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1 OUTDOOR MALARIA TRANSMISSION IN AFRICAGe
OUTDOOR MALARIA TRANSMISSION IN AFRICAGerry Killeen, Nicodem Govella, Dan Msellemu, Isaac Namango, Neil Lobo, Ying Zhou, Alpha Malishee, Nabie Bayoh, Chadwick Sikaala, Aklilu Seyoum, Jenny Stevenson, Brandy St. Lawrent, Jon
2 Cox, Chris Drakeley, Frank Collins, Tan
Cox, Chris Drakeley, Frank Collins, Tanya Russell, Tom Burkot, Bernie Huho,Salim Abdulla, Diadier Diallo, Olivier Briët, Tom Smith, John Gimnig, Sarah Moore, Silas Majambere, Katarina Kreppel& Heather Ferguson Huho et al 2
3 012 Int J Epidemiol (In press)
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11 81.01.21.4 Huho et al 2012 Int J Epidemi
81.01.21.4 Huho et al 2012 Int J Epidemiol (In press) An. arabiensisRarieda, KenyaProportion caught indoors ( IndoorsOutdoors An. quadriannulatusLuangwa, ZambiaAn. gambiaeRufiji, TanzaniaAn. gambiaeUlanga, TanzaniaAn. gambi
12 aeOubritenga, Burkina FasoAn. gambiaeKor
aeOubritenga, Burkina FasoAn. gambiaeKorweogo, Burkina FasoAn. gambiaeBioko, Equatorial GuineaProportion caught during sleeping hours fl SleepingWakingProportion of human exposure occurring indoors for a non-userof LLINs (
13 IndoorsOutdoorsProportion of human expos
IndoorsOutdoorsProportion of human exposure occurring indoors for an LLIN user i,n IndoorsOutdoors Reddy et al 2011 Malar J 10: 184Huho et al 2012 Int J Epidemiol (In press) Huho et al 2012 Int J Epidemiol (In press)An. fun
14 estus s.l.Rarieda, KenyaProportion caugh
estus s.l.Rarieda, KenyaProportion caught indoors IndoorsOutdoorsAn. funestus s.l.Luangwa, ZambiaAn. funestus s.l.Oubritenga, Burkina FasoAn. funestus s.l.Korweogo, Burkina FasoProportion caught during sleeping hours fl Sl
15 eepingWakingProportion of human exposure
eepingWakingProportion of human exposure occurring indoors for anLLIN non-user IndoorsOutdoorsProportion of human exposure occurring indoors for an LLIN user i,n IndoorsOutdoors Bayoh et al 2010 Malaria Journal 9: 62 Bayoh
16 et al 2010 Malaria Journal 9: 62 7 Kita
et al 2010 Malaria Journal 9: 62 7 Kitau et al. 2012 PLoS One 7: e31481 Russell et al 2010 Malaria Journal 9: 187 Year = -0.0013, se = 4.1910-50.0001 Proportion An. gambiae s.s. 11 && & &&& \n
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#+&+ ##&&\r # 6 +5+\r# #+&+ ##&&\r # 6 ,&\r # \r 7#+# #+ &)8# 8) 8 7
20 8#85 #$9&:2 ;* 8#85
8#85 #$9&:2 ;* 8#85 #$9&:2 ;* !/#- # #--!"#3"#$1 8#85 #$9&:2 ;* 12 13 14 Trape et al.2011 Lancet Infectious Diseases 11:925
21 $ $. \n:#2 =. \n.
$ $. \n:#2 =. \n. \n(':#2 � 9&:#2 � -$. \n Attack related survival probability per feeding cycle:= 1 (h,pA,p+ h,u(1-CA,p)) values derived from historical (2001-2004) d
22 ata sets: An gambiaes.l(Huho et al, IHI,
ata sets: An gambiaes.l(Huho et al, IHI, unpublished)Recent estimates from Dar esSalaam (Govella et al, 2010) Pooled July and August data from Zanzibar (ZMCP / IHI / BMGF 2010) 7 Indoors(). Outdoors. The proportion of bites
23 received indoors given local patterns o
received indoors given local patterns of human behaviour. Courtesy of Juma Mcha (ZMCP) and Greg Devine (IHI/LSTM) Moiroux et al 2012 J Infect Dis 206: 1622 19 20 Kiware et al 2012 PLoS One 7: e37661Absolute EIR average com
24 munity member (EIRRelative EIR for non-u
munity member (EIRRelative EIR for non-users h,0,= EIRh,0,/EIRh,0,0Line ITN coverage (C) Proportional of exposure occurring indoors (0 Not relevant0.8
25 0.9
0.9 \n HUMAN BLOOD INDEX (Q Stevenson et al.2012 Emerg Infect Dis 18: 1547 22 Draper & Smith 1960 TRSTMH 54: 342 23 Draper & Smith
26 1960 TRSTMH 54: 342 24 Molineaux & Grami
1960 TRSTMH 54: 342 24 Molineaux & Gramiccia (1980) The Garki Project WHO Monograph 25 Molineaux 1976 Bull WHO 54: 3530 26 Molineaux 1976 Bull WHO 54: 3530 27 Molineaux & Gramiccia (1980) The Garki Project WHO MonographDiet
27 z et al.(1974) Bull WHO 50:347-357 28 29
z et al.(1974) Bull WHO 50:347-357 28 29 Table 1: Relative risk of malaria infection estimated by generalised linear models, for age and proportion of indoor exposure () for LLIN users and non-users in Dar es Salaam. :Refer
28 ence; CI: Confidence Interval; OR: Odds
ence; CI: Confidence Interval; OR: Odds Ratio; NA: Not Applicable; : Proportion of exposure to vectors occurring indoors ! #5 \r "' ##" ##" $?@A#* ,# $?@A#* , #8
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32 5+\r # 5+#+ #8 ' 8
5+\r # 5+#+ #8 ' 8 \r#) )\r+# 57 ## # #-\r9#!69# +#7#+ 5+# # # )#& & ## ) #.& # #) # ) #88 #+ #* 33 4!55#$)
33 %5 (!$!!,#5! +
%5 (!$!!,#5! +& +# #- )#\n�22;#,-#\r@F#G� 34 Muller et al. Malar J 9: 262 35 Rowland et al.2001 Lancet 357: 1837 38 )92/"!# #! I!4# /#,"4 /"!
34 # # ! #,,!4 2 -"#,
# # ! #,,!4 2 -"#, , ! "# # 3-#! "# 3# 3"-#$H)92-"#, , ! "# # 3"#I, - # "#" -#$B92Kiware et al.2012 Biol Lett 8: 874 39 )92/"!# #! I!4# /#,"
35 4 /"!# # ! #,,!4 2
4 /"!# # ! #,,!4 2 -"#, , ! "# # 3-#! "# 3# 3"-#$H)92-"#, , ! "# # 3"#I, - # "#" -#$B92 An. arabiensis Kiware et al.2012 Biol Lett 8: 874 An. rivulorum e
36 tc? 40 )92/"!# #! I!4# /#,
tc? 40 )92/"!# #! I!4# /#,"4 /"!# # ! #,,!4 2 -"#, , ! "# # 3-#! "# 3# 3"-#$H)92-"#, , ! "# # 3"#I, - # "#" -#$B92 An. funestus An. gam
37 biae An. arabiensis Kiware et al.2012 Bi
biae An. arabiensis Kiware et al.2012 Biol Lett 8: 874 An. rivulorum etc? Majambere et al 2013 Parasit Vectors In Press 42 PROPORTION OF MOSQUITOES CAUGHT BY ELECTRIC GRIDS RATHER THAN HUMAN LANDING CATCHMajambere et al 201
38 3 Parasit Vectors In Press 43 PARTICIPAN
3 Parasit Vectors In Press 43 PARTICIPANTS IN HUMAN LANDING CATCHES PROVIDED WITH CHEMOPROPHYLAXIS ARE SAFER FROM MALARIA THAN THEIR NEIGHBOURSGimnig et al.2013 AJTMH In press 44 QUANTIFYING THE HUMAN FACTOR Geissbühler et
39 al. 2007 Malar J 6: 126 45 46 CONCLUSION
al. 2007 Malar J 6: 126 45 46 CONCLUSIONS:1.Stable outdoor malaria transmission always has been ubiquitous in Africa2.Outdoor transmission doesnt cause LLIN/IRS failure-it just defines the limit of what they can realistica
40 lly achieve3.Expect surprising vectors t
lly achieve3.Expect surprising vectors to become more obvious with LLIN/IRS scale up4.Dead mosquitoes tell no tales: Recent reports of increased proportions of outdoor transmission, particularly by An. arabiensis, predomin
41 antly reflect success of LLINs/IRS for c
antly reflect success of LLINs/IRS for controlling indoor transmission and pre-existing phenotypic plasticityRECOMMENDATIONS:1.Dont panic and carefully communicate the overwhelming success of indoor control measures-manage
42 the sensationalist-prone media.2.Standa
the sensationalist-prone media.2.Standardized entomological measurement of the proportions of human exposure occurring indoors () with HLC and questionnaires.3.Develop equivalent measures for resting site () and sugar reso
43 urces () 4.Extract pre-intervention esti
urces () 4.Extract pre-intervention estimates from historical literature to understand impact on missing/modified vector taxa post IRS/LLINs5.Develop prototype products for preventing outdoor transmission by repelling or ki
44 lling mosquitoes (host or sugar feeding)
lling mosquitoes (host or sugar feeding).6.Ensure these new products dont undermine LLINs/IRS impact on endophilic/endophagic An. gambiaeand An. funestusby repelling mosquitoes from houses through co-application 47 KenyaNa
45 bie Bayoh, CDC-KEMRI, KenyaJenny Stevens
bie Bayoh, CDC-KEMRI, KenyaJenny Stevenson, LSHTMSwitzerlandNakul Chitnis, Swiss TPHTom Smith, Swiss TPHOlivier Brit, Swiss TPHAustralia & Solomon IslandsTanya Russell, James Cook UnivTom Burkot, James Cook UnivIndonesiaB
46 ill Hawley, UNICEF IndonesiaPa Arbani, N
ill Hawley, UNICEF IndonesiaPa Arbani, NMCP IndonesiaZambiaChadwick Sikaala, NMCC/LSTMBusiku Haimanza, NMCC/LSTMAklilu Seyoum, NMCC/LSTMBurkina FasoDiadier DialloTanzaniaNico Govella, IHI/LSTMBernie Huho, IHI/Swiss TPHSalim
47 Abdulla, IHIProsper Chaki, IHI/LSTMFred
Abdulla, IHIProsper Chaki, IHI/LSTMFred Okumu, IHI, LSHTMDan Msellemu, IHI/LSHTMSilas Majambere, IHI/LSTMSam Kiware, IHI/MUSheila Ogoma, IHI/LSHTMSarah Moore, IHI/LSHTMIssac Namango, IHI/UoNGerry Killeen, IHI/LSTMKathy Kre
48 ppel, IHI, Univ. of GlasgowUnited Kingdo
ppel, IHI, Univ. of GlasgowUnited KingdomChris Drakeley, LSHTMJon Cox, LSHTMHeather Ferguson, Univ. of GlasgowUSANeil Lobo, Notre Dame Univ.Brandy St. Laurent, Notre Dame Univ.Ying Zhou, Notre Dame Univ.Frank Collins, Notre
49 Dame Univ.John Gimnig, CDC AtlantaMary
Dame Univ.John Gimnig, CDC AtlantaMary Hamel, CDC AtlantaStephen Merrill, Univ. of Marquette Malaria Transmission Intensity and Mortality Burden Across Africa Funded by UNDP/World Bank/WHO Special Programme for Research an