating parasite clones. Together, the results describe important molecular aspects of transmission excluded from the traditional EIR measurement. These elements may provide more sensitive measures with which to assess changes in transmission intensity and risk in vector and parasite surveillance programs.

Nchelenge District in Luapula Province, northern Zambia, experiences holoendemic malaria despite implementation of vector control programs. The major Anopheles vectors that contribute to Plasmodium falciparum transmission in this area had not previously been well defined. Three collections performed during the 2012 wet and dry seasons and the 2013 wet season revealed Anopheles funestus sensu stricto and Anopheles gambiae sensu stricto as the main vectors, where 80–85% of each collection was composed of An. funestus. Both vectors were found to be highly anthropophilic, and An. funestus has higher sporozoite infection rates (SIRs) and entomological inoculation rates (EIRs) year-round compared with An. gambiae: SIRs of 1.8–3.0% and 0–2.5%, respectively, and EIRs of 3.7–41.5 infectious bites per 6-month period (ib/p/6mo) and 0–5.9 ib/p/6mo, respectively. Spatial and temporal changes in each vector's dynamics and bionomics were also observed. Anopheles funestus was the predominant vector in the villages near Kenani Stream in both wet and dry seasons, whereas An. gambiae was found to be the main vector in areas near Lake Mweru during the wet season. The vector data illustrate the need for broader temporal and spatial sampling in Nchelenge and present unique opportunities to further our understanding of malarial transmission and implications for malarial control in high-risk areas.

Background Long-lasting insecticidal nets (LLINs) are a mainstay of malaria prevention in Africa. More LLINs are available now than in any time previously due to increases in funding for malaria control. LLINs are expected to last three to five years before they need to be replaced. Reports of nets lasting less than three years are frequent in Zambia, which, if true, will increase the number of LLINs needed to maintain universal coverage. Methods This study collected nets distributed during mass distribution campaigns. One net was collected from each participating home in 12 districts in 2010 and all nets were examined for holes. One household member was surveyed about net use and care. Results The study collected 713 polyester nets with a median age of 31 months (range 27–44 months, interquartile (IQR) range: 29–36 months), median number of holes was 17 (IQR: 5–33), and median total hole size was 88.3 sq cm (IQR: 14.5-360.4). The median total number of holes did differ by age of the net, from 27–44 months, but not in a linear fashion. The difference in the number of holes in the newest and oldest nets was not statistically significant. The mean deltamethrin level for all nets was 23 mg/sq m (≥8 mg/sq m is considered effective). There was a larger total hole area in the lower half of the nets (repeat measures ANOVA, F = 228.43, df = 2, p

Background Defining the anopheline mosquito vectors and their foraging behaviour in malaria endemic areas is crucial for disease control and surveillance. The standard protocol for molecular identification of host blood meals in mosquitoes is to morphologically identify fed mosquitoes and then perform polymerase chain reaction (PCR), precipitin tests, or ELISA assays. The purpose of this study was to determine the extent to which the feeding rate and human blood indices (HBIs) of malaria vectors were underestimated when molecular confirmation by PCR was performed on both visually fed and unfed mosquitoes. Methods In association with the Southern Africa International Centers of Excellence in Malaria Research (ICEMR), mosquito collections were performed at three sites: Choma district in southern Zambia, Nchelenge district in northern Zambia, and Mutasa district in eastern Zimbabwe. All anophelines were classified visually as fed or unfed, and tested for blood meal species using PCR methods. The HBIs of visually fed mosquitoes were compared to the HBIs of overall PCR confirmed fed mosquitoes by Pearson’s Chi-Square Test of Independence. Results The mosquito collections consisted of Anopheles arabiensis from Choma, Anopheles funestus s.s., Anopheles gambiae s.s. and Anopheles leesoni from Nchelenge, and An. funestus s.s. and An. leesoni from Mutasa. The malaria vectors at all three sites had large human blood indices (HBI) suggesting high anthropophily. When only visually fed mosquitoes tested by PCR for blood meal species were compared to testing those classified as both visually fed and unfed mosquitoes, it was found that the proportion blooded was underestimated by up to 18.7%. For most Anopheles species at each site, there was a statistically significant relationship (P

In the past decade there has been a significant reduction in malaria incidence globally. In some places continuous surveillance has indicated that the reduction in malaria cases has been sustained to the point of near elimination. The drastic reduction in malaria cases may be attributed to the unprecedented financial support to national malaria control programmes by several donors. The use of interventions such as insecticide treated nets, indoor residual insecticide spraying and to some extent environmental manipulation aimed at eliminating mosquito breeding sites have been responsible for the gains achieved. Application of a combination of these measures has brought about heterogeneity of malaria transmission within some countries. Some areas have recorded drastic reduction in the malaria burden, whereas in other parts of the same country transmission has remained relatively unchanged. This situation implicitly indicates that different approaches to malaria prevention and control or elimination are required in different parts of the same country. Changing malaria epidemiological patterns should also dictate the methods of malaria surveillance that are not only robust but also cost effective. Techniques for malaria diagnosis to support surveillance have to be sensitive and specific enough to pick up the lingering infections especially in low malaria transmission areas. In many malaria endemic countries application of such methods also require deployment of resources differentially in various parts of the same country, and that is a challenge. Chemoprophylaxis has been used in various ways to prevent malaria or avoid its complications in vulnerable populations. When transmission becomes low, new criteria are needed to identify populations that become more vulnerable to the adverse effects of malaria and qualify for chemoprophylaxis. The dynamic malaria epidemiological patterns emerging within countries are presenting unprecedented challenges that will need novel and cost effective ways of managing resources to sustain the reduction or elimination of malaria.

Background Two mitochondrial DNA clades have been described in Anopheles funestus populations from southern Africa. Clade I is common across the continent while clade II is known only from Mozambique and Madagascar. The specific biological status of these clades is at present unknown. We investigated the possible role that each clade might play in the transmission of Plasmodium falciparum and the insecticide resistance status of An. funestus from Zimbabwe and Zambia. Methods Mosquitoes were collected inside houses from Nchelenge District, Zambia and Honde Valley, Zimbabwe in 2013 and 2014. WHO susceptibility tests, synergist assays and resistance intensity tests were conducted on wild females and progeny of wild females. ELISA was used to detect Plasmodium falciparum circumsporozoite protein. Specimens were identified to species and mtDNA clades using standard molecular methods. Results The Zimbabwean samples were all clade I while the Zambian population comprised 80% clade I and 20% clade II in both years of collection. ELISA tests gave an overall infection rate of 2.3% and 2.1% in 2013, and 3.5% and 9.2% in 2014 for Zimbabwe and Zambia respectively. No significant difference was observed between the clades. All populations were resistant to pyrethroids and carbamates but susceptible to organochlorines and organophosphates. Synergist assays indicated that pyrethroid resistance is mediated by cytochrome P450 mono-oxygenases. Resistance intensity tests showed high survival rates after 8-hrs continuous exposure to pyrethroids but exposure to bendiocarb gave the same results as the susceptible control. Conclusions This is the first record of An. funestus mtDNA clade II occurring in Zambia. No evidence was found to suggest that the clades are markers of biologically separate populations. The ability of An. funestus to withstand prolonged exposure to pyrethroids has serious implications for the use of these insecticides, either through LLINs or IRS, in southern Africa in general and resistance management strategies should be urgently implemented.

Background: Malaria control interventions have been scaled-up in Zambia in conjunction with a malaria surveillance system. Although substantial progress has been achieved in reducing morbidity and mortality, national and local information demonstrated marked heterogeneity in the impact of malaria control across the country. This study reports the high burden of malaria in Nchelenge District, Luapula Province, Zambia from 2006 to 2012 after seven years of control measures. Methods: Yearly aggregated information on cases of malaria, malaria deaths, use of malaria diagnostics, and malaria control interventions from 2006 to 2012 were obtained from the Nchelenge District Health Office. Trends in the number of malaria cases, methods of diagnosis, malaria positivity rate among pregnant women, and intervention coverage were analysed using descriptive statistics. Results: Malaria prevalence remained high, increasing from 38% in 2006 to 53% in 2012. Increasing numbers of cases of severe malaria were reported until 2010. Intense seasonal malaria transmission was observed with seasonal declines in the number of cases between April and August, although malaria transmission continued throughout the year. Clinical diagnosis without accompanying confirmation declined from 95% in 2006 to 35% in 2012. Intervention coverage with long-lasting insecticide-treated nets and indoor residual spraying increased from 2006 to 2012. Conclusions: Despite high coverage with vector control interventions, the burden of malaria in Nchelenge District, Zambia remained high. The high parasite prevalence could accurately reflect the true burden, perhaps in part as a consequence of population movement, or improved access to care and case reporting. Quality information at fine spatial scales will be critical for targeting effective interventions and measurement of progress.

Background Nchelenge district is a holoendemic malaria transmission zone in northern Zambia. The district occurs in a region characterised by a mix of water, marshes, islands and lagoons presenting a uniquely suitable ecology for mosquitoes. Annual indoor residual spraying (IRS) campaigns are carried out between September and December synchronised with other regions in the country with different environmental conditions. Targeted vector control interventions have been applied since 2008 without appreciable impact on disease burden. The timing and targeting of vector control measures are not guided by an informed entomological baseline. This study was aimed at providing entomological information on the seasonal abundance, spatial distribution and Plasmodium falciparum sporozoite infections in the local malaria vector species in order to guide implementation of vector control in the district. Methods Entomological studies were conducted intermittently spanning the rainy, cold-dry, and hot-dry seasons from 2015–2016. Mosquitoes were collected by CDC light traps, identified to species both morphologically and by PCR techniques. Circumsporozoite ELISA assay was used to detect P. falciparum in mosquito salivary glands. Results A total of 5437 female Anopheles funestus and An. gambiae and over 6000 culicines, mostly Mansonia mosquitoes were collected. The peak number of the An. funestus from all sites occurred in July. Overall P. falciparum infection rates in An. funestus were Kilwa island 2.7% (4/146), Mainland 2.5% (3/122), Chisenga island 0.4% (1/220), Isokwe 5.9% (2/34) and in An. leesoni from Kilwa 33% (1/3). The highest number of An. gambiae was collected from Kilwa and none was found infected with P. falciparum regardless of collection site. Conclusions The annual IRS conducted between September and December may be ineffective in controlling malaria as this misses the vector peak abundance and peak transmission season. Two rounds of IRS covering more areas would be needed to control the two vector species with different population peak seasons and malaria transmission.

Williams mean (Mw) catch (95Â % C.I.) of An. funestus (s.l.) and An. gambiae (s.l.) by season and locality. Collections were made from CDC miniature light traps from May 2012 to April 2014 in Nchelenge district, Zambia and are presented by season (Dry: May to September, Rainy: November to April) and by locality (within 3Â km of the lake; inland). Data represent catches from cross-sectional study households and first visit to longitudinal households. (DOCX 12Â kb)

Williams mean (Mw) catch (95Â % C.I.) of An. funestus (s.l.) and An. gambiae (s.l.) by season and locality. Collections were made from CDC miniature light traps from May 2012 to April 2014 in Nchelenge district, Zambia and are presented by season (Dry: May to September, Rainy: November to April) and by locality (within 3Â km of the lake; inland). Data represent catches from cross-sectional study households and first visit to longitudinal households. (DOCX 12Â kb)